5.0 Special needs and infant challenges [Domain 6]
Challenges
When we apply the '10 Steps to Successful Breastfeeding' along with excellent prenatal care and postpartum support, we can expect that most parents:
- are educated in breastfeeding skills and normal baby behavior,
- have a healthy pregnancy and a normal labour without interventions, and
- care for their babies in extended skin-to-skin contact
Our aim is for as many mothers, parents, and babies to receive all of those things to get off to the best start. For some families, that is not entirely possible and it is crucial to quickly identify those families who are going to require additional assistance from you to establish breastfeeding or chestfeeding.
Step 5. Support mothers to initiate and maintain breastfeeding and manage common difficulties
(New Zealand) Step 5: Support mothers to initiate and maintain breastfeeding and manage common difficulties, even when baby is unable to be with mother.
(Canada) Step 5: Support mothers/parents to initiate and maintain breastfeeding and manage common difficulties.

Points 4 and 5 of the Seven-point Plan for Sustaining Breastfeeding in the Community:
Point 4. Support mothers to establish and maintain exclusive breastfeeding to six months
Point 5. Encourage sustained breastfeeding beyond six months to two years or more, alongside the introduction of appropriate, adequate, and safe complementary foods.
Identified during pregnancy
Infant
- twins, triplets, or more
- neuromotor problems (eg. Down Syndrome)
- facial or other abnormalities (eg cleft lip or palate)
Maternal
- Diabetes (Type I, II, or gestational)
- History of difficulty breastfeeding
- History of breast reduction/surgery, chest injury, or radiation
Identified during birthing
- intrapartum analgesics and/or anesthetics
- birth trauma, assisted delivery (vacuum, forceps, or emergency c/section)
- low Apgar Scores, required resuscitation
- no or brief skin-to-skin care following birth
- preterm (<34/6 weeks) or late-preterm birth (34/0-37/6)
Identified postpartum
- small or large for gestational age
- breast refusal or inconsistent ability to latch-on
- hypoglycemia
- hyperbilirubinemia
- ankyloglossia
- excessive sleepiness or irritability
When a referral is needed
- Don't endanger breastfeeding by delaying referral.
- Some conditions identified will require expertise beyond your own, or for a continuing period of time. Refer as early as possible to give them the best chance for breastfeeding success.
- Early identification ensures assistance is directed where most needed.

Early support is essential.
© Carole Dobrich