Hesperian Health Guides

Special Situations

Babies with special needs can breastfeed

Small baby.
If a small baby cannot suckle strongly enough to feed itself, you will need to remove your milk by hand and feed the baby with a cup. Begin right after birth, and continue even when the baby can suckle some by itself. This will help your breasts make more milk. If your baby weighs less than 1½ kilos or 3½ pounds, it may need special medical care, including a tube that goes through the nose and down to the stomach. Your milk can be given through that tube. Talk with a health worker about this.

Baby born too early.

a woman holding a baby under her clothing
Babies that were born too early or very small should be kept against your skin for warmth.

Babies born too early need extra help to stay warm. Place the baby naked, with a hat and a diaper or nappy, upright inside your clothing, against your skin and between your breasts. (It helps to wear a loose blouse, sweater, or wrap tied atthe waist.) In some places this is called ‘Kangaroo Care’. Keep skin-to-skin contact inside your clothing day and night, and breastfeed often. If the baby suckles weakly, also give milk you have removed by hand.

Cleft lip or cleft palate.
These babies may need special help to learn how to suckle. If the baby has only a cleft lip, it can still suckle well. (To help make a seal, use your finger to cover the cleft.) If the roof of the mouth is also open, try to hold the baby up straight while keeping a good feeding position. You may need to get special help. You can remove your milk by hand to keep up a good supply while the baby is learning to suckle.

Yellow baby (jaundice).
A yellow baby needs plenty of sunlight and breast milk to get the jaundice out of its body. Some babies with jaundice are very sleepy. If a baby is too sleepy to take the breast, remove milk by hand and give it with a cup and spoon, at least 10 times in 24 hours. Put the baby in the sun in the early morning and late afternoon. Or keep the baby in a bright room.

Most jaundice does not start until after the first 3 days of life and clears up by the 10th day. If the baby has jaundice or very yellow eyes at any other time, or if a jaundiced baby was also born very early, or if the yellow or sleepiness gets worse, the baby could have a serious illness. If possible, take the baby to a health center or hospital.

Twins. Sometimes one twin is smaller or weaker. Be sure that each baby gets plenty of your milk. You have enough milk for both babies. Be sure you are getting enough to eat, too.
a woman feeding two babies, one at each breast

When your baby is sick

  • If your baby is sick you should not stop breastfeeding. Your baby will get better more quickly if it is breastfed.
  • Diarrhea is especially dangerous in babies. Often no medicine is needed, but special care must be taken because a baby can die very quickly of dehydration.
  • For diarrhea, breastfeed more often and also give sips of rehydration drink.
a sick naked baby lying on its side
  • Breastfeed more often if the baby is weak. If the baby is too weak to breastfeed, remove the milk by hand and give the milk with a cup. Take the baby to a health worker.
  • For vomiting, give shorter feeds more often, and also give rehydration drink in small sips with a cup every 5 to 10 minutes. If you can, see a health worker—dehydration can lead to death.
  • Keep breastfeeding your baby even if the baby needs to go to the hospital. If you cannot stay at the hospital, try to remove your milk by hand and get someone to give it to the baby with a cup.
How to feed a baby with a cup

a woman holding a glass of milk to a baby's mouth
  1. Use a small, very clean cup. If boiling it is not possible, wash it with soap and clean water.
  2. Hold the baby upright or almost upright on your lap.
  3. Hold the cup of milk to the baby’s mouth. Tip the cup so the milk just reaches the baby’s lips. Rest the cup lightly on the baby’s lower lip and let the edges touch the baby’s upper lip.
  4. Do not pour the milk into the baby’s mouth. Let the baby take the milk into its mouth from the cup.

When the mother is sick

If you have HIV, see information about breastfeeding and HIV.

If she can, it is almost always better for a sick mother to breastfeed her baby than to feed other foods too soon. If you have a high fever and sweat a lot, you may make less milk. To keep producing enough milk, drink plenty of liquid and continue to breastfeed often. If it is more comfortable for you, breastfeed in the lying-down position.

If you need to stop breastfeeding for a few days, remove the milk by hand (if necessary someone can help you).

Get treatment right away for any serious disease caused by infection, like TB, typhoid or cholera, so it does not spread to the baby.

To prevent passing any infection to the baby, wash your hands well with soap and water before touching your baby or breasts.

When the mother needs medicine

Most medicines pass into breast milk in very small and weak amounts, so they do not harm the baby. It is usually more harmful to the baby to stop breastfeeding.

There are a few drugs that cause side effects. In this book we have marked these medicines with a warning and suggest other medicines that will be safer (see the “Green Pages”). If a health worker tells you to take a medicine, remind her that you are breastfeeding so that a safe one can be selected.

a woman holding a small baby with her arm around an older baby
A woman with a new baby and an older baby can safely breastfeed both of them.

When a woman becomes pregnant or gives birth to another child

a pregnant woman breastfeeding a child
It is safe to breastfeed when you are pregnant.

If a nursing mother becomes pregnant, she can continue to breastfeed. Since breastfeeding and pregnancy take a lot from her own body, she should eat plenty of good foods.

It is also safe to continue breastfeeding an older child when a woman has a new baby. The new baby should be fed before the older child.

This page was updated:17 Apr 2019