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Protecting, promoting and supporting breastfeeding: The Baby Friendly Hospital Initiative for small, sick and preterm newborns

Implementation of the Ten Steps in facilities caring for populations of small, sick and preterm newborns can dramatically increase breastfeeding rates. Facilities ensuring adherence to evidence-based recommendations on maternity and newborn care can substantially improve the health and well-being of both mothers and infants, globally.


This guidance is based on, and complements the 2018 WHO/UNICEF BFHI Implementation Guidance with provision of special guidance for the support of infant feeding in neonatal wards. The purpose of focusing on small, sick, and premature newborns is to ensure that these vulnerable infants receive the care necessary to establish optimal infant feeding and thereby reach their full health potential.

This document follows the general format of the 2018 BFHI Implementation Guidance, discussing each of the Ten Steps and referencing the BFHI global standards where appropriate for neonatal wards, while giving additional clinical guidance as needed.

This guidance focuses specifically on infants requiring medical care beyond that routinely provided to infants in a newborn nursery or postpartum care facility. This includes neonates separated from their mother due to maternal or infant illness, or infants requiring special procedures (for example, phototherapy or supplementation) in the mother’s room. The mothers of these infants may need additional assistance in establishing and maintaining milk supply.

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