Breastfeeding – getting through the first few weeks

South African policy, following WHO guidance, recommends exclusive breastfeeding for the first six months — breast milk only, no water, no tea, no porridge — then continued breastfeeding alongside other foods into the second year and beyond.

Exclusive means exclusive, and the reason is specific: in settings where water and hygiene cannot always be relied on, giving anything else in the first six months raises the risk of the diarrhoea and pneumonia that kill infants. It is not about purity; it is about what else would be going into the bottle.

1. 1Feed early and often — eight to twelve times in twenty-four hours is normal for a newborn, including at night.
2. 2Feed on cue rather than by clock. Rooting, hand-to-mouth and stirring are earlier signs than crying, which is a late one.
3. 3Expect colostrum first — a small amount of thick yellow milk. It looks like almost nothing and is exactly the right amount for a newborn stomach.
4. 4Milk usually 'comes in' around day two to five, often with fullness and leaking.
5. 5Skin-to-skin contact helps supply, latch and the baby's temperature and blood sugar. It is not just a nice moment.

This is the question that ends more breastfeeding than any actual problem does. You cannot see how much went in, so judge by what comes out and by weight.

• Wet nappies increasing over the first week, then roughly six or more heavy wet nappies a day.
• Stools changing from black and sticky to yellow and soft by around day four or five.
• Weight: most babies lose some in the first days and are back to birth weight by around two weeks. Your clinic plots this in the Road to Health booklet.
• The baby comes off the breast relaxed rather than frantic, and settles for at least a short stretch.
• You can hear or see swallowing during a feed.

• Sore, cracked nipples — almost always a latch problem, not a toughness problem. Pain that continues through the feed means the latch needs adjusting; get someone to watch a feed.
• Engorgement — hard, painful, full breasts in the early days. Feed frequently, express a little for comfort, and use a warm cloth before and a cool one after.
• Blocked duct — a tender lump. Keep feeding on that side, massage towards the nipple during the feed, and vary position.
• Mastitis — a hot, red, painful area with flu-like symptoms and fever. Keep feeding or expressing from that breast, and see a clinician: this often needs antibiotics and does not settle on rest alone.
• Thrush — burning pain in both nipples with shiny skin, often with white patches in the baby's mouth. Mother and baby must both be treated or it bounces back and forth.
• 'Not enough milk' — usually a supply that responds to more frequent feeding. Supply follows demand, so topping up with formula tends to reduce it further.

Public clinics have staff trained in breastfeeding support, and many hospitals have lactation support. Ask for someone to watch a whole feed rather than describing the problem — most latch issues are obvious to a trained eye in thirty seconds and invisible in a description.

If breastfeeding does not work out, a fed baby is the priority and formula prepared safely is a legitimate answer. The guidance above is what is aimed for, not a verdict on anyone who ends up somewhere else.