Intended for healthcare professionals

Practice Practice Pointer

Providing effective evidence based support for breastfeeding women in primary care

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj-2021-065927 (Published 01 November 2021) Cite this as: BMJ 2021;375:e065927
  1. Joyce Marshall, senior lecturer1,
  2. Sam Ross, general practitioner2,
  3. Phyll Buchanan, BfN breastfeeding supporter, tutor, and supervisor3,
  4. Anna Gavine, lecturer4
  1. 1Division of Maternal Health, University of Huddersfield, UK
  2. 2School of Medicine, Dentistry and Nursing, University of Glasgow and NHS Greater Glasgow and Clyde, UK
  3. 3Breastfeeding Network, UK
  4. 4School of Health Sciences, University of Dundee, UK
  1. Correspondence to j.marshall{at}hud.ac.uk

What you need to know

  • Many mothers do not find breastfeeding as easy as they expect and may have concerns or encounter challenges. For most breastfeeding women, challenges can be resolved with early, sensitive, skilled help

  • Mothers often have concerns about their breast milk supply being adequate, but few have true milk insufficiency. Encourage them to boost and maintain their supply by breastfeeding in response to their baby’s feeding cues

  • Infant crying can be distressing and parents may be tempted to attribute this to gastrointestinal problems such as gastro-oesophageal reflux disease or cow’s milk allergy, but these conditions are rare (<5%); support women by listening carefully to their concerns and carry out a full assessment in accordance with guidance from the National Institute for Health and Care Excellence

  • Remote breastfeeding support is best used to complement rather than replace face-to-face support

Baby Kyle was born at term by caesarean section after an uneventful first pregnancy. His birthweight was 3.550 kg and now at 2 weeks old he has regained his birthweight. His mother Ellie has contacted the surgery to make an appointment with the GP and attends a video consultation. Ellie is breastfeeding Kyle and explains she has struggled to access the breastfeeding support she would have liked because of the pandemic. She is concerned Kyle is not getting enough milk. She reports pain when feeding and explains that he has been crying and unsettled after feeds. Ellie has searched online and wonders if Kyle has a cow’s milk protein allergy and she asks if she should exclude dairy from her diet. She is tearful and reports feeling low and isolated.

The World Health Organization recommends exclusive breastfeeding for six months with continued breastfeeding until 2 years and beyond.12 Breast milk contains many bioactive factors, such as immune factors and cytokines that help …

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