In the World Health Organization/United Nations Children’s Fund document Baby-Friendly Hospital Initiative: Revised, Updated and
Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to
Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants
and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals
have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific
to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation
of breastfeeding, and mothers’ access to breastfeeding support during the infants’ whole hospital stay are important. Mother’s
own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent–infant separation
and facilitate parents’ unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided
only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding.
Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating
establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used
until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about
access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.