Since 1991, the Baby-Friendly Hospital Initiative (BFHI) has sought to motivate healthcare teams caring for newborns to provide the best support for successful breastfeeding, based on the Ten Steps.
In 2018, the revision of the IHAN Implementation Guide, "Breastfeeding Protection, Promotion and Support: A Friendly Hospital Initiative for Small, Sick and Premature Newborns", provides evidence-based recommendations for applying the Ten Steps in the care of small, sick and/or premature newborns who are hospitalized and separated from their mothers because of neonatal or maternal illness. It is also meant to help those needing special care (e.g., phototherapy), and who even in close proximity to their mother in the room, require an environment promoting access to human milk and exclusive breastfeeding.
Adherence to evidence-based recommendations for breastfeeding care can improve the health and well-being of women and children worldwide. The Ten Steps are:
- Step 1a. Comply with the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions.
- Step 1b. Have a strong breastfeeding policy.
- Step 1c. Have monitoring systems in place.
- Step 2. Support education and practice of staff competencies.
- Steps 3 and 5. Maintain antenatal and postnatal encouragement, counseling and support for breastfeeding initiation.
- Step 4, 7 and 8. Encourage the mother’s presence for continuous, or early, frequent and prolonged skin-to-skin contact.
- Step 6. Have expressed breast milk and banked human milk available. Otherwise, if not available, consider surrogate formula, due to the initial difficulty of direct breastfeeding in premature infants.
- Step 9. Use appropriate feeding methods (feeding tubes, cups, sippy cups). Avoid bottles and teats.
- Plan for discharge to maintain human milk supply and progression to exclusive breastfeeding if not achieved before discharge.
