Breastfeeding Information

What Does Evidence-Based Mean?

Part of the mission of Breastfeeding USA is to provide evidence-based information. What does that statement mean? What is evidence? In the strictest sense, it is information that is backed by solid, peer-reviewed research based on established scientific principles. For a very long time, there was little strong empirical evidence related to breastfeeding, and most of the existing research was concerned with the components of breastmilk. Thankfully, there is now a growing body of research on many aspects of breastfeeding. Sometimes, the results affirm what we already suspected to be true, and sometimes they are surprising. The strongest information is provided by systematic review of randomized, blinded, controlled trials. The problem with waiting for this type of affirmation is that these types of trials are either very involved and expensive or impossible to conduct. Who will pay for this kind of investigation into best breastfeeding practices? And even with the best research, there can be questions about whether the results can be generalized to a large population.

So, what if there is no research on a particular topic? There are many common breastfeeding (and medical) practices that have no formal research to support them. From an editorial in the British Medical Journal in 1996, "The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research." This article stresses the need to customize the application of new information based on the client's circumstances and preferences. What are the implications for Breastfeeding Counselors? We should use the results of the latest and best research, our own observations, and the experiences of others working with breastfeeding dyads to make decisions when working with mothers and babies.

We have seen the problems inherent in using anecdotal information and poorly-designed research. For example, we no longer advise mothers to toughen up their nipples or to nurse their babies in only a few, very specific positions. Indeed, recent ultrasound studies seem to negate the very existence of the long-recognized milk sinuses that (we thought and taught) babies needed to compress in order to receive milk. Those individuals working with breastfeeding dyads need to more systematically document and share what they are seeing and how mothers and babies respond to various interventions so that we can advance our knowledge of what truly works and what doesn't. Counselors and health professionals should not routinely offer suggestions that many others have found are rarely successful. If we have access to the combined observations of many skilled counselors and health professionals, we can feel more confident in using information that is not backed by formal research. Also, we must be careful to differentiate between observation and interpretation. It is not unusual for two people to witness the same event and have different ideas about what they have seen: does a swaddled baby stop crying because he is calmed and happy or because he is overwhelmed and has shut down?

An evidence-based practice is balanced. We must consider the circumstances, values, and preferences of the mothers we serve as we share our evidence-based information. Without the best current and classic external research, practice and information become outdated and may be ineffective or even harmful. Without clinical and/or personal experience, practice and information risk becoming solely research-dominated and may not take an individual mother's needs into account. Without taking into consideration the mother's values, preferences, and realities of life, practice and information become irrelevant and may become unethical.

Maintaining current knowledge of the latest, peer-reviewed research is very important for anyone who is helping mothers and babies succeed with breastfeeding. In the absence of such research, we can include, thoughtfully, the body of experience that many counselors and professionals have developed in breastfeeding their own children and through helping other dyads. An evidence-based practice not only presents the best information available but also respects the mother's right to evaluate that information and use it to make informed decisions for her family. We must not forget that much of our role as counselors has nothing to do with facts and figures but is instead focused on making a connection with another mother and empowering her to make the best decisions for herself and her baby.

The Cochrane Collaboration is a great resource for finding out more about evidence-based research and practice.


Sackett, D., Rosenberg, W., Muir Gray, J.A., Haynes, R.B., & Richardson, S. (1996). Editorial Evidence Based Medicine: What it is and What it isn't. British Medical Journal 312:71.

Thinking About Weaning?

NOTE: This is the third and final article in a series about weaning.
Depending on where you live, “weaning” may mean either introducing other foods or stopping breastfeeding. In this article, we are talking about weaning from the breast.

You may want to read the previous articles first:
When is the Best Time to Start My Baby on Foods Other Than Breastmilk?
Good Foods for Babies

Kendra was confused. “Before I had Jason, everyone was after me to breastfeed. They said it would be good for the baby. So why do they now keep asking me when I am going to wean him? Even some of the articles I read say that there is no reason to keep nursing after the first few weeks. Is this true?”

Tanya had a similar question. ”When I was still pregnant with Davy,” said Tanya, “I thought I would only nurse him for a few weeks before switching to formula. But now I have come to realize how much we both love breastfeeding, and I feel sad when I think about stopping. Davy is 9 months old and eating all kinds of other foods as well as nursing. When am I supposed to wean him?”

There is good news for both of these mothers: human milk does not suddenly turn to water after a certain length of time! Mothers can nurse their babies for as long as both they and their children wish to continue. Children will wean all by themselves when they are developmentally ready to do so.

Your milk continues to provide both food and health benefits even after your baby has begun to eat other foods. In fact, it continues to be the most important part of your baby's diet until he is about a year old. Did you know that the American Academy of Pediatrics (AAP) recommends that babies continue to nurse until they are at least a year old and that the World Health Organization (WHO) recommends continuing to nurse for at least two years?1,2

Many mothers are surprised to learn that during their baby’s second year (12-23 months), 15 ounces of their milk provides:

  • 29% of energy requirements
  • 43% of protein requirements
  • 36% of calcium requirements
  • 75% of vitamin A requirements
  • 76% of folate requirements
  • 94% of vitamin B12 requirements
  • 60% of vitamin C requirements 3,4

Why do so many mothers worry about weaning?

I'll bet you have never heard a mother say, “I will make him walk by the time he is xxx,” or “I will make him talk by the time he is xxx.” We KNOW that you cannot make a baby walk or talk before they are ready to do so! All babies are different, and there is no reason to set an exact date. The same goes for weaning; children wean when they are ready.

What can I say to people who ask when I am going to wean?

It depends who is asking. For example, you could:

  • Explain that breastfeeding is the healthy option.
  • Make a joke like, “Until she goes to an out-of-state college!”
  • Tell them that your doctor recommends natural weaning.
  • Share that natural weaning is a family tradition.

And if all else fails, ask why they need to know!

Weaning is a process, not an event!

As he gets older, your baby will gradually eat more table foods. You will notice that he needs to nurse less frequently or for shorter periods of time. However, babies nurse for many reasons besides the need for food. Even when he becomes a toddler, your baby may still need to nurse when it's time to go to sleep, when he wakes up, or when he has a boo-boo.

There will also be days when he needs to nurse more than usual: perhaps when he is teething or coming down with a cold. Nursing can help him cope with these upsets. In fact, many mothers say they could not imagine getting through the toddler stage without nursing to smooth the way. All too soon, as he progresses in natural weaning, your little one will be too busy exploring the world to nurse as often.

But what if I want a night out with my partner or friends or to go to the gym?

  • You can pump or hand express some milk to leave for your baby while you are away.
  • Be sure to nurse immediately before leaving, so that you both will feel comfortable.

For more information on leaving breastmilk for your baby while you are apart, see our article: Breast vs. Bottle: How much should baby take?

What if I have to go back to school or work?

  • You do not have to wean completely from the breast!
  • You can nurse when you are home and pump when you are away, and your sitter can give your baby your pumped milk.
  • Even if you decide to use formula while you are away, you can still nurse when you are home. Even a little milk is important to your baby's health!

What if I get sick and need to take medicine?

Most medications are safe to use when breastfeeding. For those medicines that are not safe, there is almost always another, safer drug available. Your healthcare provider can look them up online at Lactmed, a free government service, before writing a prescription.

The InfantRisk Center provides answers to questions about the use of drugs during pregnancy and breastfeeding. Call (806)-352-2519 for information about the safety of using drugs, over-the-counter drugs, herbal products, chemicals, vaccines, and other substances.

Remember, you can always get a second opinion!

What if I want to have an alcoholic drink?

Here are some things you will want to know:

  • Only a very small proportion of the alcohol will go into your milk.
  • Nurse the baby before having your drink.
  • There is no need to pump and dump, because the alcohol will pass out of your milk in the same way it passes out of your blood.
  • It takes about two hours for complete metabolism of one standard drink (12 oz of 5% beer, or 5 oz of 11% wine, or 1.5 oz of 40% liquor (80 proof) 5
  • If you are fit to drive, then you are fit to nurse.
  • If you are planning on drinking a lot, express your breastmilk ahead of time so that your baby will have milk to drink until you are sober.
  • Be sure to have somebody else care for your baby until you are able to do so safely.
  • Do not sleep in the same bed as your baby if you have been drinking.

What if I get pregnant?

  • It is usually safe to nurse through a pregnancy.
  • According to Lesley Regan, PhD, MD, head of the Miscarriage Clinic at St. Mary’s Hospital in London, the largest referral unit in Europe, and the author of Miscarriage: What every woman should know:

    "Once a pregnancy is clinically detectable, breastfeeding should pose no added risk of pregnancy loss. There isn’t any data suggesting a link between breastfeeding and miscarriage, and I see no plausible reason for there to be a link." 6

  • Many women continue to nurse while pregnant. During early pregnancy, your milk production may go down as the milk changes back to colostrum. Your baby may not like the taste and wean on his own, but many babies continue to breastfeed throughout pregnancy. Some mothers develop sore nipples when they become pregnant. If you have this kind of soreness, you can think about offering shorter nursing sessions rather than weaning completely.
  • It will not hurt the new baby if the older child also nurses. A mother who is “tandem nursing” makes enough milk for both children, just as if they were twins.

But people tell me that weaning will make life easier!

  • As a general rule, babies who are weaning need MORE attention, holding, and comforting!
  • Breastfeeding is much more than food: it is comfort and medicine, too. Your baby will still need to be held and cuddled when feeding. A propped bottle is a choking hazard, and there is a serious risk of aspiration pneumonia.
  • Although some partners start off by doing the night feeds, most don't continue for long, and then it will be you getting out of bed every night to heat a bottle when your baby cries.
  • Your baby is more likely to get sick if he is not getting antibodies from your milk, so you may be spending more time at the doctor's office and need more time off work.

If you need to wean before your baby is ready...

Do what feels right for you and your family. Each mother's circumstances are different!

  • If your baby is under a year old, talk to your doctor about which formula to use and mention any allergies that run in the family.
  • If your baby is over a year old, ask your doctor about using other milks instead of formula. You may be able to go straight to a cup.

Go slowly!

  • Each time you are ready to drop another nursing, let your baby nurse briefly at that feeding before offering the bottle during the first couple of days. This process will help him get used to the bottle more gradually. It will also help to prevent you from becoming over-full and maybe developing mastitis. If you still feel uncomfortable, pump or hand-express JUST ENOUGH to relieve pressure.
  • Let another person be the one to feed him the bottle if you will be only partially weaning. You will want your baby to associate you with breastfeeding only. Be prepared to backtrack. There will be days when your baby is not feeling well and needs to nurse. It is NEVER wrong to listen to your baby! Two steps forward and one step backwards is quite normal.

Bottle feed as much like breastfeeding as possible.

  • Use a slow-flow soft bottle nipple that has a wide base and a shorter, round nipple (not the flatter, orthodontic kind.)
  • Start by resting the tip of the nipple on your baby's upper lip, and allow him to take it into his mouth himself, just as if he was nursing.
  • Keep the bottle only slightly tilted, with baby in a more upright position, so he has to work to get the milk out. If you hold the bottle straight down, the milk will come out too fast, and he may feel as if he is drowning.

Start by substituting a bottle for one nursing a day for about a week. Keep your baby's favorite nursing sessions for the last. Follow your baby's lead as much as possible. For example, if he is sick, you may want to nurse a little more often until he is feeling better again. Unless there is an urgent reason for immediate weaning, it is easier on both of you to go slowly.

Remember, you know your baby best, and you know what is best for your family. Trust your instincts, and you won't go far wrong.

Want to know more about weaning?

Here is a great book:
How Weaning Happens by Diane Bengson

Here are some articles you may find helpful:
“A Natural Age of Weaning” by Katherine Dettwyler, PhD
Breastfeeding Past Infancy: Fact Sheet
Comfort measures for mom during weaning


1. The American Academy of Pediatrics (AAP);115/2/496
2. The World Health Organization (WHO)
3. Mandel D, Lubetzky R, Dollberg S, Barak S, Mimouni FB. Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation. Pediatrics. 2005 Sept; 116(3):e432-e435.
4. Dewey KG. Nutrition, Growth, and Complementary Feeding of the Breastfed Infant. Pediatric Clinics of North American. February 2001;48(1).
5. Texas Tech University Health Services Center (InfantRisk Center)
6. Flower, H., Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond, 2003.

© Copyright Breastfeeding USA 2012. All rights are reserved.

Good Foods for Babies

NOTE: This article is the second of a series about introducing solids and weaning. You may want to read the previous article first: When is the Best Time to Start My Baby on Foods Other Than Breastmilk? The final article in this series is: Thinking About Weaning?

As her baby approached his six month birthday, Joanna had lots of questions about starting her breastfed baby on other foods.

“Those jars of baby food are cute but so expensive. Besides, I would really prefer to feed my baby fresh food. Is it difficult to make your own baby food?"

It is very easy to make your own baby food and much cheaper, too. You do not even need special equipment, just a knife, fork and spoon.

“What are some good “starter” foods?”

Most babies like soft fruits and veggies. You can put tiny pieces of ripe banana on his tray, so he can pick them up and feed himself while you eat your dinner. Sweet potatoes are great for babies. Just scrub and prick the skin of the potato and bake it in the microwave until it is soft. After it has cooled down, you can throw away the skin and cut up the soft potato into little chunks.

“I have never heard of babies feeding themselves! I thought you had to feed them with little spoons!”

We used to think it was a good idea to start babies on solid foods when they were very young, maybe even just a few weeks old. Of course, babies that age could only eat pureed foods, which their mothers fed them with spoons. Now we know that babies are not ready for solid foods until they can sit up by themselves and use a pincer grasp with their fingers and thumbs. By that time, they can eat all kinds of things with only a little help from you. Your baby may like sitting in a high chair to eat, or he may prefer to sit on your lap or on the floor.

“Why do so many babies start with cereal?”

Cereal may be traditional, but it is not necessarily one of the best first foods. Iron-fortified rice cereal has been suggested as a first food in the past because of the belief that it was “hypoallergenic” and was a good source of iron. A review of research by the American Academy of Pediatrics (AAP) finds those reasons to be invalid. 1 Newer thinking suggests beginning with foods that are naturally nutrient-rich. For example, meat is naturally rich in iron and zinc. In any case, breastfed babies usually get all the iron they need from their mother's milk up until at least six months of age. 2 If your doctor is concerned about iron levels, a simple blood test can be done right in the office.

“So what else could I feed my baby?”

Lots of things! Just make sure the food is soft enough not to catch in his throat and that it is cut into little pieces. So, for example, you will want to offer cooked, not raw, carrots, green beans, and peas.

  • Try ripe avocados, pears, peaches or apples – whatever is in season.
  • Beans can be mashed after the skins have been removed.
  • If you eat meat, you can offer little pieces of chicken or maybe a meaty leg bone (with that thin sliver of attached bone removed).
  • Tofu is an easy, soft food for a meat-free family with no soy allergies.
  • As he gets closer to a year, your baby may also like to gnaw on a heel of whole wheat bread or a piece of bagel.

“Are there foods I should avoid feeding to my baby?”

  • Don't give her anything that could get stuck in her throat, so avoid hard foods like popcorn and nuts and sticky foods like peanut butter.
  • Any “round” foods, like carrots slices or grapes, should be cut into quarters.
  • You may have heard that you should delay potentially allergenic foods, and you may have seen lists of such foods. Current research suggests that there is no benefit or reduction in the development of allergies due to delaying certain foods. 1
  • Never give honey to a baby until he is over a year old because of the risk of botulism (food poisoning).
  • If there are any foods or drinks to which members of your family are allergic or sensitive, talk with your health care provider before offering them to your baby.

“How much food does he need? How many times a day should I feed him?”

Start slowly, just once a day. If you miss a day, don't worry. Table foods may be offered whenever it is most convenient. It is not necessary to stick to a strict daily schedule. At first he will mostly play with his food. If any of it gets in his mouth, consider it a bonus! Start with about a teaspoon of food and add more when he asks for it. You might want to put an old shower curtain under his chair to catch the crumbs. Wait about a week before introducing each new food. That way it will be easy to see if anything upsets his stomach or gives him a rash.

“What about juices? Won't he need extra water too?”

Whole fruits contain fiber and are much more nutritious than juices. It makes sense to either limit juices or even avoid them completely. Some mothers like to offer a little water in a sippy cup with meals.

“Wow, I am excited to start! But I was wondering, if I start on other foods, won't he nurse less often? I don't want to lose my milk, and I am not ready to stop nursing.”

Your milk remains the most important part of your baby's diet until he is about a year old. Always nurse him before offering other foods and afterwards as well if he is interested. Nursing before offering solids will both ensure that baby gets enough breastmilk and maintain your milk production.

Babies need only their mother’s milk for about the first six months. Your baby will continue to receive the same nutrition and protection from your milk as long as you continue to nurse.

The continuing protection from illness is important for your baby, because when babies become more mobile, they are toddling around and picking up all kinds of germs, some of which go straight into their mouths.

It is fun to see your baby begin to explore the different tastes and textures of various foods.

You may also like to read:

Baby Led Weaning and More on Baby Led Weaning

Whole Foods for Babies and Toddlers by Margaret Kenda

Mash and Smash Cookbook by Marian Buck-Murray

Sugar-Free Toddlers by Susan Watson

My Child Won't Eat! by Carlos González, MD

1. American Academy of Pediatrics Committee on Nutrition. Pediatric News, November 2009: “Rice Cereal Can Wait, Let Then Eat Meat First: AAP committee has changes in mind”

2. Raj, S et al. “A prospective study of iron status in exclusively breastfed term infants up to 6 months of age”, International Breastfeeding Journal, 2007.

© Copyright Breastfeeding USA 2012. All rights are reserved.

When is the Best Time to Start My Baby on Foods Other Than Breastmilk?

NOTE: This article is the first of a series about introducing solids and weaning. The next articles in the series are:
Good Foods for Babies
Thinking About Weaning?

The World Health Organization and the American Academy of Pediatrics (AAP) recommend that babies be exclusively breastfed for six months before other foods are introduced. Some babies are ready to start new foods around this time, while others show no interest until they are a bit older. The Recommendations on Breastfeeding by the AAP also state:

“Unique needs or feeding behaviors of individual infants may indicate a need for introduction of complementary foods as early as four months of age, whereas other infants may not be ready to accept other foods until approximately eight months of age.

Introduction of complementary feedings before six months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk.”1

As you can see, there is no clear cut age when it is best to start solids. The best time to start offering your baby other foods is when he shows signs of being ready.

Of course this time will be different for each baby. We do not expect all babies to crawl or walk or potty train on a certain day of their lives, and we should not expect them all to need solid foods at the same time either. You are the expert on your baby!

Here are some of the signs that your baby may be ready for solids.

He will be able to:

  • sit up on the floor for about ten minutes without support 2
  • use his finger and thumb to pick up toys and put them in his mouth
  • swallow a tiny bit of soft food, like ripe banana, without pushing it out of his mouth with his tongue

At this stage, he will probably also seem to be more hungry than usual. If you have already tried nursing him more frequently, and he still does not seem to be satisfied, he may be ready to start adding other foods to his diet. Babies sometimes also want to nurse more because they are teething or not feeling well or going through a growth spurt, so be sure to rule those things out first.

Mothers sometimes wonder if their babies are ready for solids at about four months because of the way their babies are behaving.

Four months is about the time that many babies start to become more interested in the world around them. They are taking everything in. For example, they may pull away from the breast in response to a sudden noise. They may even try to take the breast with them! They may not seem to be as interested in nursing so often or may learn to gulp down their milk quickly to get back to more fun activities.

These are all normal and common ways for four-month-olds to behave. You may find it helpful to nurse your baby in a quiet, dark room a couple of times during the day in order to avoid distractions. Some mothers like wearing a nursing necklace (beads strung and knotted on extra-strong cord that the baby can hold while nursing) because it can help him stay focused on breastfeeding.

Have you noticed your baby watching you very carefully while YOU eat? Does he pretend to chew? This behavior shows how babies learn and practice, and it is one of the signs that they will soon be ready to start eating table foods.

Just follow your baby's cues and your own instincts.

There is no rush. Nothing magical happens on the very minute/hour/day of the sixth month birthday. A switch does not suddenly turn off and make mother's milk suddenly inadequate! In fact, some babies have no interest in other foods until much later, sometimes not until they are about a year old.

As long as your baby is happy and healthy, gaining weight, and meeting all his milestones, he is doing fine!

Some parents are told that they must introduce solids by a certain age to provide extra iron and prevent anemia. If there is a concern about your baby's being anemic, your doctor can do a simple blood test. It only takes a few minutes to see if your baby has enough iron. It is almost unheard of for a completely breastfed baby to have low iron stores or low hemoglobin values before six to nine months. One study, by Piscane, 1995 3, found infants who were exclusively breastfed for seven months (not given iron fortified cereals or iron supplements) had significantly higher hemoglobin values at one year old than breastfed babies who had received solid foods before seven months. None of the babies who were breastfed exclusively for 7 months were anemic at one year, while some of the babies who did receive solids before seven months were found to be anemic. Research like this suggests that delaying solids can reduce the risks of anemia.

Enjoy this special time with your completely breastfed baby. You may be interested in reading the next article in this series, Good Foods for Babies, where I share some suggested first foods and ways to introduce your baby to the delights of a wide variety of healthy foods.

You may also like to read:

Starting Solids-The Facts Behind Today's Media Hype

1. American Academy of Pediatrics. Policy Statement on Breastfeeding and the Use of Human Milk, PEDIATRICS Vol. 115 No. 2 February 2005, pp. 496-506 (doi:10.1542/peds.2004-2491)

2. Hassink, Sandra G. MD, FAAPA Parent's Guide to Childhood Obesity: A Road Map to Health, American Academy of Pediatrics, 2006

3. Pisacane A, et al. Iron status in breast-fed infants. J Pediatrics 1995 Sep;127(3):429-31

© Copyright Breastfeeding USA 2012. All rights are reserved.

Disaster Preparedness: Breastfeeding Matters During an Emergency

One of the things that we can depend on, unfortunately, is that disasters and emergencies will continue to happen around the world. From tornadoes and hurricanes to earthquakes and floods to the effects of war, few people are immune to the possibility of dealing with at least one or more of these situations sometime in their lifetime. During a disaster or emergency, breastfeeding becomes even more important and has been proven to save lives.

The American Academy of Pediatrics states:

In an emergency
• There may be no clean drinking water.
• There may be no sterile environment.
• It may be impossible to ensure cleaning and sterilization of feeding utensils.

The cleanest, safest food for an infant is human milk.

Below is a list of resources for those looking for detailed information about breastfeeding during emergencies:

Emergency Nutrition Network:

IBFAN (International Baby Food Action Network):

American Academy of Pediatrics:


Transcript from WHO podcast from 2009: The importance of breastfeeding during emergencies

Australian Breastfeeding Association:

My power went out and I have breastmilk in the freezer – Help!

Emergency Baby carriers (broken glass is a real concern!)

© Copyright Breastfeeding USA 2011. All rights are reserved.

Find a Breastfeeding Counselor

Accredited Breastfeeding Counselors are listed by state and location. They are volunteers working from their homes, so please be considerate of the time of day when calling. Please note the type of service offered in italics. These services may include telephone helping (phone), support gatherings (meeting), and electronic helping (email).


Metro Phoenix Chapter
meetings, phone, email
Charlene (480) 543-9162
New meeting time and location coming soon!
Connect with other mothers in the Metro Phoenix area on Facebook.

West Valley Chapter
phone, text, email, in-person
Jessica (602) 551-6455


Alameda Chapter
phone, email, in-person
Patty (510) 410-7752
Facebook: San Francisco Bay Area Chapter

Amador, Calaveras, Tuolumne Counties Chapter
Motherlode Moms

meetings, phone, email
Teglene (209) 795-4393
Jen (209) 985-9284
Facebook: Motherlode Moms

Breastfeeding USA/Antelope Valley
phone, email, meetings, in-person, text
Angela Hayes (323) 450-7969
Meeting info coming soon.

Inland Empire Chapter
email, in-person, in-person, meetings
Tamika Simpson

Greater Sacramento Area Chapter
meetings, phone, email
Jewel (530) 318-1097

Redlands Chapter
phone, email, in-person
Cristy (909) 521-0746
Meetings held 2nd Thursday of every month at 10AM.

San Francisco Bay Area Chapter
phone, email, in-person
Patty (510) 410-7752
Facebook: San Francisco Bay Area Chapter

SF South Bay Breastfeeders
email, online
Meeting info: Meetings coming soon
Facebook: BfUSASouthBay

Santa Clarita Chapter
in-person, email, text, phone
Nina Withers (661) 977.6872
Meeting Information: Coming Soon

Silicon Valley Chapter
in-person, email, text, phone
Kristy Johnson (734) 377-4417
Meetings coming soon!

Torrance Chapter
phone, email, online
Karen (626) 318-8218
Genevieve (818) 980-5090


Castle Rock Chapter
phone, email, meetings
Kari Wheeler (303) 880-4534
Meetings: First Friday of every month, from 11am to 12pm, at the Family Enrichment Center, 107 5th Street, Castle Rock

Denver Metro
email, text, phone, meetings
Natalie (303) 475-1586
Meeting Info: Toddler Meet-up, First Fridays at 3pm, The Family Room - 6279 W 38th Ave in Wheat Ridge

Front Range Chapter
phone, email
Sharon (315) 331-2140

Grand County Breastfeeding Network
phone, email, in-person, meetings
Rosalie (303) 478-2054
Meeting information: 4th Thursday of the month, from 2-3 pm, at the Pregnancy Resource Connections building in Granby Colorado.

Morgan County Nurslings
phone, email, in-person
Cassie Potts (970) 370-4948

South Denver Suburbs
phone, email, in-person
Gena (813) 495-1428


meeting, phone, email
Nicky Prince (860) 729-2970
1st Monday of each month, 6:30pm: Colchester Library, 8 Linwood Ave Norton Room B
Facebook: Connecticut Chapter of Breastfeeding USA

East Hartford
meeting, phone, email
Jennie Bernstein (860) 372-5276
Mia Gonzalez
Sherri Witherell (860) 595-2358
2nd Monday of each month, 6pm: With Women Wellness, 87 Church Street Suite 204, East Hartford
Facebook: Connecticut Chapter of Breastfeeding USA

meeting, phone, email
Carol Delaney (860) 644-4109
Joy Delaney (860) 375-0569
Kora Gilbert (860) 468-5790
3rd Monday of each month, 7:30pm: Indian Valley YMCA (childcare room), 11 Pinney Street
Facebook: Connecticut Chapter of Breastfeeding USA

meeting, phone, email
Becca Dean (860) 916-5543
Spencer Joslin-Montlick (860)580-9630
2nd Saturday of each month, 10:15am: 7 Elm Street (St. Francis Access Center), room 301
Facebook: Connecticut Chapter of Breastfeeding USA

New Britain
meeting, phone, email
Alexis Hennessey (860) 281-1121
Shiyrah S (860) 880-0817
Last Thursday of each month, 6:00pm: YWCA New Britain, 19 Franklin Square
Facebook: Connecticut Chapter of Breastfeeding USA

New Haven
phone, email
Meredith Sinclair (860) 468-5270
Facebook: Connecticut Chapter of Breastfeeding USA

South Windsor
phone, email
Jaime Lyn Procaccini (860) 644-2117
Facebook: Connecticut Chapter of Breastfeeding USA

phone, email
Jennifer Veit (860) 690-9853
Facebook: Connecticut Chapter of Breastfeeding USA

West Hartford
meetings, phone, email
Erica Grossman
Shiyrah S (860) 880-0817
1st Wednesday of each month, 7pm: Outer Peace Wellness, 12 North Main Street
Facebook: Connecticut Chapter of Breastfeeding USA


East Central Chapter of Florida
Facebook: East Central Chapter of Florida

North Central Florida Chapter
meetings, phone, email
Stormy (352) 247-2333
Cynthia (352) 247-2333
Facebook: North Central Florida Chapter

Northeast Florida Chapter
phone, email, text, in-person
Cara Piper (904) 891-4941

St. John's County
email, text, phone, in-person
Roslyn Morrow (904) 315-7026

Southwest Florida Chapter
phone, email, in-person
Lauren (850) 491-3001
Facebook: Southwest Florida Chapter
Meetings: Coming soon!


Middle Georgia Chapter
phone, email, in-person, meetings, classes
Evelina (478) 216-8333
Denise (478) 216-8333
Monthly breastfeeding support meetings hosted in collaboration with the Middle Georgia Breastfeeding Alliance.


West Oahu Chapter
phone, email
Naomi S. (808) 221-3179


Breastfeeding USA: Treasure Valley, ID Chapter
phone, email, in-person
Sarah (219) 921-4178


Breastfeeding USA West Dundee
phone, email, meetings
Beth & Aimee (630) 220-0765
Babies and children always welcome. Meetings always free of charge.
Weekday Chapter meetings: Second Monday of each month from 10am-12noon at Radiant Heart Yoga, 647 S 8th St, West Dundee, IL 60118.
***There will be no Chapter Meeting on October 12, 2015. Please come on Monday, October 19 from 10-12 instead.***
Nursing Beyond Infancy meetings (for those seeking support for nursing older babies (over 5 months) and toddlers, 2015: January 26, March 16, April 27, June 15, July 20, August 31, October 19, November 30, January 11, 2016 at Radiant Heart Yoga, 647 S 8th St, West Dundee, IL 60118.
Facebook: BFUSAWestDundee

Breastfeed DeKalb
phone, email, in-person, meetings
Deanna Soper-Pinkelman (219) 928-0620
Facebook: BreastfeedDekalb

Champaign-Urbana, IL
phone, email
Ashley Price (217) 391-3946

Chicago - Northside
Aimee Barker

Chicago - North Suburbs
email, meetings
Susan Urbanski
Contact Susan for meeting information.

Chicago - West
(Serving the areas in Chicago's near-western suburbs)
phone, email, meetings, in-person, text
Maura Frauenhofer (716) 799-3290
Elle Morton (314) 560-6672
For the remainder of 2015, meetings are held the first Saturday of the month & third Wednesday of the month from 9-11 am at Mission House Cafe located at 6818 W 34th St, Berwyn IL 60402
Facebook Page: Please check our page the day of meetings in case of changes or cancelations.

Chicago Area
phone, email
Danika Amusin (773) 510-3416

Chicago Area
phone, email, in-person
Shevy Lowinger (773) 240-1762

DuPage County Chapter, Mother-to-Mother
email, phone
Lisa (630) 474-4815
Facebook: DuPage Mother to Mother

Elmhurst Area Chapter
email, meetings
Elise Fulara:
Heather Dvorak:
Group website & meeting calendar:
Facebook page: Elmhurst Area Chapter

Joliet Chapter
meeting, email, phone
Colleen and Karyn
(815) 317-6065
Facebook: Breastfeeding USA- Joliet Chapter
Meetings are held the 4th Monday of the month, 7:00 PM. No RSVP required. Meetings held at ANEW Medical and Rehabilitation 115 Republic Ave. Joliet, IL 60435

Mt. Vernon Chapter
meeting, phone, email
Rose (618) 204-9081
Meeting time and location: 2nd Tuesday evening of each month 6:30 pm
Hosted at: First United Methodist Church 1133 Main St. Mt. Vernon, IL (enter through back door)

Schaumburg Area Chapter
Tracy Torgerson (224) 200-7031

Spring Grove, IL Chapter
phone, email
Kristy Hinz (847) 533-5361
Facebook: Spring Grove, IL Chapter

Tri-Cities Chapter
Serving Batavia, Geneva, St Charles, and surrounding areas
phone, email, text, meetings
Krista (630) 934-6214
Meeting details: second Tuesday of every month from 10-12am. Located in the basement youth room of the Geneva United Methodist Church at 211 Hamilton St. Geneva, IL 60134. Babies and children always welcome.


Breastfeeding USA of Bloomington
meetings, phone, email
Brianna Horne (571) 921-2559
Next Meeting: Wednesday, September 23rd from 6pm-8 pm in meeting room 2A at the Main Library in Bloomington, IN.
Facebook: Breastfeeding USA Bloomington

Hamilton County Moms Breastfeed
meeting, email, phone
Amie (317) 674-3237
Elissa (317) 674-3237
Chapter Meetings:
Morning meetings second Wednesdays of each month, 10 a.m.-12 p.m. Please see our Facebook page for additional meeting times and locations.
Facebook Page: Hamilton County Moms Breastfeed
Facebook Chat Group

Indy Breastfeeding Moms
meeting, phone, email
Ali, Amie, Megan, Jillian, Jasmine, Ann, & Sara
(317) 782-5819
Facebook Page: Indy Breastfeeding Moms Chapter
Facebook Chat Group: Indy Breastfeeding Moms Chat Group
Morning Chapter Meetings: Second Friday of each month,10:15 AM
College Avenue Branch Library, 4180 N. College Ave.
Evening Chapter Meetings: First Wednesday of each month, 6:00 PM
Nora Library, 8625 Guilford Avenue.

Lawrence (East Indy) Chapter
meetings, email, in-person
Chapter Meetings:
Indianapolis-Marion County Public Library LAWRENCE Branch Meeting Room:
August 6, September 17, October 1, November 19, December 17
ALL meetings will start at 6:00 pm
Panera, located at 9145 East 56th Street, Indianapolis, IN 46216:
September 3, November 12, December 3
ALL meetings will start at 6:00 pm

Southeastern Indiana Breastfeeding Moms
meeting, phone, social media, email
Cara (812) 212-9512


Breastfeeding USA Eastern Iowa Chapter
meetings, email, text, in-person
Natalie Goyette (319) 329-6875
Sarah Bengtson
Meetings are held at Birth, Baby & Beyond, 4330 Czech Square, Cedar Rapids, IA 52402. We meet the second Thursday of the month at 7 pm and the 4th Monday at 10 am.

Iowa City Chapter
email, social media
Facebook: Iowa City Chapter

North Iowa Chapter
phone, text, email, meetings, in-person
Alissa Gomez-Dean (641) 512-6614


Kansas City Breastfeeding USA
email, online
Heather Owen
Visit us on Facebook


Breastfeeding Moms of Ashland
meeting, phone, email
Alissa Parker (925) 297-KIDS
Meeting Info: First Saturday of the month, 10:00am
Visit us on Facebook


Northeast Louisiana Chapter
phone, email, in-person
Nina (318) 348-7999


Greater Western MA Chapter
meeting, phone, email
Kate N. (413) 213-0843
Rachael (413) 221-1582
Meeting Information: 2nd Friday of each month at 6:30pm at the Belchertown Family Center
Visit us on Facebook


Carroll/Baltimore County Chapter
meeting, phone, email, in-person, text
Brittany (410) 800-7048
Julie KL (703) 395-8957
Meeting information: First Saturday of each month at Amazing Spiral, 5851 York Road, Baltimore, MD 21212, 10:30-11:30 am

Montgomery County Chapter
meeting, phone, email
Beth (301) 326-4715
Chapter meetings are the third Tuesday of each month at Holy Cross Resource Center, 9805 Dameron Dr., Silver Spring, MD 20902. 6:00 pm
Visit us on Facebook


Genesee County Chapter
Toi L.

Kalamazoo Chapter
phone, email, meetings
Jennifer (269) 317-8581

Michigan Chapter
phone, email
Shannon (616) 295-1128


Greater Twin Cities Chapter
phone, email, in-person
Becca Morgan (320) 333-4496

Maple Grove/Plymouth Chapter
phone, email, meetings, in-person, text
Andrea Meyer (612) 413-5611

Twin Cities Chapter
phone, email
Alison (612) 314-5504
Visit us on Facebook


St. Louis Metro Breastfeeding USA
phone, email, in-person
Dorothy (314) 635-8692
Visit us on Facebook

Kansas City Breastfeeding USA
email, online
Heather Owen
Visit us on Facebook

West County St. Louis
phone, email, online
Skype Number: (314) 720.6863 Please email to set up a phone consult if phone is preferred to Skype.


Mineral County
email, phone, in-person, meetings
Amy L. (406) 207-4020


Breastfeeding USA of Kearney
phone, email, meetings
Victoria Narcisse (402) 413-8811

New Hampshire

Monadnock-Brattleboro Chapter
email, text, phone, in-person, meetings, online support group
Clarissa Murch (929) 322-3872
Meeting information: Please check our Facebook page for current meeting times and locations
Facebook Page: Monadnock-BrattleboroBFUSA
Online Support Group: Monadnock Breastfeeding Group
Babies and children and partners always welcome. Meetings always free of charge.

New Jersey

North Jersey Chapter
phone, email, in-person
Steph Stohrer (973) 534-9368
Gina (516) 713-6576
Allyson Murphy (908) 331-0243
Please visit our Facebook page for meeting details.

New Mexico

Curry County
email, phone
Tiffany (850) 496-6163

Greater Albuquerque Area Chapter
Base Breastfeeding Support Group
Meeting Information: 2nd Fridays, 10 am - Noon, Kirtland Airforce Base, Family Housing Town Center, 1008 Golden SmokeDrive SE
Facebook Page: AlbuquerqueBFUSA
Next Event Page: AlbuquerqueBFUSA Events

New York

Capital Region
meetings, email
Anne O.
Facebook: Capital Region Chapter
Chapter meetings:
-Clifton Park: Second Saturday each month, 10:15am to 11:30am. For meeting location, email Anne
-Glenville: Second and Fourth Tuesdays of the month, 10:15am to noon. East Glenville Fire Department, 433 Saratoga Road (Rt 50), Glenville, NY 12302

Mechanicville Chapter
Erica Svatek
Meetings: First and third Tuesday of the month from 10-11:30 am at the Mechanicville Area Community Services Center
Facebook: BFUSAMechanicville

Tompkins/Cortland Chapter
phone, email, in-person, meetings
Brenda (315) 510-5760
Facebook: tompkins.cortland.mothers
Meeting Schedule Still Evolving, Please check our facebook page or email Brenda for up to the date information!

North Carolina

Cary Chapter
phone, email, text
Anna (919) 593-4681
Lindsay (860) 389-6262
Meetings are held on 2nd and 4th Tuesdays at 10am in downtown Cary. Contact Anna for directions.

Lake Norman Chapter
email, phone, text, meetings
Volunteer Breastfeeding USA Counselors: Rebecca, Kate, Brittany

Central Mooresville meeting, 3rd Thursdays 7pm-9pm
Warmline: (704) 761-8238 -- call or text
Facebook: Lake Norman Chapter

East Mooresville meeting, 1st Tuesdays 10am-noon
Warmline: (704) 980-8238 -- call or text

South Charlotte/Fort Mill
email, phone, meetings
Amie (704) 619-9469
Meeting info: 3rd Saturday of each month at 10am

Wilmington, NC Chapter
meetings, phone, email
Jess Zeffiro (412) 983-2982
Meeting information: 2nd and 4th Thursday of each month @ Angel Food Lactation & Nutrition: 700 Military Cutoff Rd, Suite 210, Wilmington NC
Facebook: wilmingtonbfusa


Cincinnati Breastfeeding Moms
meetings, email, phone, text
Suzanne Please send text to (513) 226-9272
Krista (513) 377-6328
Chapter meetings are the third Thursday of each month.
Cincinnati Breastfeeding Mothers Yahoo! Group

Greater Cleveland West Chapter
phone, email, meetings
Spanish speaking - contact Samantha
Facebook - BFUSA.CuyahogaWest
(216) 618-5265
Chapter meetings are 4th Tuesday of every month at 7pm.
Toddler meetings on the First Friday of each month.
Meetings are held at 15800 Detroit Avenue, Lakewood, OH 44107, Suite D

Breastfeeding Support of Central Ohio (Columbus)
phone, text, meetings, email
Rachelle Lesteshen (614) 500-3862
Meeting Information: Northwest Columbus Lunchtime Chat, 2nd Friday of every month (starting January 2016), 11:30-1:30, Northwest Library (Worthington Libraries) 2280 Hard Road, Columbus, OH 43235
Visit our Facebook Group

Dayton Area: Wright-Patt Nature & Nurture Nursing Support Group
phone, email, text, meetings, in-person
Mary (937) 405-6103
Meetings: 1st Wednesday of month at 5:30pm; 3rd Tuesday of month at 7pm (contact Mary for locations)
Facebook: Wright-Patt Nature & Nurture Nursing Support Group


Breastfeeding USA Edmond
phone, email, in-person, text
Zonna (405) 513-1494
Meetings are the third Saturday of the month at 10:00am at Hackney Chiropractic, 408 S. Santa Fe Ave., Edmond, OK 73003.
Facebook Group: Breastfeeding USA Edmond

Oklahoma County Chapter
in-person, phone, email, text
Nikki (405) 651-2880
Visit us on Facebook for meeting details.


Breastfeeding USA Beaverton, OR Chapter
meetings, phone, email, in-person
Piper (971) 236-7055
Facebook: BfUSABeavertonOR
Meeting information:
-Beaverton evening meeting, 7pm on the 4th Wednesday of every month, Aloha Fire Station Community Room (20665 SW Blanton St. Aloha, OR 97007)
-Beaverton morning meeting, 10am on the 2nd Saturday of every month, Aloha Fire Station Community Room (20665 SW Blanton St. Aloha, OR 97007)
-Portland morning meeting (Starts in October), 10am on the 3rd Monday of every month, First United Methodist Church of Portland, 1838 SW Jefferson St, Portland, OR 97201

Silverton Breastfeeding USA Chapter
phone, email, in-person
Bethany (503) 419-4151
Facebook: SilvertonOregonBFUSA


Breastfeeding USA Pittsburgh Chapter
phone, email, text
Jamie Hornych (412) 608-8215
Meeting Info: Meetings are the first Wednesday of every month at 10:30 in the Lincoln Gallery at Andrew Carnegie Free Library and Music Hall.

Central Pennsylvania Chapter
phone, email, meetings, classes
Ruth (570) 884-4398 email
Please contact Ruth for more information on monthly meetings and classes.
Central PA Facebook Page

Southwestern Pennsylvania Chapter
email, phone, text, in-person, classes, meetings
Mallary Powell, (724) 557- 0857
Phone messages will be returned after 6pm (generally) Monday- Friday. Times will vary on Saturday and Sunday.
Facebook group: Breastfeeding USA Southwestern Pennsylvania Chapter
Meeting information: Please contact Mallary or refer to Facebook for meeting information

South Carolina

Upcountry South Carolina Chapter
phone, email
Carol (864) 558-5020

South Dakota

Breastfeeding USA General Support
phone, email, text
Jacklyn Rymer (816) 457-3069


Monroe/Loudon Nursing Mamas
email, online support group
Lisa Paul
Facebook (friend me, and I will add you to the private group)

Murfreesboro Mom-to-Mom Breastfeeding Support
phone, email
Melissa (615) 567-3890


DFW Chapter
phone, email, meetings, in-person , text
Aly Colman (817) 925.5206

El Paso Chapter
phone, email, in-person, meetings
Bonnie Rutkowski (915) 490-3407
In-Person counseling available on Thursdays from 9a-5p at 2301 N. Lee Trevino Middle Door Pregnancy Resource Center
Meeting information will be posted soon.

Houston Chapter
phone, email, in-person, meetings
Nikkole Cooper (713) 553-0296
Meeting Info: Contact Nikkole for dates and location.

North Dallas Chapter
phone, text, email, meetings, in-person
Melanie Louise (972) 802-8265
Facebook Page: BFUSANorthDallas

Orange County Chapter-Breastfeeding USA
phone, meetings, email
Erin Sanderson (409) 466-8303
Facebook Page: orangecountybfusa
Facebook Group: orangecountybfusa group

Waco Chapter
phone, email, meetings
Ashley Jones (254) 744-6984
Meeting Info: Free weekly breastfeeding support meeting at My Little Play Place (7524 Bosque Blvd Waco, Tx 76712) on Fridays at 10:30 am.
Facebook Group: TXBfUSA


Monadnock-Brattleboro Chapter
email, text, phone, in-person, meetings, online support group
Clarissa Murch (929) 322-3872
Meeting information: Please check our Facebook page for current meeting times and locations
Facebook Page: Monadnock-BrattleboroBFUSA
Online Support Group: Monadnock Breastfeeding Group
Babies and children and partners always welcome. Meetings always free of charge.


Central Virginia Chapter
phone, email, in-person
Maggie (434) 547-0454
Facebook Page: CentralVaBFUSA

Fredericksburg Chapter

Northern Virginia Chapter
phone, email, meetings
Ellyn Fine (703) 966-3170
Leah (301) 593-2082
Facebook Page: breastfeedingusaNOVA

Shenandoah Valley Chapter
phone, email, meetings, classes
Megan Hartless (540) 860-0567
Facebook Page: Breastfeeding USA: Shenandoah Valley Chapter
Facebook Group: Breastfeeding USA Shenandoah Valley Circle
Website: Shenandoah Valley Chapter


Lake Tapps, Wa Chapter
phone, email, meetings, in-person, text
Chelsea (206) 890-0833
Facebook: laketappsbfusa

Tacoma Area Chapter
phone, email, meetings
Sarah Harding: (515) 201-6418
Meetings: Email for dates and location
Facebook: Tacoma Area Breastfeeding Moms

Whatcom Breastfeeding Moms
phone, email, in-person
Elizabeth (360) 474-7286
Website: Whatcom Breastfeeding Moms
Facebook Chat Group: Whatcom Breastfeeding Moms
Facebook Page: whatcombreastfeedingmoms


Burlington Chapter
phone, in-person, email, meetings
Kristy Hinz (847) 533-5361
Facebook Page
Chapter Meetings: Second Friday of the month 10am
Drop In Support: Monday and Wednesday 9-5
Located at 101 S. Pine St. Burlington WI

Marinette Chapter
phone, email
Phenix Mieko Patrick (715) 732-1658

Watch us grow! More chapters opening soon.

Nipple Shield: Friend or Foe?

I recently spoke to a mother whose 1-month-old baby was born 4 weeks preterm. She was breastfeeding with a nipple shield, which she was given in the hospital, and she was confused by conflicting advice. Should she pump after feedings? Was her baby getting enough milk? How should she wean from the shield? This was her sixth breastfeeding baby but her first preterm baby and first time using a shield. She was emotional and unsure of herself. My answers below were based on the research described in my book, Breastfeeding Answers Made Simple.

Express milk after breastfeeding? As long as her baby was gaining weight normally (which she was), there was no reason to pump after feedings. A study of 54 mothers and babies compared babies breastfeeding with a nipple shield to those breastfeeding without it and found no difference in weight gain during the first 2 months of life. 1 Although one 1980 study found babies took 22% less milk at the breast with a shield,2 these mothers used thicker, rubber shields. As long as the baby is suckling effective, today’s thin, silicone shields do not appear to decrease milk intake during breastfeeding.

How to gauge baby’s milk intake. Weight gain is the best way to know a breastfeeding baby is getting enough milk. This baby was gaining well, so adequate milk intake was guaranteed. After feedings, other signs of milk intake include reduced feelings of breast fullness and milk seen in the tip of the shield.

Weaning off the shield. A hospital nurse told this mother to wean her baby from the shield by gradually cutting it away. This strategy made sense with rubber shields, but cutting silicone shields produces sharp edges that could irritate the baby’s mouth. A better strategy is to start the baby feeding with the shield and when the mother hears swallowing to quickly slip off the shield and slip in the breast. But I told this mother to be patient. Her preterm baby may not be ready to wean from the shield. One study found nipple shields increased milk intake in preterm babies having trouble suckling actively and staying on the breast.3 While not all preterm babies need to use a shield, I told this mother that for now her preterm baby may breastfeed better with it. The baby’s readiness to wean from the shield is as important as the mother’s readiness.

In general, should nipple shields be considered “friend” or “foe”? It depends. As 88% of the mothers in one study reported,4 when used appropriately, nipple shields can help preserve breastfeeding. Or—like any breastfeeding tool—they can be misused and undermine it. In some cases, weaning off the shield may be the right thing to do. In others, a mother should be patient and wean from the shield later rather than decrease her baby’s breastfeeding effectiveness or turn the breast into a battleground.


1. Chertok, I. Reexamination of ultra-thin nipple shield use, infant growth and maternal satisfaction. J Clin Nurs 2009;18(21):2949-2955.

2. Woolridge, M. et al. Effect of a traditional and of a new nipple shield on sucking patterns and milk flow. Early Hum Dev 1980; 4(4):357-364.

3. Powers, D., & Tapia, V. B. Women's experiences using a nipple shield. J Hum Lact 2004; 20(3):327-334.

4. Meier, P. et al. Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding. J Hum Lact 2000; 16(2):106-114.

Used with permission. Article originally appeared on the website Breastfeeding Reporter (, where you can find complete article licensing information.

Should All Breastfed Babies Have Above Average Weight Gains?

Just like in the fictional Minnesota town of Lake Wobegon, where “all the children are above average,” many parents believe there is something wrong if their breastfeeding baby’s weight isn’t above the 50th percentile. While it is human to want our children to excel, the assumption that babies at a higher weight percentile are healthier or somehow “better” reflects a basic misunderstanding of growth charts and what they mean.

The purpose of a growth chart is to plot a baby’s growth on a series of percentiles, with the average baby at the 50th percentile. What this really means in terms of weight is that out of 100 children, 49 will weigh less and 50 will weigh more. A weight that falls at a higher percentile is not “good” and a weight that falls at a lower percentile is not “bad.” By definition, there will be healthy children at every percentile. Some will be chunky and some will be petite, but their percentile does not necessarily reflect their overall health or growth.

A child at the 5th percentile is not necessarily growing poorly and the child at the 95th percentile is not necessarily growing well. That’s because growth can only be evaluated over time. For example, a preterm baby born very small will likely fall on a low percentile for weight at first, even when he is gaining weight well. Also, if during pregnancy a mother had high blood sugar levels, gained a lot of weight, or received lots of IV fluids during labor, her baby’s birth weight may be unnaturally high. In these situations, after birth a large baby may fall in percentiles to a weight closer to what his genes naturally dictate.1

But parents are not the only ones confused. A U.K. study2 examined both mothers’ and healthcare providers’ perceptions of growth charts, and found that many mothers worried about their baby’s weight gain between checkups and that both mothers and healthcare providers erroneously considered the 50th percentile a goal to be achieved. When babies fell below the 50th percentile, healthcare providers often recommended the mothers give their babies formula and solid foods to try to boost baby’s weight gain to reach this “desirable” percentile. The researchers concluded that healthcare providers need more training on how to assess the growth of breastfeeding babies and how to support breastfeeding rather than undermine it.

Normal growth means a baby is gaining weight at a healthy pace and growing well in length and head circumference. One point on a baby’s growth chart should never be considered in isolation but rather compared to other points. It’s a baby’s growth pattern over days, weeks, and months that provides an accurate picture of how breastfeeding is going. If a baby is growing consistently and well, his actual percentile is irrelevant.

If over time, however, his weight-for-age percentile drops, first it’s important to determine whether the chart is based on breastfeeding norms, as many are not. (Click here for the World Health Organization’s growth charts based on exclusively breastfed babies.) If the chart is based on breastfed babies and the baby’s weight-for-age percentile has dropped, this is a red flag to take a closer look and see if breastfeeding dynamics can be improved.


1. Mohrbacher, N. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Amarillo, TX: Hale Publishing, 2010.

2. Sachs, M., Dykes, F., & Carter, B. Feeding by numbers: an ethnographic study of how breastfeeding women understand their babies' weight charts. Int Breastfeed J 2006; 1:29.

Used with permission. Article originally appeared on the website Breastfeeding Reporter (, where you can find complete article licensing information.

Worries About Foremilk and Hindmilk

A little knowledge can be a dangerous thing. This has never been so true as in the ongoing debate about foremilk and hindmilk and their impact on breastfeeding. The misunderstandings around these concepts have caused anxiety, upset, and even led to breastfeeding problems and premature weaning.

The 2003 edition of The Breastfeeding Answer Book defines these terms this way:

“The milk the baby receives when he begins breastfeeding is called the ‘foremilk,’ which is high in volume but low in fat. As the feeding progresses, the fat content of the milk rises steadily as the volume decreases. The milk near the end of the feeding is low in volume but high in fat and is called the ‘hindmilk’” (Mohrbacher and Stock, p. 34).

It goes on to explain that by simply letting the baby “finish the first breast first”—switching breasts when the baby comes off the breast on his own rather than after a set time—the mother can be sure her baby receives the “proper balance of fluid and fat.” Since this book was published, research has expanded our understanding of foremilk and hindmilk and answered many of the common questions mothers have about these concepts.

What worries? Confusion about foremilk and hindmilk has led to all sorts of uncertainty. Are there two distinctly different types of milk? Does the baby need to breastfeed for a specific number of minutes before foremilk suddenly turns to hindmilk? Can a baby miss out on hindmilk altogether if he breastfeeds for too short a time? If this happens often, will his weight gain suffer? Sometimes healthcare providers get into the act, telling breastfeeding mothers they should watch the clock to make sure their baby breastfeeds “long enough to get the hindmilk,” with the number of minutes recommended varying by adviser What do we really need to know about foremilk and hindmilk? And is there any reason to worry?

The truth about foremilk and hindmilk. Research has found this concept is not as simple as it sounds. It is true that fat sticks to the milk ducts in the breast and the percentage of fat in the milk increases during a breastfeeding as the fat is released from the ducts during milk ejections. But the reality of this seemingly simple dynamic is not always as it seems.

There are not “two kinds of milk.” Despite this common belief, there is no “magic moment” when foremilk becomes hindmilk. As the baby breastfeeds, the increase in fat content is gradual, with the milk becoming fattier and fattier over time as the breast drains more fully.

The total milk consumed daily—not the hindmilk—determines baby’s weight gain. Whether babies breastfeed often for shorter periods or go for hours between feedings and feed longer, the total daily fat consumption does not actually vary.

Foremilk is not always low-fat. The reason for this is that at the fat content of the foremilk varies greatly, depending on the daily breastfeeding pattern. If the baby breastfeeds again soon after the last feeding, the foremilk at that feeding may be higher in fat than the hindmilk consumed at other feedings.

How does this work? Interestingly, foremilk and hindmilk are concepts that really only make sense when longer intervals such as two to three hours or more occur between feedings. The longer the time gap between feedings and the fuller a mother’s breasts become, the greater the difference in fat content between her foremilk and hindmilk. These differences in fat content can vary greatly over the course of a day even among individual mothers. For example, when a long breastfeeding gap occurs during the night, at the next feeding a mother’s foremilk will be lower in fat than during the evening when her baby breastfeeds more often.

What really matters. Research indicates that there is no reason to worry about foremilk and hindmilk or to coax a baby to feed longer. As long as a baby is breastfeeding effectively and the mother does not cut feedings short, baby will receive about the same amount of milk fat over the course of a day no matter what the breastfeeding pattern (Kent, 2007). This is because the baby who breastfeeds more often consumes foremilk higher in fat than the baby who breastfeeds less often. So in the end it all evens out.

What’s most important to a baby’s weight gain and growth is the total volume of milk consumed every 24 hours. On average, babies consume about 750 mL of milk per day (Kent et al., 2006). As far as growth is concerned, it doesn’t matter if a baby takes 30 mL every hour or 95 mL every three hours, as long as he receives enough milk overall (Mohrbacher, 2010). In fact, researchers have found that whether babies practice the frequent feedings of traditional cultures or the longer intervals common in the West, they take about the same amount of milk each day (Hartmann, 2007) and get about the same amount of milk fat. Let’s simplify breastfeeding for the mothers we help and once and for all cross foremilk and hindmilk off our “worry lists.”


Hartmann, P.E. (2007). Mammary gland: Past, present, and future. in eds. Hale, T.W. & Hartmann, P.E. Hale & Hartmann's Textbook of Human Lactation. Amarillo, TX: Hale Publishing, pp. 3-16.

Kent, J. C. (2007). How breastfeeding works. Journal of Midwifery & Women's Health, 52(6), 564-570.

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.

Mohrbacher, N. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Amarillo, TX: Hale Publishing, 2010.

Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book, 3rd edition. Schaumburg, IL: La Leche League International, 2003.

Used with permission. Article originally appeared on the website Breastfeeding Reporter (, where you can find complete article licensing information.

Breastfeeding Information Index

Find a Breastfeeding Counselor Near You!

Accredited Breastfeeding Counselors (BCs) are listed by state and location. They are experienced breastfeeding mothers accredited following completion of a comprehensive breastfeeding education program. They provide information and support to pregnant and breastfeeding mothers, in both one-on-one and group situations.

Breastfeeding Articles

These articles may be of interest to mothers and those who support them. This is just the beginning of an extensive online library which will grow over time as the organization grows. Our goal is to provide evidence-based information and support: What Does Evidence-Based Mean? Each article is well researched and contains up-to-date information.

Book Reviews

Book reviews were written by Breastfeeding USA Counselors, interested in sharing their love of discovering evidence-based information and sharing it with the breastfeeding community. This section is under development.

We extend sincere appreciation to all the authors who have donated articles and reviews to Breastfeeding USA.

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