In all complex medical problems, health professionals should remember that breastfeeding is not solely about nutrition, and that families may value partial breastfeeding, and breastmilk feeding, even if supplementary feeds are necessary. Breastfeeding is a source of comfort for parent and child, and is particularly useful for analgesia during painful procedures. Babies who are mixed fed can receive infant formula while suckling at the breast with a supplementary nursing system, or can combine bottle and breastfeeding, or exclusively bottle feed with both expressed milk and formula.

While babies with complex medical problems may find breastfeeding more difficult, they are also likely to have the most to gain from the immunological and neurocognitive effects of human milk feeding - for example in congenital heart disease. Breastmilk feeding in babies with congenital heart disease seems to be highly influenced by the culture of the managing medical team - who are often cited as barriers to breastfeeding. However good lactation support and specific targeted projects can significantly increase breastfeeding in this context and high levels of breastmilk feeding can be achieved. Indeed, in one unit where "human milk is viewed as a medical intervention for hospitalized infants" and all mothers with congenital heart disease are intensively counselled by a lactation consultant, over 98% initiate lactation and most are discharged breastfeeding. The key to establishing a full milk supply is the same as for parents of preterm babies covered here.

There is an Academy of Breastfeeding Medicine guideline for breastfeeding babies and young children with Insulin-dependent Diabetes

There is an Academy of Breastfeeding Medicine guideline for breastfeeding babies with hypotonia (with particular focus on Downs' syndrome). In the UK, health professionals tend to believe that babies with Downs' syndrome can't breastfeed, are unskilled in maximising breastfeeding potential and undervalue retention of partial breastfeeding or breastmilk feeding, as summarised here. La Leche League Canada have made a useful parent guide to breastfeeding in Downs Syndrome. Read one family's story here.

Metabolic disorders - The American Academy of Pediatrics advises that "alternating breastfeeding with special protein-free or modified formulas can be used in feeding infants with metabolic diseases other than galactosaemia, provided that appropriate blood monitoring is available". A case series reports success with a variety of metabolic disorders 

Surgical Problems

Breastmilk is not equivalent to infant formula for fasting guidance before anaesthetic or sedation. The Academy of Breastfeeding Medicine recommends breastfeeding can continue until 4 hours prior to sedation, and can restart immediately after the infant or child is alert and haemodynamically stable. Some UK settings have reduced this to 3 hours - check your local guideline. Breastfeeding parents of young babies may need to express milk due to the length of the fasting period, particularly if this is for a lengthy procedure.

There is an Academy of Breastfeeding Medicine guideline for breastfeeding babies with cleft lip and palate

Craniofacial or gut anomalies may prevent oral feeding. The key to establishing a full milk supply is the same as for parents of preterm babies covered here.

The voice of the breastfeeding family

Have a look at Louise, Anna, Marie, Gemma, Sarah, Hannah & Zoe's stories on our site, or have a look at this beautiful video about breastfeeding children with life threatening illnesses.


Thank you for visiting the Hospital Infant Feeding Network. This website is a repository of relevant knowledge and best practice resources for health professionals. To join the conversation, ask questions and share your experiences please join us on Facebook or Twitter.


We will be running Q&A sessions on various topics, which will be advertised on our social media sites. Please email if you have ideas or want to get more involved. We welcome health professionals passionate about supporting breastfeeding and lactation in the hospital setting to join our steering group, please get in contact if this is you!

You may have noticed that we use 'additive' language on our website to refer to lactation and human milk feeding. This means that we might refer to 'breastfeeding/chestfeeding'. Chestfeeding is a term that some non-binary people use to refer to feeding their child at the chest if the word breast is not congruent with their gender identity. Using additive language helps reduce a feeling of exclusion for non-binary and transgender people, without taking away from the importance of words like breastfeeding and mother. There is a much more detailed description of the additive approach here.

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