Protecting, Promoting and Supporting Breastfeeding: Canadian Recommendation and the Ten Steps to Successful Breastfeeding

Exclusive breastfeeding for the first 6 months, and sustained for up to 2 years or longer with appropriate complementary feedings.

Step WHO/UNICEF (2018) Canada (2011)
Step 1 a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.
b. Have a written infant feeding policy that is routinely communicated to staff and parents.
c. Establish ongoing monitoring and data-management systems.
Have a written infant feeding policy that is routinely communicated to all staff, health care providers and volunteers.
Step 2 Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding. Ensure all staff, health care providers and volunteers have the knowledge and skills necessary to implement the infant feeding policy.
Step 3 Discuss the importance and management of breastfeeding with pregnant women and their families. Inform pregnant women and their families about the importance and process of breastfeeding.
Step 4 Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth. Place babies in uninterrupted skin-to-skin contact with their mothers immediately following birth for at least an hour or until completion of the first feeding or as long as the mother wishes. Encourage mothers to recognize when their babies are ready to feed, offering help as needed.
Step 5 Support mothers to initiate and maintain breastfeeding and manage common difficulties. Assist mothers to breastfeed and maintain lactation should they face challenges including separation from their infants.
Step 6 Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated. Support mothers to exclusively breastfeed for the first six months, unless supplements are medically indicated.
Step 7 Enable mothers and their infants to remain together and to practise rooming-in 24 hours a day. Facilitate 24-hour rooming-in for all mother-infant dyads: mothers and infants remain together.
Step 8 Support mothers to recognize and respond to their infants’ cues for feeding. Encourage responsive , cue-based feeding. Encourage sustained breastfeeding beyond six months with appropriate introduction of complementary foods.
Step 9 Counsel mothers on the use and risks of feeding bottles, teats and pacifiers. Support mothers to feed and care for their breastfeeding babies without the use of artificial teats or pacifiers (dummies or soothers).
Step 10 Coordinate discharge so that parents and their infants have timely access to ongoing support and care. Provide a seamless transition between the services provided by the hospital, community health services and peer support programs. Apply principles of Primary Health Care and Population Health to support the continuum of care and implement strategies that affect the broad determinants that will improve breastfeeding outcomes.
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