Evidence-Informed Tips for Supporting Breastfeeding

Lilian White, MD
Posted on April 15, 2025

Breastfeeding is encouraged for its many benefits for both mother and baby. The US Preventive Services Task Force recommends providing interventions during pregnancy and after birth to support breastfeeding (Grade B), and a Cochrane review found ”moderate evidence that women who receive breastfeeding support interventions are more likely to continue breastfeeding up to 6 months postpartum.” More than 80% of mothers initially choose to breastfeed; however, almost 50% of mothers stop breastfeeding by 6 months. Women who are younger or primiparous or from disadvantaged communities are more likely to discontinue breastfeeding.

Breastfeeding is associated with higher IQ later in life; reduced risk of gastrointestinal infection and eczema in infants; and reduced risk of postpartum depression, cancer (breast and ovarian), and cardiometabolic disease in mothers. Breastfeeding is recommended exclusively for at least 6 months. Additional foods may be introduced after this time, with breastfeeding generally encouraged until at least 12 months of age.

Challenges to breastfeeding/chestfeeding include painful nipples or breasts, inadequate latching, and insufficient milk supply. The most common reason mothers discontinue breastfeeding is due to inadequate milk supply. To assess milk supply, infants may be weighed before and after feeding, with a weight gain of 1 g approximating 1 mL of breast milk consumption. This helps to distinguish perceived insufficiency from true insufficient intake.

Education may be offered to mothers with perceived insufficient supply on age-adjusted norms for infant feeding. Signs of insufficient milk supply are listed in an American Family Physician article, Breastfeeding: Common Questions and Answers. Milk supply may be improved by frequent and effective breastfeeding (or pumping). Additional fluid intake is generally not necessary in breastfeeding mothers beyond what their own physiologic needs require, and it does not appear to improve milk supply. Although galactagogues (eg, fenugreek, metoclopramide) may be useful, evidence to support their use is limited.

An ideal latch is characterized by a comfortable position for both mother and baby. The infant’s neck is in a neutral position with the infant’s nose free to breath. Most of the areola is in the infant’s mouth, with the nipple directed toward the roof of the mouth. The infant is able to suck and swallow in an easy, rhythmic way with a successful latch.

Painful nipples or breasts are another common reason mothers stop breastfeeding. Almost 90% of nipple pain is due to latch or positioning. Other causes of breast pain include mastitis, cellulitis, abscess, rashes, clogged milk ducts, engorgement, inverted nipples, and infant palate abnormality. A randomized controlled trial comparing lanolin and expressed breast milk for the treatment of nipple damage found both to be similarly effective. Laid-back positioning may also reduce nipple pain and trauma, with the mother in a “comfortable, semi-reclined position where every part of the body is supported, especially the shoulders, neck and arms, while the baby lies prone or on the stomach and the

If breastfeeding is painful despite optimal positioning, ankyloglossia (ie, tongue tie) in the infant is worth considering. Ankyloglossia may cause pain after the initial 30 to 60 seconds of breastfeeding. Treatment of ankyloglossia with frenotomy has mixed evidence to support its use, but a Cochrane review found frenotomy improved nipple pain in the short term.

Apps (eg, LactApp, My Baby Now) have been shown to be helpful for supporting breastfeeding. Support groups such as La Leche League International may also be helpful. Referral to a lactation consultant may be considered in breastfeeding mothers who require additional support. Prenatal breastfeeding education has been found to increase rates of success in breastfeeding mothers.