Table 1 The components of the Neo-BFHI

Three guiding principles

GP 1

Staff attitudes toward the mother must focus on the individual mother and her situation

GP 2

The facility must provide familycentered care supported by the environment.

GP 3

The health care system must ensure continuity of care from pregnancy to after the infant’s discharge.

Expanded Ten Steps to Successful Breastfeeding

Step 1

Have a written breastfeeding policy that is routinely communicated to all healthcare staff.

Step 2

Educate and train all staff in the specific knowledge and skills necessary to implement this policy.

Step 3

Inform hospitalized pregnant women at risk for preterm delivery or birth of a sick infant about the benefits of breastfeeding and the management of lactation and breastfeeding.

Step 4

Encourage early, continuous, and prolonged mother-infant skin-to-skin contact/ Kangaroo Mother Care.

Step 5

Show mothers how to initiate and maintain lactation and establish early breastfeeding with infant stability as the only criterion.

Step 6

Give newborn infants no food or drink other than breast milk unless medically indicated.

Step 7

Enable mothers and infants to remain together 24 h a day.

Step 8

Encourage demand breastfeeding or, when needed, semi-demand feeding as a transitional strategy for preterm and sick infants.

Step 9

Use alternatives to bottle feeding, at least until breastfeeding is well established, and use pacifiers and nipple shields only for justifiable reasons.

Step 10

Prepare parents for continued breastfeeding and ensure access to support services/groups after hospital discharge.

Code

Compliance with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions