Step 6: Give newborn infants no food or drink other than breast milk unless medically indicated.

Every facility providing maternity services and care for newborn infants should:

Step 6: Give newborn infants no food or drink other than breast milk unless medically indicated.

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For any breastfeeding babies being given food or drink other than breastmilk there should be acceptable medical reasons. No promotion for infant foods or drinks other than breastmilk should be displayed or distributed to mothers, staff, or the facility.

Families and health workers may believe that infants need pre-lacteal feeds of formula or glucose water or other drinks before their mother’s milk “comes in.” This may lead to failure to breastfeed. Infant formula and advertisements in maternities can mislead people on this important point. Breast milk is pure and complete, while giving babies water or other liquids can pose risks due to contaminated water.

The sixth step stresses that a newborn baby must not be given any food or drinks other than breast milk unless it is medically indicated. As the pregnant women are counseled in advance and the hospital staff is trained, we rarely have to give anything other than colostrums – the first breast milk to the babies.

What You Can Do.

Step 6: WABA Action Chart

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General
Families and health workers may believe that infants need prelacteal feeds of formula or glucose water or other drinks before their mother's milk "comes in". This may lead to failure to breastfeed. Infant formula and advertisements in maternities can mislead people on this important point.
Health System
Make sure that mothers receive help to breastfeed effectively, so that they do not feel a need to give a baby other drinks.

Make sure that health workers understand that supplements are seldom needed, even in the first few days when the volume of breast milk is small; and that the first milk, colostrum is what a baby needs.

Raise awareness of what are the very few medical indications for supplements and what are not medical indications, so that babies do not receive supplements unnecessarily. (see Resources section)
Community
Work with the community to raise awareness about the importance of colostrum, and why a baby needs nothing else in the first few days; and of continuing to breastfeed exclusively six months.
National / Global
Advocate for renewal of government efforts to implement, monitor and legislate all provisions of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant WHA resolutions.

Key Points:

Acceptable Medical Reasons for Supplementation

Infants in Special Care
Infants with a very low birth weight <1,500g, or infants born before 32 weeks gestational age
Small for gestational age with potentially severe hypoglycemia, and who do not improve through increased breastfeeding or by being given breast milk
Infants well enough to be with their mothers receiving additional supplements must have been diagnosed as:
- Infants whose mothers have severe maternal illness
- Infants with inborn errors of metabolism
- Infants with acute water loss
- Infants whose mothers are taking medication with is contraindicated when breastfeeding.

HIV Issues to Consider

Step 6: Give newborn infants no food or drink other than breast milk unless medically indicated.
Issues to consider while implementing this step in relation to feeding recommendations for children of HIV-infected mothers and for settings with high HIV prevalence.

Staff members should find out whether HIV-positive mothers have made a feeding choice and make sure they don't give babies of breastfeeding mothers any other food or drink.
Being an HIV-positive mother and having decided not to breastfeed is a medical indication for replacement feeding.
Staff members should counsel HIV-positive mothers who have decided to breastfeed on the risks if they do not exclusively breastfeed. Mixed feeding brings both the risk of HIV from breastfeeding and other infections.
Even if many mothers are giving replacement feeds, this does not prevent a hospital from being designated as baby-friendly, if those mothers have all been counselled and offered testing and made genuine choices.