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Breastfeeding Guide (Nigeria)

Exclusive breastfeeding for the first 6 months — benefits, techniques, and overcoming common challenges

Breastfeeding is the optimal nutrition for infants. The WHO and Nigerian government policy recommend exclusive breastfeeding for the first 6 months of life — meaning breast milk only, with no water, formula, or other foods. Yet only 17% of Nigerian infants are exclusively breastfed for 6 months, despite the country's high rates of childhood malnutrition, diarrhoea, and pneumonia — all dramatically reduced by breastfeeding. This guide helps mothers and families understand the benefits, technique, and how to overcome the most common breastfeeding challenges.

Signs and Symptoms

✓ Breastfeeding is normal and healthy — these are challenges, not symptoms:
✓ Engorgement — breast fullness and firmness in first 3–5 days as milk 'comes in'
✓ Nipple soreness — common in the first 1–2 weeks; usually improves with correct latch
✓ Mastitis — breast redness, warmth, pain, and fever — requires antibiotics
✓ Blocked duct — a firm, tender lump in the breast without systemic fever
✓ Low milk supply concerns — often perceived rather than actual
✓ Breastfeeding pain throughout the feed — may indicate thrush or poor latch

Risk Factors

When to Seek Help

Same dayFever >38°C with a red, hot, painful area of the breast — mastitis; needs antibiotic treatment
Within 48 hoursSevere nipple pain, bleeding nipples, or white patches in the baby's mouth with nipple pain — possible thrush (candida)
SoonBaby not gaining weight adequately — review feeding frequency, latch, and milk transfer
Urgent (baby)Baby not wetting 6+ nappies daily by day 5, baby appearing jaundiced, or baby not waking for feeds — assess hydration and milk intake
RoutineDifficulty with latch — postnatal ward staff or a lactation consultant can usually resolve this within 1–2 sessions

Tests & Diagnosis

🧪 Baby's weight gain
Expected weight loss up to 7% in first 3–5 days, then regain and exceed birth weight by 10–14 days. After that: gain of 150–200 g/week in first 3 months. Plotted on WHO child growth standards
🧪 Wet and dirty nappies
Day 1: 1 wet nappy. Day 3: 3 wet nappies. By day 5+: ≥6 wet nappies and 2–3 yellow stools daily. Good indicator of adequate milk intake
🧪 Breast milk culture
For recurrent mastitis — identifies the organism (usually Staphylococcus aureus) and antibiotic sensitivities
🧪 Baby's blood glucose
For babies of diabetic mothers, premature, or growth-restricted babies — neonatal hypoglycaemia needs prompt treatment

Treatment Options

1
Initiate breastfeeding within 1 hour of birth
The first hour is the 'golden hour' — skin-to-skin contact, first breastfeed. Colostrum (the first milk) is rich in antibodies and immune factors. Extremely valuable — not 'waste milk'
2
Correct latch — the foundation
Baby's mouth should cover the nipple AND a large portion of the areola (dark area). Baby's chin touches the breast. Lips flanged outward ('fish lips'). Nose clear. If latch is painful throughout the feed, take the baby off and re-latch. Nipple soreness is usually caused by incorrect latch
3
Feed on demand — 8–12 times per 24 hours in the first weeks
Do not watch the clock — feed when baby shows hunger cues (rooting, sucking hands, turning head). Frequent feeding builds milk supply. Supplement with formula only on clear medical indication
4
Engorgement management
Frequent feeding or expressing. Warm compress before feeding (improves flow). Cold compress after (reduces swelling). Correct latch. Gentle breast massage. Usually resolves within 48–72 hours as supply regulates
5
Blocked duct
Continue feeding frequently from the affected breast. Warm compress. Gentle massage towards the nipple during feeds. Usually resolves within 24–48 hours with good drainage
6
Mastitis treatment
Continue breastfeeding — stopping worsens mastitis. Antibiotics: flucloxacillin 500 mg four times daily for 10–14 days (safe during breastfeeding). Or cefalexin 500 mg four times daily. Analgesics: paracetamol or ibuprofen. If an abscess forms — surgical drainage needed
7
Nipple thrush
White patches in baby's mouth + burning nipple pain throughout the feed. Treat both mother and baby simultaneously. Nystatin drops for baby's mouth. Nystatin cream or miconazole gel for mother's nipples. Clotrimazole cream is an alternative
8
HIV and breastfeeding in Nigeria
WHO now recommends: HIV-positive mothers who are on ART with undetectable viral load SHOULD breastfeed exclusively for 6 months. ART-suppressed mothers transmit through breast milk at <1% — far safer than formula in settings where clean water is unreliable. Follow PMTCT guidelines and discuss with your HIV clinic
9
Returning to work — maintaining breastfeeding
Introduce a bottle of expressed breast milk at 4–6 weeks (before returning to work). Express milk at work during feeding times using a breast pump. Stored milk: 4 hours at room temperature, 4 days in refrigerator, 6 months in freezer

Frequently Asked Questions

Does my baby need water in addition to breast milk?
No — breast milk is 88% water and fully hydrates the baby in all climates, including Nigeria's heat. Giving water to exclusively breastfed babies reduces the protective effect of breast milk and can cause water intoxication (dangerously low sodium) in newborns. No water, no herbal preparations — breast milk only for the first 6 months.
How do I know if my baby is getting enough milk?
Adequate weight gain (150–200 g/week), at least 6 wet nappies daily by day 5, a satisfied baby who comes off the breast spontaneously and appears content, and regular yellow stools. Breast size does not indicate supply. Milk supply is demand-driven — the more the baby feeds, the more milk is made.
Can I breastfeed if I have inverted nipples?
Yes. Most inverted nipples become less inverted during pregnancy and with breastfeeding stimulation. A lactation consultant can help with latch techniques. Nipple shields can assist some mothers. With correct support, most women with inverted nipples successfully breastfeed.
My mother-in-law says I should give agbo (herbal preparation) to my newborn. Should I?
No. Any substance given to a newborn apart from breast milk can cause harm. Herbal preparations have caused liver failure, serious infections, and deaths in Nigerian newborns. This is a clear and consistent public health message. Colostrum (the first breast milk) provides everything the newborn needs, including the immune protection that agbo cannot match.

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