The optimization of breast-feeding in the perinatal period.

Mounting scientific evidence documents the diverse health benefits of successful breast-feeding for infants and mothers. The trend toward earlier discharge of newborns, however, has been linked with adverse outcomes in breast-fed babies, including hypernatremic dehydration and hyperbilirubinemia. This article reviews practical strategies for promoting the successful initiation of breast-feeding, beginning with effective prenatal education and a screening breast exam to detect lactation risk factors. Supportive hospital practices are discussed, including the Baby-Friendly Hospital Initiative and correct breast-feeding technique. The importance of regular, effective removal of milk for continued milk production is explained. The early follow-up of infants after hospital discharge and the use of specific maternal and infant criteria to assess the onset of breast-feeding can readily identify mother-baby pairs who require timely intervention to improve breast-feeding outcome.