Chapter 3 - The Breastfeeding Rite

Understanding the composition and properties of breast milk helps dispel many unfounded and counterproductive myths about breastfeeding, allows for evidence-based recommendations, and gives mothers back awareness and full confidence in their abilities.

For example, it is absolutely not true that colostrum is insufficient or lacks the nutrients needed by a newborn. It contains everything required to support healthy development in the first days of life. Supplementing it with formula milk or glucose solution would interfere with the initiation of breastfeeding. If the baby is allowed to stay with the mother and nurse whenever they wish, without fixed schedules, it is the baby who triggers the milk coming in through frequent suckling.

In the days and months that follow, through the same mechanism, the baby regulates milk production according to their needs: the hungrier they are, the more frequently they nurse, and the more they stimulate the breast to produce.

In the first 2–4 days after birth, a baby loses up to 10% of their initial weight. This is known as the physiological weight loss, a natural phenomenon observed in all healthy, full-term, breastfed babies. It should not be a cause for concern: it does not mean the baby is undernourished. Over the following days, the lost weight is naturally regained, with the baby typically returning to their birth weight by the second week of life⁽⁴⁾.

Another normal phenomenon that should not cause concern is the fact that, during the first few weeks, the baby often seems to be constantly hungry and frequently asks to nurse. Does this mean the mother’s milk is not nutritious enough? Absolutely not: the newborn has a small stomach and can only hold a small amount of milk at each feeding. To meet their daily energy needs, they may nurse as often as 10–12 times in 24 hours. Some babies feed quickly and are satisfied in just a few minutes, while others are slower and need more time, spending longer at the breast. Their feeding patterns are physiological, and it is important to respond to them.

Every baby has their own needs and rhythms. The practice of scheduled feeding at fixed times for all infants—once recommended by childcare manuals—is now rightly seen as an unnecessary constraint. In the first months of life, it’s difficult even for the same baby to feed at the exact same times every day: there are days when the baby has less appetite, hot days when they feel thirsty and nurse more often to stay hydrated, or days when they’ve reached a new developmental milestone and need an extra boost of energy.

But how can you tell if a baby is well nourished? In the past, it was common practice to do a “double weighing,” meaning the baby was weighed before and after each feed to check if they had eaten enough. Today, this method is no longer recommended. Since the composition and caloric density of breast milk can vary even throughout the day, the amount taken at each feed is not a meaningful indicator of whether the baby is feeding adequately. It’s more useful to check how often the baby wets their nappy: in the first weeks of life, they should be filling 5–6 nappies a day. Regular check-ups with the paediatrician are also crucial. If the doctor confirms that the baby is growing appropriately, it means they are well nourished and do not need to be encouraged to drink more milk.

Allowing the baby to eat when they are hungry and stop when they are full helps them develop the ability to self-regulate—a skill that protects against the risk of obesity throughout life. Feeding on demand also supports the baby’s cognitive development. A British study from 2013 showed that babies fed in this way have higher IQs and better academic performance, at least up to the age of 14⁽⁵⁾.

As the months go by, feeds naturally become less frequent. The baby’s stomach grows, they consume more milk at each feeding, and the milk itself becomes richer in fats and nutrients essential for growth. The WHO recommends continuing exclusive breastfeeding up to six months of age, and then introducing complementary foods—without removing or limiting breast milk. It is important to keep responding to the baby’s cues, trusting the self-regulation skills they developed in the first weeks of life⁽⁶⁾. Breastfeeding can continue up to two years and beyond, if both mother and baby wish to do so.

As for maternal diet and lifestyle during breastfeeding, the recommendations are the same as those for overall good health⁽⁷⁾. There is no need to “eat for two,” since the woman’s body draws on fat reserves accumulated during pregnancy to produce milk, helping her return to her pre-pregnancy weight. The diet should be healthy and varied; alcohol is not completely prohibited as it is during pregnancy, but should be limited to one glass of wine per day. It is also recommended to avoid or moderate coffee consumption. Smoking is strongly discouraged during breastfeeding, just as it is during pregnancy. Dietary supplements and herbal products should be taken with caution and only after consulting a doctor.