# Breastfeeding Counselling

> Nursing notes on breastfeeding counselling: WHO recommendations, attachment and positioning signs, common difficulties and counsellor skills for exams.

- Canonical URL: https://prepelephant.com/topics/allied/nursing/breastfeeding-counselling
- Exam / course: Allied Health · Subject: Nursing
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Breastfeeding Counselling", PrepElephant, https://prepelephant.com/topics/allied/nursing/breastfeeding-counselling

## Direct answer

WHO and UNICEF recommend initiating breastfeeding within one hour of birth, exclusive breastfeeding for the first six months and continued breastfeeding with complementary foods for two years or beyond. Counselling is built on confidence and support rather than instruction: observe a feed, praise what is right, give relevant information simply, and help the mother solve her own difficulties. Most breastfeeding problems stem from incorrect attachment or positioning, so counselling focuses there first.

## What you must remember

- Good attachment: the chin touches the breast, the mouth is wide open, the lower lip is turned outward and more areola shows above the mouth than below; suckling is slow and deep and painless.
- Good positioning: head and body in one straight line, the whole body supported, the baby facing the breast with nose opposite the nipple, mother relaxed.
- Demand feeding day and night — usually at least eight feeds in 24 hours in the early weeks; wake a sleepy baby when feeds are too few or weight gain is poor.
- Early feeding cues (stirring, rooting, hand to mouth) are the right time to feed; crying is a late cue.
- Colostrum, the thick yellow first milk, is rich in antibodies and must never be discarded; no prelacteal feeds, water or animal milk during exclusive breastfeeding.
- Common difficulties: sore nipples (usually poor attachment — correct the latch and continue feeding), engorgement (frequent effective feeds, warmth before and cold after), mastitis (continue feeding, seek care if fever persists), and perceived insufficiency (reassure with weight gain and wet nappies).
- Expressed milk keeps a few hours at cool room temperature and about three days refrigerated by common guidance; warm in water, never boil or microwave, and follow facility policy on exact durations.

## Common confusion

"Insufficient milk" is the commonest reason mothers abandon breastfeeding, yet true lactation failure is rare — frequent well-attached feeding, fluids, rest and reassurance usually restore supply. Foremilk and hindmilk also confuse: watery foremilk quenches thirst while fat-rich hindmilk satisfies hunger, so the baby should finish one breast before switching. Exclusive means not even water for six months, and discarding colostrum — an old custom — is the practice examinations ask you to refute.

## Exam-focused takeaway

Learn the numbers — initiation within one hour, exclusivity for six months, continuation to two years or beyond, at least eight feeds a day — and the four attachment signs, the most-tested list. Scenario questions feature cracked nipples (fix attachment, do not stop feeding), a sleepy newborn feeding twice daily (wake and feed at least eight times) and a working mother (teach expression and storage). The counselling sequence — observe, praise, advise, check understanding — is itself testable.

## Frequently asked questions

### When should breastfeeding be started and for how long?

Within one hour of birth, exclusively for six months, then continued with complementary foods for two years or beyond.

### How does the nurse know a baby is well attached?

The chin touches the breast, the mouth is wide open, the lower lip is everted and more areola shows above the mouth — painlessly.

### How often should a newborn be fed?

On demand, day and night, usually at least eight times in 24 hours in the first weeks, recognising early cues.

### What is the advice for sore nipples?

Correct attachment first and continue feeding, start on the less sore side, express a little milk to air-dry on the nipple and avoid soap.

### Can expressed breast milk be stored?

Yes — a few hours at room temperature and around three days refrigerated by common guidance; warm in water, never boil or microwave, following local policy.