Registered Nurses' Association of Ontario

Defining Breastfeeding and Breastfeeding Initiation, Exclusivity and Continuation

  • The guideline recognizes and includes the varied ways in which breast milk may be fed to a newborn, infant, or young child including direct breastfeeding, expressed breast milk (EBM), and/ or donor human milk.
  • Human milk also may be obtained from donors via wet nursing, informal milk sharing or from a breast milk bank. The use of wet nurses, cross-feeding, or informal breast milk sharing between a donor and a recipient is recognized as a decision that some breastfeeding persons may make as an alternative to human milk substitutes however only the use of pasteurized donor human milk from an accredited milk bank is recommended in this BPG.
  • The use of formula supplementation or other manufactured infant and young child feeding products are included in the BPG only as clinically necessary and when breast or donor breast milk is not accessible, with the goal of achieving the initiation and continuation of breastfeeding.
  • Breastfeeding initiation refers to the introductory steps taken to support and achieve the onset of lactation, including skin-to-skin contact, positioning and latch attempts, and colostrum expression, either via hand or pump. It is included in this guideline as a means of promoting the goal of breastfeeding exclusivity and occurs ideally within the first hour of life or as soon as the breastfeeding dyad is clinically stable.
  • Breastfeeding exclusivity refers to infant feeding of only breast milk directly at the breast or indirectly, as EBM, as well as any vitamin or mineral supplements or medications to six months of age. No other liquids or solids are received.
  • Breastfeeding continuation refers to any breastfeeding beyond six months and up to two years or longer.

Women and Children
Breastfeeding Best Practice Guidelines for Nurses
Background Information