International Journal of Medical Science and Pharmaceutical Research

Background: Perceived insufficient milk remains an important reason for early supplementation and breastfeeding discontinuation among hospitalized neonates. 

Objectives: To assess clinical profile of mother–infant dyads with perceived lactation failure and assessed post-discharge growth following structured lactation support. 

Methods: This descriptive cross-sectional study was conducted in a tertiary care neonatal unit in northern India from September 2024 to August 2025. Neonates weighing 1000 g or more and whose mothers were willing to breastfeed were enrolled. Maternal perception of breast milk sufficiency was recorded using a structured interview, breast milk sodium concentration was measured, and neonatal anthropometry was assessed at admission, discharge, and follow-up up to three months. 

Results: Of 570 mothers, 376 (66.0%) reported insufficient milk perception and 194 (34.0%) reported adequate milk output. Elevated breast milk sodium (>16 mmol/L) was found in 284 mothers (75.5%) in the crisis group compared with 42 (21.6%) in the non-crisis group. Reduced urine passage, defined as fewer than six voids in 24 hours, was reported in 300 infants (79.8%) versus 30 (15.5%), respectively. Delayed initiation of breastfeeding, cessation of suckling, prelacteal feeds, and use of bottles or pacifiers were more common in the crisis group. Infants in the crisis group had lower admission and discharge weights, but post-discharge growth velocity in preterm and term infants was comparable between groups over three months. 

Conclusion: Perceived lactation failure was common and was strongly associated with delayed initiation of breastfeeding and other modifiable feeding practices. Structured lactation counselling and repeated reinforcement should be integrated into routine neonatal care.

Breastfeeding; Lactation failure; Neonate; Breast milk insufficiency; Counselling

1. World Health Organization. Breastfeeding. Available from: https://www.who.int/health-topics/breastfeeding. Accessed May 22, 2026.
2. World Health Organization. Guideline: counselling of women to improve breastfeeding practices. Available from: https://www.who.int/publications/i/item/9789241550468. Accessed May 22, 2026.
3. Mathur NB, Dhingra D. Perceived breast milk insufficiency in mothers of neonates hospitalized in neonatal intensive care unit. Indian J Pediatr. 2009;76(10):1003-6.
4. Mathur GP, Chitranshi S, Mathur S, Singh SB, Bhalla M. Lactation failure. Indian J Pediatr. 1992;29(12):1541-4.
5. Jones J, Steketee RW, Black RE, Bhutta ZA, Morris SS. How many child deaths can we prevent this year? Lancet. 2003;362:65-71.
6. Reinert do Nascimento MB, Issler H. Breastfeeding the premature infant: experience of a baby friendly hospital in Brazil. J Hum Lact. 2005;21(1):47-52.
7. De NC, Pandit B, Mishra SK, Pappu K, Chaudhuri SN. Initiating the process of relactation: an institute based study. Indian J Pediatr. 2002;39:173-8.
8. Batterjee M, Zedan H. Distinguishing between lactation failure and breastfeeding cessation: A scoping review. Breastfeeding Medicine. 2025 Jan 1;20(1):5-18.
9. Erat Nergiz M, Barutçu A, Güneş B, Almış H, Yılmaz Öztorun Z, Tezol Ö, Karabayır N, Kabakoğlu Ünsur E, Örün E, Yalçın SS. Breastfeeding problems and associated factors: a cross-sectional study after the 2023 Türkiye earthquake. International Breastfeeding Journal. 2025 Apr 18;20(1):32.
10. Neifert MR. Prevention of breastfeeding tragedies. Pediatr Clin North Am. 2001;48:273.
11. Eker A, Şenol DK, Aslan E. The Impact of Care Based on the Lactation Management Model Offered to Mothers With Infants in the Intensive Care Unit on the Quantity of Human Milk and Breastfeeding Duration: A Randomized Controlled Trial Study. Advances in Neonatal Care. 2026 Apr 1;26(2):187-96.
12. Kumari S, Koppad R, Singh A, Singh B, Qazi MS, Jaber Amin MH. Prevalence of cognitive dysfunction and associated behavioral changes, lactational failure, and their determinants among postpartum women in South India: A community‐based study. International Journal of Gynecology & Obstetrics. 2025 Aug;170(2):703-16.
13. Targhaq S, Hosseinzadeh M, Mirghafourvand M, Mousavi Z. Breastfeeding empowerment and its relationship with health literacy and spousal support among breastfeeding mothers in Tabriz, Iran: a cross-sectional study. BMJ open. 2025 Jan 1;15(1):e084337.
14. Muktamath VU, Sunitha NH, Ravi Y, Hegde PR, Biradar S, Saptagiri TV, Ilager S. Understanding insufficient maternal milk production: Clinical causes and remedies. InClinical Guidance in Breastfeeding-Physiology, Success, and Challenges 2025 Apr 11. IntechOpen.
15. Scott SF, Searcy J, Jordan I. “Why Is There Not a Doctor that Knows Anything About This Part of My Body?” Patient Perspectives on Chronic Lactation Insufficiency. Breastfeeding Medicine. 2025 Aug 1;20(8):554-9.