There are few contraindications to breastfeeding/chestfeeding because of the infant's medical condition.

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Absolute contraindications:

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• Classical galactosaemia

• Congenital lactose intolerance

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Relative contraindications:

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• High flow therapy - may be possible for stable patients. May require SALT review first, for example in the setting of prematurity

• Other metabolic disorders - The American Academy of Pediatrics advises that "alternating breastfeeding with special protein-free or modified formulas can be used in feeding infants with other metabolic diseases (such as phenylketonuria), provided that appropriate blood monitoring is available". One case series reports predominantly success with a variety of metabolic disorders, another showed variable success. Partial breastfeeding in phenyloketonuria is well established, and breastfeeding may be linked to lower phenylalanine levels and higher weight gain for the infant.

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Problems with oral intake:

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If lack of oral feeding is the only problem, babies can be fed expressed milk. Parents will need expert advice on establishing or maintaining milk supply with exclusive expressing, which follows the same principles as for very preterm babies outlined here.

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If supplementary feeds are necessary but oral feeding is not contraindicated, remember breastfeeding/chestfeeding is a source of comfort for parent and child, and is particularly useful for analgesia during painful procedures. Babies who are mixed fed can receive infant formula while suckling at the breast/chest with a supplementary nursing system (also called an at breast supplementer).

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Breastfeeding/chestfeeding is not all or nothing

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There are many ways to retain some of the valuable breastfeeding/chestfeeding experience even if oral feeds are not possible or need to be supplemented with other feeding modes or types of milk