Problems nursing, especially during the first 2 months, was the leading risk factor for stopping breastfeeding among new moms, findings from a prospective study indicate.

The peak adjusted relative risk for stopping breastfeeding at day 3 was 9.2 (95% CI: 3.0-infinity) among those who expressed concerns about nursing, Laurie A. Nommsen-Rivers, PhD, IBCLC, from Cincinnati Children’s Hospital Medical Center, and colleagues reported in Pediatrics.

The largest  population attributable risk (PAR) for stopping breastfeeding including “feeding difficulty” (PAR 32%) at day seven and “milk quantity” (PAR 23%) at day 14.

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“Adjustment for maternal education and prenatal breastfeeding intentions only strengthened associations between concerns and adverse outcomes, suggesting that our findings are not explained by weak intentions or demographic factors,” the researchers wrote.

As many as three-fourths of new mothers in the United States start breastfeeding, but only 13% continue to exclusively breastfeed for the recommended 6-month period.

To determine factors that contribute to breastfeeding discontinuation, Nommsen-Rivers and colleagues interviewed 523 pregnant women before and after giving birth and recorded feeding status at 0,3, 4, 7,14, 30 and 60 days postpartum.

The interview included questions that addressed breastfeeding attitudes and concerns, perceived sense of breastfeeding efficacy, infant feeding practices among family and friends, the intended duration of breastfeeding and at what age they intended to introduce formula.

During prenatal interviews, the majority of women — 79% — reported at least one infant feeding concerns. In the nearly 3,000 interviews conducted during the study period, the researchers identified more than 4,000 breastfeeding concerns. These were grouped into nine main categories, which included infant feeding difficulties, milk quantity, uncertainty in breastfeeding ability, pain, inadequate intake, mother-infant separation, maternal health, too much milk and other.

The three most common concerns were related to infant feeding difficulties at the breast (52%), followed by breastfeeding pain (44%) and milk quantity (40%), the researchers found.

Among those who stated they planned to breastfeed exclusively for 2 months during the prenatal interview, 47% gave their child formula between 30 and 60 days; 21% reported stopping breastfeeding by 60 days.

The relative risk for giving any formula between days 30 and 60 was highest at day three (ARR 3.3, 95% CI: 1.7–15.0).

“Overall, our results reinforce the recommendation of the American Academy of Pediatrics that all breastfed newborns receive an evaluation by a provider knowledgeable in lactation management within 2 to 3 days post-discharge,” the researchers wrote.


  1. Wagner EA et al. “Breastfeeding Concerns at 3 and 7 Days Postpartum and Feeding Status at 2 Months” Pediatrics 2013; 132: e865–e875.