By Dr Khutso N. Sebetseba — Paediatrician | Pocket Paediatrics with Dr K
A two-week-old baby is brought to my rooms because he’s “not feeding well.”
His weight gain has slowed. His mother worries he is still hungry after every feed. A well-meaning relative has suggested that her milk is “too thin.” Another has advised her to start formula because “a hungry baby doesn’t sleep.” Social media has convinced her that by now he should be feeding every three hours and sleeping for longer stretches.
As we talk, I notice something else.
She winces every time he latches. She’s exhausted. She tells me she hasn’t eaten properly all day because every time she tries, the baby cries again. She apologises for becoming emotional, then quietly admits she’s starting to dread every feed.
Suddenly, this isn’t only a breastfeeding consultation. It’s a consultation about two patients.
In paediatrics, we often speak about the mother-baby dyad- the understanding that a mother and her infant are biologically, emotionally and socially interconnected. Nowhere is that relationship more evident than during breastfeeding.
Breastfeeding is often described as the most natural way to feed a baby. Natural, however, should never be mistaken for easy. For many mothers, the early weeks are filled with painful latch, cracked nipples, engorgement, uncertainty about milk supply, cluster feeding, conflicting advice and relentless sleep deprivation. At precisely the time a newborn depends most on them, many mothers are quietly wondering whether they are already failing.
Yet despite these challenges, breastfeeding remains one of the most remarkable physiological processes in medicine.
Human milk is far more than nutrition. It is a living biological fluid containing antibodies, immune cells, hormones, enzymes, human milk oligosaccharides and bioactive compounds that help shape the infant gut microbiome, support immune development and influence brain maturation. Its composition changes over the course of a feed, throughout the day and across the months of lactation, adapting to the changing needs of the growing infant in ways no manufactured feed can replicate.
The World Health Organization recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding alongside complementary foods for up to two years and beyond. Globally, exclusive breastfeeding rates have improved to approximately 48%, yet South Africa continues to face significant challenges, with recent estimates suggesting that only around 22% of infants younger than six months are exclusively breastfed.
The reasons are rarely as simple as a lack of knowledge. Many mothers stop breastfeeding because of pain, perceived insufficient milk supply, poor latch, early return to work, maternal illness, postnatal depression, inadequate family support or inconsistent advice from multiple sources. These are healthcare system problems, not just breastfeeding problems .
As clinicians, we naturally focus on the baby. We ask about weight gain, nappies, feeding frequency and growth. Those questions are important. But perhaps one of the most important questions in a breastfeeding consultation is also the simplest.
“How are you coping?”
The answer often explains far more than another prescription ever could. A mother who is physically recovering from childbirth, emotionally overwhelmed, anxious about her milk supply or struggling without support cannot be separated from the baby’s feeding journey. Likewise, an infant with painful feeding, poor weight gain or persistent crying inevitably affects maternal confidence and wellbeing. One struggles, and the other almost always feels it.
Supporting breastfeeding therefore extends far beyond encouraging mothers to continue. It means observing a feed rather than simply asking about one. It means recognising normal newborn behaviours such as cluster feeding before they are mistaken for feeding failure. It means identifying tongue-tie when present, treating maternal pain promptly, screening for postnatal depression and ensuring access to skilled lactation support. It also means preparing families for the realities of breastfeeding instead of allowing unrealistic expectations to undermine confidence.
Perhaps the greatest lesson breastfeeding offers us is this: babies are not raised in isolation, and neither should they be treated that way. Every breastfeeding consultation is an opportunity to care for two patients instead of one.
When we support a mother, we improve the health of her baby. When we care well for a baby, we should never forget to look beyond the growth chart and into the eyes of the person holding them.
Because there are always two patients in the room.
Clinical Pearl
Five questions worth asking at every breastfeeding consultation
Is breastfeeding comfortable or painful?
Have you been worried that your milk isn’t enough?
Who is supporting you at home?
How are you sleeping, eating and coping emotionally?
Is there anything about feeding that is making you feel overwhelmed?