This thoughtful letter from the reader restates the importance of the dyadic nature of breastfeeding and infers the critical need for nurses to always include both mother and baby in all breastfeeding facilitations.

The author is saddened if other readers interpret any suggestion in the article of the need for mothers to rigidly schedule their babies' breast-feeding to "every 2 hours, 15 minutes on as side" as was reported by the mother in the vignette. However, because it is the mother who positions the baby to initiate feedings, she will need some general parameters of when her newborn needs to nurse. Clearly, this maternal role must always be presented to mothers in the context of recognizing hunger cues, keeping the baby close, and putting him to breast when he signals hunger. Mothers should never be told to maintain a rigid feeding schedule, but may need to proactively intervene at times, for example, by waking the sleepy, breast-feeding nearterm who has not awakened to feed after 3 hours.

Donna Karl