Perceived Lactation Failure: Maternal, Feeding, and Growth Correlates among Hospitalized Neonates in Northern India

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.