Breastfeeding seems to be a safe feeding practice for infants born at term and small for gestational age, showing no association with deleterious short-term outcomes. Breastfeeding stimulation in these populations seems to be a way of preventing the health problems associated with the high risk of chronic noncommunicable diseases and obesity.

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OBJECTIVES: to compare compliance with Steps 4 to 10 of "The Steps to Successful Breastfeeding" in two hospitals accredited by the Baby-Friendly Hospital Initiative (BFHI group) with two not yet accredited hospitals in Salvador. METHODS: a cross-sectional study was conducted with 100 women in BFHI-accredited hospitals and 103 women in non-BFHI-accredited hospitals by collecting data on their obstetric history, any breast feeding counseling received during antenatal care, and data on delivery and hospitalization. Data were obtained by applying questionnaires and reviewing patients' medical charts. The chi-square test was used for bivariate variables and Student's t test for continuous variables. RESULTS: statistically significant differences (p<0.05) were found between the BFHI-accredited group and the non-BFHI group with respect to steps 5 (77% vs 35.9%), 6 (81% vs 31%), 8 (77% vs 52.4%), and 9 (100% vs 94.2%). No differences were found between the two groups with respect to steps 4, 7 or 10. Satisfactory compliance with the requirements of the Baby-Friendly Hospital Initiative in BFHIaccredited hospitals was found only with respect to steps 6, 7 and 9. CONCLUSIONS: these results highlight the benefits of BFHI accreditation but emphasize the need for continuous and systematic evaluation in order to promote breastfeeding and provide support in BFHIaccredited maternity hospitals.