The first article in this series highlighted the challenges that mothers face in establishing breastfeeding (Wallis and Harper 2007). Breastfeeding a sick infant in hospital presents additional challenges such as small, sleepy babies, babies who may be nil by mouth for prolonged periods and babies who may find breastfeeding difficult due to mechanical problems. There is very little published abut the needs of babies with complex medical or surgical conditions who may have had significant delays in their feeding or numerous starts and stops along the way. This article and Part 2b in the November issue illustrate some of the common challenges and propose principles of care that are transferable to caring for other sick babies with similar problems.