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Ketogenic diet therapy (KDT) is a safe and effective treatment for epilepsy and glucose transporter type 1 (GLUT1) deficiency syndrome in infancy. Complete weaning from breastfeeding is not required to implement KDT; however, breastfeeding remains uncommon. Barriers include feasibility concerns and lack of referrals to expert centres. Therefore, practical strategies are needed to help mothers and professionals overcome these barriers and facilitate the inclusion of breastfeeding and human milk during KDT. A multidisciplinary expert panel met online to address clinical concerns, systematically reviewed the literature, and conducted two international surveys to develop an expert consensus of practical recommendations for including human milk and breastfeeding in KDT. The need to educate about the nutritional benefits of human milk and to increase breastfeeding rates is emphasized. Prospective real‐world registries could help to collect data on the implementation of breastfeeding and the use of human milk in KDT, while systematically including non‐seizure‐related outcomes, such as quality of life, and social and emotional well‐being, which could improve outcomes for infants and mothers. What this paper adds: Human milk and breastfeeding can be incorporated safely into ketogenic diet therapy.With expert guidance, human milk and breastfeeding do not reduce diet effectiveness.We show two strategies for clinical practice to include human milk.Mothers can be encouraged to continue breastfeeding. [ABSTRACT FROM AUTHOR]

• The KD is effectively and safely used in infants showing seizure reduction over > 50% in 48%–80% and seizure freedom in 14%–54%. • The KD is gradually introduced with a fixed fat/ non-fat ratio of 3: 1, modified if necessary without fasting and fluid restriction. • The KD should be used early in specific epilepsy syndromes and genetic etiologies. • Adverse effects in infants are most frequently emesis, hypoglycemia food and liquid refusal, all of them mostly transient and resolvable by dietary adjustments. • Complete weaning from breastfeeding is not necessary as well as breast milk and nursing at the breast can be included into the KD. Ketogenic diets (KD) are high-fat, low-carbohydrate therapies, established in the treatment for drug-resistant epilepsy in childhood since the 1920ies. This review focuses on the use of ketogenic diet therapies in young childhood with an emphasis on the most recent advances. The KD has been used effectively and safely in childhood, and has increasingly been offered in infancy during the last decade. The introduction of a KD is recommended with a fixed fat/ non-fat ratio of 3:1, modified if necessary. In infants the KD is initiated without fasting and fluid restriction and with a shorter treatment duration than in older children. Twenty studies that also included infants below 1 year of age are available. When the KD is used early and in an approach based on syndromes and etiology, seizure freedom is achieved and maintained more often than when used as last ressort. In infants with genetic causes already recognized in early infancy, the KD has shown to be even more effective. Most frequent adverse effects in infancy include emesis, hypoglycemia, food/ liquid refusal and constipation which are mostly transient and resolvable by dietary adjustments. Promising data on the inclusion of expressed breast milk to the KD and maintaining actual breastfeeding while on the KD have shown that complete weaning from breast-feeding is not necessary and inclusion of breast milk as well as breastfeeding should be encouraged. The ketogenic diet is a versatile therapy, and effective and safe in its use in infancy. There is growing evidence and guidelines that specify indications where the KD should be used early. [ABSTRACT FROM AUTHOR]