Introduction: the World Health Organization recommends exclusive breastfeeding for the first six months of life. Over 85% of infants are exclusively breastfed in Rwanda, with nearly 20% of them being stunted by this age. This suggests nutritional issues start few weeks after birth and even antenatally. It is postulated that mother-and-infant health care designed to promote infant nutrition may be one solution to this issue. Our objectives were to conduct a baseline assessment of hospital practices against the Ten Steps to Successful Breastfeeding, identify gaps, and suggest potential solutions. Methods: in a cross-sectional survey at the University Teaching Hospital of Kigali (CHUK, from French: “Centre Hospitalier Universitaire de Kigali”), data were collected on 311 participants over two months and using the adjusted hospital self-appraisal tool by United Nations Children's Fund/World Health Organization (UNICEF/WHO). Logistic regression was performed to determine factors that influence exclusive breastfeeding in the hospital. Results: CHUK has no written breastfeeding policy and 299/311 (96.1%) of women received no education about breastfeeding during their antenatal care. All mothers initiated breastfeeding after delivery with nearly a third of their infants also receiving formula. Infants in the special care unit are more likely to receive formula with p-value < 0.0001. Conclusion: adherence to the Ten Steps is deficient. Lack of breastfeeding education is one of the main gaps. We recommend hospital-initiated policies focusing on breastfeeding education as part of routine antenatal and neonatal care. This can be one way of preventing high rates of stunting noted in infants when breastmilk is their sole food.