Objective: Exclusive breast-feeding is estimated to reduce infant mortality in lowincome countries by up to 13 %. The aim of the present study was to determine the risk factors associated with suboptimal breast-feeding practices in Pakistan. Design: A cross-sectional study using data extracted from the multistage cluster sample survey of the Pakistan Demographic and Health Survey 2006-2007. Setting: A nationally representative sample of households. Subjects: Last-born alive children aged 0-23 months (total weighted sample size 3103). Results: The prevalences of timely initiation of breast-feeding, bottle-feeding in children aged 0-23 months, exclusive breast-feeding and predominant breastfeeding in infants aged 0-5 months were 27?3 %, 32?1 %, 37?1 % and 18?7 %, respectively. Multivariate analysis indicated that working mothers (OR 5 1?48, 95 % CI 1?16, 1?87; P 5 0?001) and mothers who delivered by Caesarean section (OR 5 1?95, 95 % CI 1?30, 2?90; P 5 0?001) had significantly higher odds for no timely initiation of breast-feeding. Mothers from North West Frontier Province were significantly less likely (OR 5 0?37, 95 % CI 0?23, 0?59; P , 0?001) not to breast-feed their babies exclusively. Mothers delivered by traditional birth attendants had significantly higher odds to predominantly breast-feed their babies (OR 5 1?96, 95 % CI 1?18, 3?24; P 5 0?009). The odds of being bottle-fed was significantly higher in infants whose mothers had four or more antenatal clinic visits (OR 5 1?93, 95 % CI 1?46, 2?55; P , 0?001) and belonged to the richest wealth quintile (OR 5 2?41, 95 % CI 1?62, 3?58; P , 0?001). Conclusions: The majority of Pakistani mothers have suboptimal breast-feeding practices. To gain the full benefits of breast-feeding for child health and nutrition, there is an urgent need to develop interventions to improve the rates of exclusive breast-feeding.