Abstract Background Adolescent mothers in the U.S. are much less likely to initiate breastfeeding than older mothers, and teens who do initiate breastfeeding tend to breastfeed for shorter durations. The purpose of this mixed-methods study is to investigate breastfeeding practices, barriers and facilitators among adolescent mothers ages 17 and younger. Methods Quantitative descriptive analyses are conducted using data from the North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS). The population-based sample comprises 389 teens ages 13-17 giving birth to a live born infant in North Carolina in 2000 - 2005 and in 2007. Qualitative analyses are based on in-depth interviews with 22 Black, White and Hispanic teen mothers residing in rural and urban areas of North Carolina conducted between November 2007 and February 2009. Results In quantitative analyses, 52% (196 of 389) of North Carolina teen mothers initiated breastfeeding, but half of those who initiated breastfeeding (92/196) stopped within the first month postpartum. Hispanic teens (44/52 or 89%) were much more likely than Black (61/159 or 41%) or White teens (87/164 or 52%) to initiate breastfeeding and to continue for a longer duration. Nearly sixty two percent (29/52) of Hispanic respondents breastfed for greater than four weeks as compared to 16% (29/159) of Black respondents and 26% (39/164) of White respondents. Common barriers to breastfeeding initiation and continuation included not liking breastfeeding, returning to school, nipple pain, and insufficient milk. Qualitative data provided context for the quantitative findings, elucidating the barriers and facilitators to breastfeeding from the teens' perspective and insight into the ways in which breastfeeding support to teens could be enhanced. Conclusions The large number of adolescents ceasing breastfeeding within the first month points to the need for more individualized follow-up after hospital discharge in the first few days postpartum, to address common technical challenges and to provide assistance managing the transition back to school. Provision of an extra home visit or outpatient visit for teens within the first few days following hospital discharge, and advocacy to make schools more compatible with breastfeeding, could potentially help teens who desire to breastfeed to successfully continue. These interventions warrant further research to test their effectiveness among adolescents.