The bulk of pre-weaning piglet deaths occur in the first 48 hours after birth. Therefore, close supervision and provision of optimum environmental conditions at this time can be very rewarding. Birth weight has a major influence on piglet survival and this can be maximized by optimizing parity profile and increasing feed levels to sows in late gestation. Overlying and crushings are major contributors to pre-weaning mortality. Closing piglets into the creep area for an hour each time the sow is fed in the first two days of life can help. When the rearing capacity of the sow cannot cope with excessively large litters, cross fostering should be carried out, where possible. Quality colostrum and a high milk yield by the sow are essential for piglet survival. Sow feeding during gestation and in lactation can influence the yield and quality of sows’ milk.