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1
Assessment and Documentation
of Feedings
Birth & Beyond California: Breastfeeding Training & QI
Project
2
Objectives
• Identify two signs of comfortable positioning
• List three signs of an effective latch• Identify two latch problems in need
of referral to a lactation consultant
3
Signs of Comfortable Positioning
• Mother in physiological alignment– Back straight, joints flexed, no straining– Posture supported with pillows, foot rest
• Infant facing mother– Head, chest, hips in straight line– Ventral flexion– Trunk and head supported
6
Signs of Effective Latch
• Wide angled mouth opening• Chin deep into breast – head tilted
back• Much of areola taken into mouth • Lips flanged back by breast• Tongue visible under areola
7
Signs of Effective Latch
• Gliding jaw movements• Rhythmic sucking bursts with
swallows• Mother comfortable – baby relaxed
13
Breastfeeding Assessment Tools
• A psychometrically sound neonate feeding assessment tool has not yet been empirically validated
• Clinicians who use these tools for clinical and research purposes should take into account this lack of evidence of psychometric soundness and interpret results of assessment with precautions
• Well-designed research is needed to study the scientific integrity of these instruments for program evaluations in neonatal care
Howe, Lin et al. JOGNN, 2008.
14
Latch AudibleSwallowing
Type ofNipple
Comfort Hold
0 Sleepy reluctant no latch
1 Attempts to hold nipple in mouth, sucks with stimulation
2 Grasps breast deeply, tongue
down, lips
flanged, rhythmical sucking
0 None
1 Few - A few with stimulation
2 Spontaneous
and
Intermittent
<24hrs,
Spontaneous
and frequent,
> 24 hrs
0 Inverted
1 Flat
2 Everted (afte4
stimulation)
0 Severe Pain:
engorged, cracked, bleeding, blisters bruises,
1 Moderate Pain: reddened, blisters bruises
2 No pain
Comfortable
0 Full Assist (staff
holds)
1 Minimal assist teach one side, mom does other, staff holds mom takes over
2 No Assist mom able
to
position/hold
baby
LATCH Reporting
17
Mother Reported Assessments
• Several feedings should be directly observed by a nurse in each 24 hours
• Mother self reported assessments may be used between nurse observations
18
Latch Problems in Need of Referral
• Refusal to latch after 24 hours• Poor/inconsistent latch after 24 hours • No audible swallowing• Inverted nipples• Unresolved pain, >3 in the 10-point
pain scale
19
Plan of Care: Ineffective Breastfeeding
• Refer to lactation consultant
• Feed the baby– Supplement appropriately
• Protect mother's milk supply– Mechanical & hand expression
20
Summary
• Feedings need to be observed by a nurse on each shift
• Assessments need to be shared with the mother and documented on patient chart and progress notes
• Maternal self reported assessments may be used between nurse observations
• Couplets will be referred to a more experienced lactation professional as needed