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Assessment and Documentation of Feedings

Assessment and Documentation of Feedings. Birth & Beyond California: Breastfeeding Training & QI Project. 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 .

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Assessment and Documentation of Feedings

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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

  4. Evaluate Positioning

  5. Evaluate Positioning

  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

  8. Evaluate Latch

  9. Evaluate Latch

  10. Evaluate Latch

  11. Evaluate Latch

  12. Nipple Appearance After Feeding Undistorted Nipple Pinched nipple

  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 Reporting

  15. Helping a New Mother to Breastfeed Royal College of Midwives

  16. ACTIVITY • Breastfeeding Assessment Documentation

  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

  21. Photo Credits • Slide 1 – Winter Nursing by J. Kirk Richards

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