Assessment and Documentation of Feedings

1. Assessment and Documentation of Feedings Birth & Beyond California: Breastfeeding Training & QI Project With funding from the federal Title V Block Grant

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 2

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 3

4. Evaluate Positioning 4

5. Evaluate Positioning 5

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 6

7. Signs of Effective Latch • Gliding jaw movements • Rhythmic sucking bursts with swallows • Mother comfortable – baby relaxed 7

8. Evaluate Latch 8

9. Evaluate Latch 9

10. Evaluate Latch 10

11. Evaluate Latch 11

12. Nipple Appearance After Feeding Undistorted Nipple Pinched nipple 12

13. Breastfeeding Assessment Tools • Howe, Lin et al. JOGNN, 2008. 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 13

14. LATCH Reporting 14

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

16. ACTIVITY Breastfeeding Assessment Documentation 16

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 17

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 18

19. Plan of Care: Ineffective Breastfeeding • Refer to lactation consultant • Feed the baby • Supplement appropriately • Protect mother's milk supply • Mechanical & hand expression 19

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 20