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Assessment and Documentation

of Feedings

Birth & Beyond California: Breastfeeding Training & QI

Project

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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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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

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Evaluate Positioning

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Evaluate Positioning

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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

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Signs of Effective Latch

• Gliding jaw movements• Rhythmic sucking bursts with

swallows• Mother comfortable – baby relaxed

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Evaluate Latch

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Evaluate Latch

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Evaluate Latch

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Evaluate Latch

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Nipple Appearance After Feeding

Undistorted Nipple Pinched nipple

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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.

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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

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Helping a New Mother to Breastfeed

Royal College of Midwives

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ACTIVITY

• Breastfeeding Assessment Documentation

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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

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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

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Plan of Care: Ineffective Breastfeeding

• Refer to lactation consultant

• Feed the baby– Supplement appropriately

• Protect mother's milk supply– Mechanical & hand expression

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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

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Photo Credits

• Slide 1 – Winter Nursing by J. Kirk Richards