Guidelines to Enhance Successful Breast-feeding
Janet F. Geyer, RN, ARNP, C.P.N.P.
Peer Review Status: Internally Peer Reviewed - 2/27/12
Advocating for breast-feeding of ill or preterm infants
For inpatient mothers, the nurse or LIP will:
- Discuss feeding options with mother
- Provide breastfeeding handouts
- Instruct the mother on pumping and storage of breast milk
- Assure that pumping is initiated within the first 6 hours after delivery
For mothers of transported infants, the transport nurses will:
- Give breastfeeding handout to mother
- Ask the local maternity nurse to assure that pumping begins within 6 hours
Initiating non-nutritive "time at the breast"
Baby meets these criteria:
- Corrected gestational age about 32 weeks
- Has ability to swallow own secretions
- Temperature stability
- Tolerates kangaroo care
- Discuss goals of non-nutritive "time at the breast" with mother
- Help position the baby at the breast
- Review pumping techniques with mother and assess her ability to pump
- Arrange housing for the mother close to the nurseries
Progress toward non-nutritive sucking
Baby displays these signs:
- Mouth is at breast, but may not latch on or suck
- May swallow once or twice
- May fall asleep at the breast
- Avoid feeding with a bottle; continue with orogastric or nasogastric gavage
- Time feedings with infant hunger cues if possible
- Teach mother infant feeding cues
- Begin using the SAIB (Systematic Assessment of Infant at Breast) scale to assess progress toward nutritive sucking
- Review with mother the importance of pumping at least 8-10 times a day
Progress toward nutritive sucking
Baby displays these signs:
- Consistently latches on
- Feeds for about 5 minutes
- Shows progress on the SAIB scale
- Communicate infant's feeding progress with physicians and/or nurse practitioners
- Continue supplements as ordered
- If infant breast feeds < 5 minutes, provide the entire ordered feeding volume by gavage
- If infant breast feeds 5-10 minutes, provide 1/2 of the ordered feeding by gavage
- If infant breast feeds > 10 minutes, no supplementation is needed
- Use cue-based feedings when possible
- Use finger feeding when the mother is unavailable to breastfeed
- Teach mother to continue to pump between or after feedings if needed
- Minimize pacifier use until breast-feeding proficiency is achieved
Successful transition to breast-feeding
- Baby wakes up for feedings
- Mother identifies nutritive suck and swallow
- Baby feeds well based on SAIB scale
- Baby shows adequate hydration and weight gain without supplementation
- Mother is confident in her ability to breast-feed baby at home
- When mother is not available for breastfeeding, provide milk or formula by gavage or by bottle
- Provide information for local breastfeeding support (Primary care provider, La Leche League, WIC consutant, lactation specialist)
- Complete discharge teaching, document in electronic medical record
Originally written by the Pediatric Nursing Research Committee
References: N-CWS-PEDS-13.010 Breastfeeding: Promotion, Support and Protection SOP
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