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

Nursing interventions:

  • 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

Nursing interventions:

  • 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

Nursing interventions:

  • 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

Nursing interventions:

  • 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

  1. Alade, R. L. (1992). Sucking technique and its effects on success of breastfeeding. Birth. 19(4), 185-189.
  2. American Academy of Breastfeeding Medicine. #7 Model Breastfeeding Policy.
  3. American Academy of Pediatrics. Policy Statement, Breastfeeding and the Use of Human Milk. Pediatrics, 115(2) (February 2005), 496-506.
  4. Dix, D. (1991). Why women decide not to breastfeed. Birth:  Issues in Perinatal Care and Education. 18(4), 222-225.
  5. Glass, P. (1994). The Vulnerable Neonate and the Intensive Care Environment. Neonatology, Pathophysiology, and Management of the Newborn (4th ed.). J. B. Lippincott.
  6. Hubbard, Deborah, Lactation Specialist, Children’s and Women’s Services, UIHC.
  7. International Lactation Consultants Association (ILCA). Clinical Guidelines for Establishment of Exclusive Breastfeeding (June, 2005).
  8. Isaccson, Laura J. (2006). Steps to Successfully Breastfeed the Premature Infant. Neonatal Network, 25(2), 77-86.
  9. Mohrbacher, N., Stock, J. (Eds.) (2003). The Breastfeeding Answer Book. LaLeche League International (3rd ed.). Schaumburg, IL, 542-545.
  10. Morris, S. E., Klein, M. D. (1987). Pre-Feeding Skills. Therapy Skill Builders (pub.).
  11. Palmer, M. M., Vandenberg, K. A. (1998). A Closer Look at Neonatal Sucking. Neonatal Network, 17 (2), 77-79.
  12. Riordan, J., Auerbach, K. (Eds.) (2005). Breastfeeding and Human Lactation (3rd ed.). Jones and Bartlett pub., Boston, MA, 449-481.
  13. Zaichkin, J. (2002). Newborn Intensive Care: What Every Parent Needs to Know. NICU Ink, Petaluma, CA.

Research References

  1. Alade, R. L. (1990). Effect of delivery room routines on the success of first breastfeed. Lancet. 336, 1105-1107.
  2. Arafat, I., Allen, D., Fox, J. (1981). Maternal practice and attitudes towards breastfeeding. JOGNN. 10, 91-95.
  3. Baranowski, T., Bee D. E., Rassin, D. L., et al. (1983). Social support, social influence, ethnicity and the breastfeeding decision. Social Science Medicine. 17, 1599-1611.
  4. Meier, P. & Mangurten, H. (1993). Breastfeeding the preterm infant. In:  Riordan, J. & Auerbach, K.G. (Eds). Breastfeeding and Human Lactation. Boston:  Jones & Bartlett Publishers, Inc.
  5. Ludington-Hoe, S. & others (1994). Kangaroo Care:  Research results and practice implications and guidelines. Neonatal Network, 13, 19-27.
  6. Lawrence, R. (2005). Breastfeeding:  A Guide for the Medical Profession, (6th ed.). St. Louis: Mosby.
  7. Shrago, L. & Bocar, D. (1990). The Infant’s Contribution to Breastfeeding. JOGNN, 19(3), 209-215.
  8. Stine, M. (1990). Breastfeeding the Premature Newborn:  A Protocol Without Bottles. Journal of Human Lactation, 6(4), 167-170.
  9. Byzak, Susan (1990). Factors Associated with the Transition to Oral Feeding in Infants Fed by Nasogastric Tubes. The American Journal of Occupational Therapy, 44 (12), 1070-1078.
  10. Human Milk Bank Association of North America (2005). Best Practice for Expressing, Storage, and Handling Human Milk in Hospitals, Homes, and Child Care Settings.