Breastfeeding Observation and Assessment Tool – for use from day 5 approx. What to observe / ask about Appearance and frequency of bab e and di na ie Bab c l ale ne and tone? Weight of baby (following initial post birth weight loss)? Number of breastfeeds in the last 24 hours? Bab beha i d ing breastfeeds? Bab ucking pattern during breastfeeds? How baby breastfeeds? Is baby offered second breast? How baby ends breastfeeds? Bab beha i af e breastfeeds? Shape of m he nipples after breastfeeds? M he e n he ni le and breasts? Ob e a i n f m he nipples and breasts?
Green Column Suggests Effective Breastfeeding
Amber Column Suggests Breastfeeding Challenge
Baby has 3-6 wet heavy nappies over 24 hrs (pale yellow or clear urine) and 3-8 stools (yellow, seedy, runny to loose) daily Baby may have evidence of normal physiological jaundice Baby is alert, Baby has good tone Bab eigh l i f bi h eigh Baby has returned to birth weight by day 14 Baby breastfeeds on demand, or is fed responsively according to early feeding cues, with at least 8-12 feeds in each 24 hour period Baby is generally relaxed and calm
Baby has damp nappies, less frequent wet nappies Baby has scant, hard or difficulty passing stools Bab ja ndice i ening n im ing Baby is lethargic; not waking up to feed; has poor tone Bab eigh l i f bi h eigh Birth weight not regained by Day 14 Baby has fewer than 8 breastfeeds in the last 24 hour period
Baby initially sucks rapidly then changes to slower sucks with pauses and audible regular soft swallowing (may be less audible until milk comes in) Baby feeds actively from first breast until satisfied Baby is offered second breast Baby feeds from second breast or not, according to appetite Baby releases breast spontaneously, or does so when breast is gently lifted Baby is content after most feeds
Baby does not change sucking pattern during breastfeeds Baby makes noises when feeding, (e.g. clicking) Baby is unsatisfied despite regular breastfeeds Mother restricts the baby to one breast per feed
M he nipples are rounded similar to when the breastfeed began or the nipples may be slightly elongated M he nipples and breasts are comfortable
M he
nipples are misshapen or pinched at the end of breastfeeds
M he
nipples are sore or damaged, breasts are uncomfortable
Baby is unsettled during breastfeeds, or refuses to breastfeed
Baby does not release breast spontaneously, mother removes baby from breast Baby is unsettled after breastfeeding
M he nipples are intact and breasts are comfortable with no redness, lumps or tenderness
Mother may have symptoms of thrush (e.g. pink, shiny, flaky nipple, burning pain in breast after breastfeeds), breasts may be engorged or have signs of mastitis (e.g. hot sore breast area, feeling unwell) M he s wellbeing? Mother appears relaxed, comfortable and healthy with good eye contact Mother appears unwell, tense, uncomfortable with little/no eye with baby contact with baby Use of maternal nipple shields, Mother does not use nipple shields Mother uses nipple shields bottle feeds, formula? Baby breastfeeds exclusively with no bottle feeds or infant formula milk Baby offered bottle feeds or infant formula milk Breastfeeding challenge or concern with positioning/latch Refer to Lactation Consultant, bleep 347/023 Breastfeeding Clinic, Thursdays 9:30-12:30pm, 65/66 Mount St. Classroom Slow weight gain/growth or concern with nutrition/intake Refer to Dietitian, bleep 124 or ext. 3314, Monday to Friday See also to www.mychild.ie - breastfeeding V1.1: Adapted from the Guideline on the Observation of a Breastfeed and Use of the Breastfeeding Observation and Assessment Tool (BOAT) Resource, HSE, 2018, by the Dept of Clinical Nutrition and Dietetics, National Maternity Hospital, Holles St., Dublin 2. Date: March 2020 Review date: March 2022 Document number: Page 1 of 2
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