Indicators of Effective Breastfeeding and Estimates of Breast Milk Intake

Abstract

The authors tested indicators of effective breastfeeding to identify those that provide reliable estimates of human milk intake. Human milk intake of 82 full-term infants was measured by test weights before and after feeding and compared with commonly used breastfeeding indicators: rooting, length of time before latch-on, latch-on, suckle, observable swallowing, and audible swallowing. Two models were tested: model 1, describing indicators at 96 hours postpartum, and model 2, describing indicators at > 96 hours postpartum. Median (interquartile) milliliters of mother’s milk consumed per feeding was 26 ml (range, 4-47) at 96 hours and 54 ml (range, 26-73) at > 96 hours. Significant predictors of human milk intake in model 1 were rooting and observable swallowing (R ² = 26%, P < .01). In model 2, audible swallowing alone estimated human milk intake (R ² = 29%, P < .001). Observed swallowing and rooting during the first 4 days (96 hours) following birth and audible swallowing after that time should be included in the breastfeeding assessment of full-term infants.

Keywords

breastfeeding assessment breast milk indicators swallowing

References

Jensen D , Wallace S , Kelsay P . LATCH: a breastfeeding charting system and documentation tool. JOGNN. 1994;23:27-32.

Matthews MK . Developing an instrument to assess infant breastfeeding behaviour in the early neonatal period. Midwifery. 1988;4:154-165.

Mulford C . The mother-baby assessment (MBA): an “Apgar Score” for breastfeeding. J Hum Lact. 1992;8:79-82.

Riordan J . Predicting breastfeeding problems. AWHONN Lifelines. 1998;2:31-33.

Riordan J , Koehn M . Reliability and validity testing of three breast-feeding assessment tools. JOGNN. 1997;26:181-187.

Riordan J , Bibb D , Miller M . Predicting breastfeeding duration using the LATCH breastfeeding assessment tool. J Hum Lact. 2001;17:20-23.

DiMauro Satyshur RF , McGovern MJ , O’Brien-Pallas L . Ineffective breastfeeding. In: McFarland G , ed. Nursing Diagnosis & Intervention Planning for Patient Care. 3rd ed. St. Louis, MO: Mosby; 1997:128.

DiMauro Satyshur RF , Garzon LS . Effective breastfeeding. In: McFarland G , ed. Nursing Diagnosis & Intervention Planning for Patient Care. 3rd ed. St. Louis, MO: Mosby; 1997:129.

Dewey KG , Nommsen-Rivers LA , Heinig J , Cohen RJ . Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003;112:607-619.

10.

Neville MC , Morton J , Imemura S . Lactogenesis. In: Schanler RJ , ed. Breastfeeding 2001, Part 1. Philadelphia: W. B. Saunders; 2001:35-52.

11.

Powers N . Low intake in the breastfed infant: maternal and infant considerations. In: Riordan J , ed. Breastfeeding and Human Lactation. 3rd ed. Sudbury, MA: Jones & Bartlett; 2004:281.

12.

Betzold CM , Hoover KL , Snyder CL . Lactogenesis 11: a comparison of four cases. J Nurse Midwifery. 2004;49:132-137.

13.

Adams D , Hewell SD . Maternal and professional assessment of breast-feeding. J Hum Lact. 1997;113:279-283.

14.

Schlomer JA , Kemmerer J , Twiss J . Evaluating the association of two breastfeeding assessment tools with breastfeeding problems and breastfeeding satisfaction. J Hum Lact. 1999;15:35-39.

15.

Shrago LC , Bocar DL . The infant’s contribution to breastfeeding. JOGNN. 1990;19:211-217.

16.

Lau C , Henning SJ . A noninvasive method for determining patterns of milk intake in the breast-fed infant. J Pediatr Gastroenterol Nutr. 1989;9:481-487.

17.

Hall RT , Mercer AM , Teasley SL , McPherson DM , Simon SD , Santos S . A breastfeeding assessment score to evaluate the risk for cessation of breastfeedingby7to10daysofage. J Pediatr. 2002;41:659-664.

18.

Widstrom AM , Thingstrom-Paulsson J . The position of the tongue during rooting reflexes elicited in newborn infants before the first suckle. Acta Paediatr. 1992;82:281-283.

19.

Woolridge M . The ‘anatomy’ of infant sucking. Midwifery. 1986;2:164-171.

20.

Meier P , Anderson GC . Responses of small preterm infants to bottle- and breast-feeding. MCN Am J Matern Child Nurs. 1987;12:97-105.

21.

Bu’Lock F , Woolridge MS , Baum JD . Development of coordination of sucking, swallowing and breathing: ultrasound study of term and preterm infants. Dev Med Child Neurol. 1990;32:669-678.

22.

Weber F , Woolridge MW , Baum JD . An ultrasonographic study of the organization of sucking and swallowing by newborn infants. Dev Med Child Neurol. 1986;28:19-24.