Iowa Neonatology Handbook: Feeding

Guidelines to Enhance Successful Breast-feeding

Janet F. Geyer, RN, ARNP, C.P.N.P.
Peer Review Status: Internally Peer Reviewed

A. Advocating for breast-feeding of ill or preterm infants:

For inpatient mothers, the Labor and Delivery or Postpartum nurses will:

• Give breast-feeding handouts and discuss feeding options with mother
• Instruct the mother on pumping and storage of breast milk
• Assure that pumping is initiated within the first 24 hours after delivery

For mothers of transported infants, the transport nurses will:

• Give breast-feeding handout to mother
• Ask the local maternity nurse to assure that pumping begins with 24 hours
• Reinforce decision to breast-feed at regular "call back" times

B. Initiating non-nutritive "time at the breast":

Baby meets these criteria:

• Corrected gestational age about 32 weeks
• Has ability to swallow own secretions
• Stable outside incubator at least 10 minutes
• Tolerates kangarocare

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

C. 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 every 3 hours (8 times a day) or 100 minutes per day

D. 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, nsupplementation 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

E. Successful transition tbreast-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 breast-feeding, provide milk or formula by finger feeding or, at mother's request, provide milk or formula by bottle
• Arrange for local breast-feeding support (MD, La Leche League, lactation specialist)
• Complete discharge teaching, document in patient record

Written by the Pediatric Nursing Research Committee

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