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Annexures

Annexure A: Breastfeeding Assessment Tools​

LATCH Breastfeeding Assessment Tool​

Reference: Jensen D, Wallace S, Kelsay P. LATCH: a breastfeeding charting system and documentation tool. J Obstet Gynecol Neonatal Nurs. 1994 Jan;23(1):27-32. doi: 10.1111/j.1552-6909.1994.tb01847.x. PMID: 8176525.

Infant Breastfeeding Assessment Tool​

Reference: Matthews MK. Developing an instrument to assess infant breastfeeding behaviour in the early neonatal period. Midwifery. 1988 Dec;4(4):154-65. doi: 10.1016/s0266-6138(88)80071-8. PMID: 3210979.

LATCH Breastfeeding Assessment Tool​

ComponentScore 0Score 1Score 2
L - LatchToo sleepy or reluctant to latch No latch achievedRepeated attempts Holds nipple in mouth Stimulate to suckGrasps breast Tongue down Lips flanged Rhythmic sucking
A - Audible swallowingNoneA few with stimulationSpontaneous and intermittent (less than 24 hrs old) Spontaneous and frequent (more than 24 hrs old)
T - Type of nippleInverted (drawn inward when compressed)Flat (not protruding when compressed)Everted or protruding after stimulation
C - Comfort (breast/nipple)Engorged Cracked, bleeding, large blisters or bruises Severe discomfortFilling Reddened/small blisters or bruises Mild/moderate discomfortSoft Non-tender
H - Hold (positioning)Full assistance required (staff holds infant at breast)Minimal assistance (help with positioning or support)No assistance required Mother able to position/hold infant

Scoring:

  • Total possible score: 10 points
  • 0-3: Poor - significant intervention needed
  • 4-6: Fair - some assistance required
  • 7-10: Good - minimal intervention needed

Infant Breastfeeding Assessment Tool (IBFAT)​

CriterionScore 0Score 1Score 2Score 3
Readiness to feedDid not feedNeeded mild stimulationNeeded moderate stimulationEager to feed
RootingDid not rootShowed some rootingShowed obvious rootingRooted effectively
Fixing (latch-on)Did not fixNeeded assistance to fixFixed with stimulationFixed readily
Sucking patternNo sucking or sucking without attachmentWeak and/or intermittent suckingStrong sucking, but pausing frequentlyStrong continuous sucking

Scoring:

  • Total possible score: 12 points
  • 0-3: Ineffective breastfeeding
  • 4-7: Moderately effective
  • 8-10: Effective
  • 11-12: Very effective
Breastfeeding Observation Aid

Breastfeeding Observation Aid PDF

Textbooks​

  1. Lawrence RA, Lawrence RM. Breastfeeding: A Guide for the Medical Profession. 9th ed. Philadelphia: Elsevier; 2021. ISBN: 978-0-323-68013-4.
  2. Wambach K, Spencer B. Breastfeeding and Human Lactation. 6th ed. Burlington: Jones & Bartlett Learning; 2019. ISBN: 978-1-284-15156-5.

National Guidelines​

  1. Ministry of Health and Family Welfare, Government of India. National Guidelines on Lactation Management Centres in Public Health Facilities. New Delhi: MoHFW; 2017. Available from: https://nhm.hp.gov.in/storage/app/media/uploaded-files/CLMC%20guidelines.pdf
  2. National Neonatology Forum India. Evidence Based Clinical Practice Guidelines. NNF India; 2022. Available from: https://www.nnfi.org/nnf-cpg-guidelines.php
  3. Bharadva K, Tiwari S, Mishra S, et al. Human milk banking guidelines. Indian Pediatr. 2014 Jun;51(6):469-74. doi: 10.1007/s13312-014-0424-x. PMID: 24986283. Available from: https://pubmed.ncbi.nlm.nih.gov/24986283/

International Guidelines​

  1. World Health Organization. Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services: The Revised Baby-Friendly Hospital Initiative. Geneva: WHO; 2018. Available from: https://www.who.int/publications/i/item/9789241513807
  2. European Milk Bank Association (EMBA). Guidelines for the Establishment and Operation of Human Milk Banks. 2019. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6409313/

Key Reviews​

  1. Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016 Jan 30;387(10017):475-490. doi: 10.1016/S0140-6736(15)01024-7. PMID: 26869575. Available from: https://pubmed.ncbi.nlm.nih.gov/26869575/
  2. Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am. 2013 Feb;60(1):49-74. doi: 10.1016/j.pcl.2012.10.002. PMID: 23178060; PMCID: PMC3586783. Available from: https://pubmed.ncbi.nlm.nih.gov/23178060/
Cover Pages

The complete cover pages (cover, title page, acknowledgments, disclaimer, prefaces) are available as a print-ready PDF:
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