Assessment of Breastfeeding and Infant Growth

Pamela D. Hill, RN, CBE, PhD; Teresa S. Johnson, RN, PhD


J Midwifery Womens Health. 2007;52(6):571-578. 

In This Article

Breastfeeding Assessment Tools

The most frequently used breastfeeding assessment tools include: the Infant Breastfeeding Assessment Tool, the Mother-Baby Assessment, the LATCH tool, the Systematic Assessment of the Infant at the Breast, and the Lactation Assessment Tool. The Mother-Infant Breastfeeding Progress Tool was recently published.

The Infant Breastfeeding Assessment Tool (IBFAT) was first published in 1988 and consists of four items that represent the major components of infant breastfeeding behavior[10]: 1) readiness to feed; 2) rooting; 3) fixing (latching on); and 4) sucking ( Table 1 ). The IBFAT also measures the mother's perception and satisfaction about the feeding. This tool was developed from a review of the literature, observations made in clinical practice, and consultations with experts in the area of neonatal behavior.[10] An interrater reliability of 91% was obtained between the mothers and researchers.[10] Mothers who reported a low satisfaction with breastfeeding also rated their infant low on the IBFAT.[11]

The Systematic Assessment of the Infant at Breast (SAIB) was first published in 1990 and is a simple and straightforward tool to evaluate the effectiveness of the infant's breastfeeding behavior. The provider must directly observe a breastfeeding session to make an accurate assessment[12] ( Table 2 ). No scoring system is available. The SAIB serves as a teaching guide when the mother does not know how to begin to breastfeed.[12]

The Mother-Baby Assessment (MBA) tool was first published in 1992 and allows for assessment and documentation of the infant's breastfeeding efforts using a score similar to the Apgar score.[13] The MBA is used to rate the progress of a mother and newborn who are learning to breastfeed. There are five steps or criteria that are listed in Table 3 . For each of the five steps, the mother and infant each receive a score. Interrater reliability for 23 observations ranged from 0.33 to 0.66.[14]

The LATCH assessment was also modeled on the Apgar scoring system, and a composite score of 0 to 10 is possible.[15] This tool was first published in 1994 and is to be used to identify interventions needed to facilitate charting or documentation ( Table 4 ). Interrater reliability for 23 observations ranged from 0.11 to 0.46.[14]

The Lactation Assessment Tool (LAT™) was first developed in 1999 for a research project conducted in Latvia. The LAT™ is a guided documentation form with correction interventions for mothers with sore nipples ( Table 5 ). Ninety-five mothers who delivered a healthy, term infant and reported sore nipples the first 10 days postpartum scored their pain during the study that first used this tool. The midwife of each mother observed, assessed, and documented a breastfeed using the LAT™. Each of the assessment parameters was correlated with the mother's reported level of pain.[16] Reliability and validity of the LAT™ are in progress (Karin Cadwell, oral communication, June 4, 2007).

The Mother-Infant Breastfeeding Progress Tool (MIBPT) was developed with the recognition that both the mother and infant contribute to the development and success of the breastfeeding relationship.[17] The tool consists of eight items which can be assessed by observing a feeding; these items are listed in Table 6 . A sample of 81 breastfeeding observations was obtained from 62 mother-infant dyads. The percent agreement between raters varied from 79.0% to 95.1%. The assessment of responsiveness to feeding cues, timing of feeding, and nutritive suckling bursts all had an interrater agreement of more than 90%, while the agreement of positioning and latching factors had an interrater agreement greater than 80%. Evidence of trauma on a mother's nipples had an agreement of 79%. The health care professional using the MIBPT needs to address both infant behavior states and how the mother or parents responded to their infant. The MIBPT, as a checklist, has the potential to be highly effective to assess maternal and infant behaviors useful to support a mother-infant dyad in successful breastfeeding. Keeping this checklist at the bedside to use with the mother and family for teaching and support can facilitate dialogue between health care providers and families and help provide support for the breastfeeding dyad.


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