An assessment should explore the mother’s breastfeeding goals and preference, current knowledge regarding breastfeeding, potential complications, and recommendations from the mother’s healthcare provider, mother’s support network for successful breastfeeding and the reason for requesting formula.

↪ Assessment Areas

↪ Signs of Adequate Intake

↪ Additional Assessment

↪ Probing Questions for Assessment Use

ASSESSMENT AREAS

• Maternal and infant medical condition
• Physician’s advice on medical conditions and medications related to breastfeeding
• Mom’s breastfeeding goal
• Mom’s breastfeeding knowledge and experience
• Mom’s perception of breastfeeding success or challenges
• Reason for formula request
• Feeding plan (human milk and formula, complementary foods)
• Feeding pattern (frequency, duration and amount)
• Positioning
• Latch
• Sucking pattern
• Hunger and fullness cues
• Infant behavior
• Infant development skills
• Breastfeeding strike
• Appetite sprouts and growth spurts
• Tolerance (spit up, vomit, reflux)
• Formula tailoring opportunity
• Support network/workplace environment
• Feeding preference (breast only, bottle only, breast and bottle)
• Breastfeeding history
• Mom’s breast issues (surgery, flat nipples, engorgement)
• Low milk vs over production

Signs of Adequate Intake 

• Growth pattern
• Wet/dirty diapers
• Milk intake/transfer
• Breast softens after feed
• Baby wakes to feed
• Sleeping pattern

Additional Assessment

• Hospital/Birth experience
• Basic breast care (i.e. breast massage)
• Expressed milk (pumping or hand)
• Workplace environment
• Milk storage
• Weaning (baby-led or mom-led)
• Breastfeeding aids
• Alternative feeding methods e.g., cup feeding, spoon feeding, and finger feeding
• Alcohol, Drugs, and Smoking
• Teething/biting

Probing Questions for Assessment Use

Probing questions are open-ended questions that help to identify the reason(s) for the formula request. Probing assessment questions include, but are not limited to, the following:
 

Breastfeeding Plan

• Are you familiar with WIC’s food packages for breastfeeding mothers and WIC breastfeeding support services?
• How are you feeding your baby?
• Tell me about your feeding plans.
• What’s your breastfeeding goal?
• Do you plan to give exclusive breastmilk or breastmilk plus formula?
• Are you familiar with how milk production works?
• Why do you feel like you need formula?
• How many fluid ounces of formula does your baby take per feeding?
• How often is formula given per day?
• Tell me the concerns you have about breastfeeding.
•  What else does the baby eat besides breastmilk?

 

Support

• Who will be keeping your baby while you are at work?
• Who else is caring for your baby? Is anyone helping you feed your baby?
• Do you have any concerns about breastfeeding or pumping when you return to work or school?
• Who helps you with breastfeeding?
• What advice has your doctor given you with breastfeeding?

Breastfeeding Experience

• Why are you requesting formula?
• Can you describe your breastfeeding experience with your baby?
• What do you like/dislike about breastfeeding?
• Is this your first baby to breastfeed?
• Do you feel discomfort or pain?
• Describe your baby’s suck strength at your breast.
• Do you have medical issues that impact breastfeeding?

Breastfeeding Feeding Pattern

• What concerns you most about feedings?
• Tell me about the baby’s feeding patterns (how often baby eats, how long, and how baby behaves during and after feedings).
• How often is your baby going to the breast?
• How often are you offering your breast to your baby?
• How long does your baby feed at your breast?
• How does the feeding end?
• Are you expressing your milk to feed your baby or offering formula? If so, how often and how much?

Growth

• What was the baby’s birth weight and current weight?
• Tell me about your baby’s growth.
• How do you feel about the way your baby is growing?

 

Hunger and Satiety Signs

• Does the baby fall off the breast on his own or do you end the feeding?
• How do you know if your baby is hungry?
• How do you know when your baby is full?

 

Wet/Soiled Diapers

• Describe your baby’s wet and dirty diapers (how many and how often, as well as color and consistency).
• What changes have you noticed?
• How many poopy diapers did your baby go through in the last couple of days?

 

Supplementing

• Is your baby receiving anything else besides breastmilk?
• If you are supplementing, are you using your expressed milk instead of formula and giving the supplement after breastfeeding?
• How long does a feeding last?
• Are you offering both breasts at each feeding?
• What makes you think your baby is satisfied after breastfeeding?
• Describe reason, when, and how much formula is given.

Breastfeeding History

• Are there any signs of discomfort when breastfeeding?
• How do your breasts feel before and after feeding your baby?
• Does it feel like milk isn’t fully removed from your breast?
• Describe how your breast feels and any changes to your breast.
• Describe the breast pain. When did you first begin noticing your breast pain?

Milk Expression

• Why are you choosing to pump your milk?
• How often do you pump?
• Are the sudden changes in how often you breastfeed, such as skipping a few feedings or pumping sessions?
• Have you ever heard of hands-on pumping or breast massage?

 

Sleeping Pattern

• What is the longest time your baby has slept at one time? How often does this happen?
• How much rest are you getting?
• How long does your baby sleep between feedings?

Baby Behavior

• Describe your baby’s exhibiting feeding reflexes (e.g., rooting, opening wide, suckling, etc.).
• How do you calm your baby?
• Tell me how you are feeling when your baby behaves that way.
• What does your baby’s behavior seem to be saying to you?

Perceived Inadequacy

• Why do you believe you are not making enough milk?
• Why do you believe that your baby is not tolerating (e.g. spit up, vomit, reflux) your milk?
• Do you hear and see your baby swallow when breastfeeding?

Positioning and Latch

• Describe any challenges you are having with positioning or latch.
• Which breastfeeding positions have you tried?
• Which positions make you and your baby more comfortable?
• Describe some common principles with all breastfeeding positions (see Tips below).

1. Baby entirely faces the mother’s body.
2. Baby is held close to the mother.
3. There should be no gaps between mom and the baby’s body. 
4. If the baby’s hands are in the way, baby is not close enough.
5. Baby’s head faces the breast and is not turned to the side. Baby’s body, head, shoulders and hips are in a straight line. The neck is not bent. Mom should not lean over the baby.

• How does the latch feel? How long is your baby able to stay latched?