HomeMy WebLinkAboutassessment-referral-quick-chartCreated June 2017 by Jeanne Kettles, MA, IBCLC Alameda County WIC Regional Breastfeeding Liaison Jeanne.Kettles@acgov.org
ASSESSMENT QUESTIONS CONSIDERATIONS
POSSIBLE REFERRAL 1, 7
MEDICAL
PROVIDER IBCLC CLE
BFPC
Age of baby
• Gestational Age (Due date vs birth date)
• Vaginal or Surgical delivery
• Induction or spontaneous labor/delivery
✓ ✓
Discharge weight
Current naked weight
Gain (+) or loss (-)
Infant Age Normal Weight Pattern 1,3,7
✓ ✓
0-5 days ↓ 7-10% weight loss is within normal
10 -14 days Regain birth weight
0-4 months 7 ounces per week
4-6 months 3.25 – 4.5 ounces per week
4-6 months Double the birth weight
Infant stools/void in
most recent 24 hour
Stools
Void
By day 4, stools should be yellow and seedy, not black or green 1,2,3
(Please refer to chart on back page for age appropriate guidelines) ✓
Interval from beginning
of feeding to next one
Feeding to baby cues
or following a
schedule?
Infant hunger cues: rooting, hands to mouth, sucking/puckering lips,
bending arms and legs
Infant (0-6 months) may feed 10 or more times in 24 hours
✓ ✓
Length of time active
suckling during feeding
Effective latch?
Active suckling?
Audible swallows?
Maintains deep wide latch for duration of feed
Consistent pull or tugging sensation with sucking.
Slow, steady jaw movement and audible swallows while baby is feeding
✓ ✓
Supplementation
What supplement?
Why? How much?
How often?
Method of delivery?
Re-evaluation timeline
If clinically indicated, supplement with expressed breastmilk first before
formula; do not supplement with water or sweetened liquids
Appropriate method of delivery will depend on clinical evaluation
All supplementation plans must include guidelines for method, amount
and frequency of supplement; as well as re-evaluation of mother and
infant within 24-72 hours as appropriate 5
✓ ✓
Pain or discomfort
How severe? (1 to 10)
Occurs when?
Where?
Pain <3 refer to Peer Counselor for comfort measures/position support 7
Pain >3 or which does not resolve in 72 hours should be referred for
evaluation by medical health care provider and/or IBCLC 1, 7
✓ ✓ ✓
Other: Mother
Temperature _______
Symptom infection?
Nipple trauma?
Medication/Herbs
All fever and/or symptoms of infection (i.e. red hot lump) are referred to
medical health care provider and IBCLC for evaluation/plan 1, 7
Nipple trauma from issues with latch and position refer to IBCLC 1, 7
Many maternal medications/herbs are safe for breastfeeding infants;
physician may consult IBCLC for adaptive lactation plan, if concern
✓ ✓
Other: Baby
Temperature _______
Jaundice/color
Active/sleep cycles
All fever or jaundice refer to medical health care provider for evaluation 1
Breastfeeding jaundice referred to IBCLC for evaluation of breastfeeding
If “too sleepy to breastfeed” or hungry after feeding, refer to IBCLC 1, 7
✓ ✓