Kathy W.,
Make sure the staff teaches the mom the latch scale just like they teach the
pain scale.  We have a problem with staff saying they keep missing the feeding
and mom "says she nursed well".  They squeeze "well" into one of the spaces
and leave it at that.  I have assessed a feeding and found a baby NOT to even
be latching so therefore I am assuming this kido has never really fed,
especially when mom confirms that is how he has "always eaten".  I look at the chart
and many times the nurse (who obviously doesn't know how to assess a proper
latch) has charted 2's for everything.  I was in the NICU and a baby went to the
breast for the first time (full term baby, there for TWO DAYS ONLY ON
BOTTLES....this baby was going home and had NEVER been to the breast!!!).  I was
working with another baby nearby.  I told the nurse to go ahead and have mommy get
started.  The nurse proclaims, "She went right on, look at that!  Wow, she is
doing great."  I was able to get to this mom within a minute or two.  The baby
was NOT latch.  Sucking the tip of the nipple and the tip of her tongue.  She
was tongue thrusting and not even on the breast.  I tried to explain this to
the nurse.  I showed mom how she wasn't even on the breast at all.  I could
NOT get this child on the breast.  They are ready to walk out the door.  I tried
a  nipple shield with the same results.  I told mom to pump each feeding
(feed her milk...the poor baby was being fed 90ml every 4 hours in NICU!!! I
wanted to cry. She may have to wean off of the formula over a day to two days until
her volume comes up. I had the parents feed 45 ml and told them to feed when
the baby wanted to feed again...not in 4 hours.), always attempt
breastfeeding, suck training (I did the demo for them and had mom do it) and call me today,
no later than tomorrow.  We review the latch score during Unit Annual Review
each year.  Whenever I can I will pull the nurse into the room when I find
these issues so she can learn from it.  Nothing is perfect.  The LATCH score
isn't perfect but it is better than writing subjectively.

We have a nurse who calls our patients back after discharge.  Yesterday she
had a complaint from a mom that the nurses were charting 2's (she knew her baby
wasn't nursing well and kept telling the nurses) and the LC who saw mom
discovered the baby wasn't even nursing on the day of discharge.  The mom was
really upset that the nurses didn't know the difference.  So today I will look into
this issue more.

Pam Hendrix, RN, IBCLC
S. Flordia...spoiled by our great weather!

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