I think you would need to encourage the parent to look at the whole picture.  A score of 3 for waking less than an hour after a feed, in and of itself would not be an issue...sadly, it's the rest of the scoring that will get you to the higher score that requires treatment.  I try to be as proactive as possible with these parents and our nicu staff (and neonatologist) goes over the scoring of these infants with the parents every day so that everyone is very clear about why the infant is scoring the way they are.  I might even say upfront to the parent, a breastfed baby is most likely going to wake more frequently but it's all the other symptoms that will cause the score to go up.  Sadly when you've worked with this population long enough, you can tell the difference between regular waking for feedings and a irritable withdrawing infant whose frequently waking.  I think transperancy with the parents is the key.

Denise Bulpitt RNBSN IBCLC
St. Vincent's 
Bridgeport, ct.    

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