Debbie,
You wrote (some time ago):
> Bonnie, I was interested to read your comments about the questions
> around the use of LATCH in describing a breastfeeding. I would be
> interested to see the tool you are using.
Finally remembered to bring home a form and keep track of it once I did. I
have decided to send this to the list as well as to you personally. Hope
you don't mind.
Latch 0=Too sleepy; reluctant; No latch achieved
1=Repeated attempts; Holds nipple in mouth; needs stim to suck
2=Grasps breast; Tongue down; lips flanged; Rhytmic sucking
Audible swallowing 0=None
1=A few with stim
2=Spontaneous and intermittent less than 24
hr.
Spontaneous and frequent greater than 24
hr.
Type of nipple 0=Inverted
1=Flat
2=Everted (after stim)
Comfort (breast/nipple)
0=Engorged; Cracked, bleeding, large blisters, bruises;
severe discomfort
1=Filling; reddened; small blisters or bruises; mild/mod
discomfort
2=Soft; tender
Hold (positioning) 0=Full assist (staff holds infant at breast)
1=Minimal assist (e.g. elevate HOB, place
pillows for support; Teach one side; mom does other; Staff holds then mom
takes over
2=No assist from staff
My comments: Latch--there is such a wide range of sucking behaviors, that I
find it hard to fit many of them into this (IMO) oversimplified
description. I use "1" to describe lots of things than are different than
the description given.
Audible swallowing--probably because my hearing is less than perfect, I
almost never hear swallowing. I use vision and touch to evaluate
swallowing. Again, I feel the "1" could include a wide range of sucking
behaviors, only one of which is mentioned. The "2," I also find a bit
nebulous. Is this based on any sort of scientific evidence. Marjorie
Palmer says an immature sucking pattern is normal for the first 4 days after
birth or for any baby less than 40 weeks post-conceptual age.
Type of nipple--this is not going to change during the hospital stay. Why
keep evaluating this. It doesn't address compressibility of the areola,
which is very important. It doesn't address nipple width or length, which
can be major factors, but, again, are not going to change during the
hospital stay.
Comfort--breast and nipple being in same category is confusing and makes
scoring difficult. As someone else said, soft is normal at first, but
filling (a "1") is good, and normal fullness is not addressed (What if mom
stays 4 days or her milk comes in early?)
Hold--doesn't really address wide range of behaviors, e.g. Does mom support
breast? Does she pull back on breast, unlatching baby? Does she fail to
support baby sufficiently and baby slides onto nipple? Is she able to
recognize good latch vs. bad latch? nutritive vs. non-nutritive sucking
pattern? Can she center nipple in baby's mouth?
Also not addressed, Does mother recognize hunger cues and respond promptly?
--
Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA
mailto:[log in to unmask]
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