Screening Form for Early Follow-

Screening Form for Early Follow-Up of Breast-Fed Infants

Baby's Name: ____________________________________________ Date: ___/___/___

Mom's Name: ____________________________________________ Number of days since delivery: _____

Your answers to these questions will help you know whether you are off to a successful start with breast-feeding. Please complete this form when your baby is 4 to 7 days old. If you answer "No" to any of questions 1 through 9 or 11 through 13, or "Yes" to questions 10 or 14, call your baby's doctor or the hospital where you delivered for advice. Many hospitals have lactation consultants or lactation nurse specialists on staff who can help breast-feeding mothers after they go home. Breast-feeding problems that are identified early are easier to correct.

1. Do you feel breast-feeding is going well for you so far?	Y N
2. Has your milk come in yet? (That is, did your breasts get firm and full between the 2nd and 5th days after delivery?)	Y N
3. Is your baby able to latch on to each breast without difficulty?	Y N
4. Is your baby able to keep suckling rhythmically a total of at least 10 minutes per feeding?	Y N
5. Does your baby usually demand to feed? (Answer "No" if you have a sleepy baby who needs to be awakened for most feedings.)	Y N
6. Does your baby usually nurse at both breasts at each feeding?	Y N
7. Does your baby nurse approximately every 2 to 3 hours (from the beginning of one feeding to the beginning of the next), with no more than one long interval of up to 5 hours at night (a total of at least 8 nursings every 24 hours)?	Y N
8. Do your breasts feel full before feedings?	Y N
9. Do your breasts feel softer after feedings?	Y N
10. Are your nipples so sore that you dread feedings?	Y N
11. Is your baby having yellow bowel movements that look like cottage cheese and mustard?	Y N
12. Is your baby having at least 4 good-sized bowel movements each day (that is, more than a stain on the diaper)?	Y N
13. Is your baby wetting his or her diaper at least 6 times each day?	Y N
14. Does your baby seem hungry after most feedings (that is, fussing and crying, sucking hands, rooting, often needing a pacifier, etc.)?	Y N

Written by Marianne Neifert, MD, and the clinical staff of The Lactation Program, Rose Medical Center, Denver, CO. 303-377-3016.

Published by RelayHealth. Last modified: 2007-08-01 Last reviewed: 2006-10-04

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.