Checklist for monitoring for effective breastfeeding and adequate intake in a newborn infant

Infant hydration and intake:

At least 1 void per day of age and at least 1 stool per day

Mucous membranes are moist, and normal skin turgor

Infant's weight loss is not excessive for delivery type and feeding method*

Infant feeding behaviors:

Feeds at the breast or mother expresses colostrum within the 2 hours after birth

Wakes frequently to feed and seems content after feeding

Audible swallows during feeds

Feeds at least 8 times in 24 hours

Maternal signs and practices:

Mother is not having nipple pain or compression

Evidence of colostrum either on the baby's mouth or upon hand expression or leaking from the nipples (reassuring, but not essential)

If infant is not consistently latching, mother is expressing either by hand or with pump at least 8 times in 24 hours

If infant is preterm, mother is also expressing either by hand or with pump with each feeding and at least 8 times in 24 hours

* Excessive weight loss is a weight below the 75^th percentile curve on the newborn weight loss tool (NEWT) nomogram^[1]. Note that higher percentiles on this nomogram indicate greater weight loss compared with other infants at the same age (unlike standard weight-for-age growth charts, in which higher percentiles indicate greater weight gain).

Reference:

PennState Health Children's Hospital. NEWT: Newborn Weight Tool. Available at: https://www.newbornweight.org/ (Accessed on March 30, 2021).

Data from Feldman-Winter L, Kellams A, Peter-Wohl S, et al. Evidence-Based Updates on the First Week of Exclusive Breastfeeding Among Infants ≥35 Weeks. Pediatrics 2020; 145.

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Checklist for monitoring for effective breastfeeding and adequate intake in a newborn infant