Screening form for the early follow-up of breastfed infants

Infant Name:_________________________Date:__________Infant age:_______days.

The following questions are designed to help us tell whether you are off to a successful start with breastfeeding. The earlier breastfeeding problems are recognized, the easier they are to correct. Many of these questions address feeding and milk supply so, if you are mostly circling answers in the left hand column then YOUR BABY IS GETTING ENOUGH OF YOUR MILK!

1. Do you feel that breastfeeding is going well for you so far? YES NO
2. Has your milk come in yet? (I.e., did your breasts get firm and full between the
second and fifth postpartum day?)
3. Is your baby able to latch on to your breasts without difficulty? YES NO
4. Is your baby able to sustain rhythmic suckling for at least 10 minutes total per feeding? YES NO
5. Does your baby usually demand to feed? ( Answer NO if you have a sleep baby who
needs to be awakened for most feedings.)
6. Does your baby usually nurse at both breasts at each feeding? YES NO
7. Does your baby nurse approximately every 2-3 hours, with no more than one longer
interval of up to 5 hours at night (at least 8 nursing in 24 hours)?
8. Do your breasts feel full before feedings? YES NO
9. Do your breasts feel softer after feedings? YES NO
10. Are your nipples extremely sore (e.g. causing you to dread feedings)? NO YES
11. Is your baby having yellow bowel movements (resembling mustard with some little curds)? YES NO
12. Is your baby having at least four good-sized bowel movements each day (more than
a stain on the diaper)?
13. Is your baby wetting his/her diapers at least six times each day? YES NO
14. Does your baby appear hungry after most feedings (e.g. Sucking hands, crying,
often needing a pacifier or continuous nursing)?
15. Do you hear rhythmic suckling and swallowing while your baby nurses? YES NO

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