Breastfeeding Checklist

by Dr. Francesca Tatad-To

This breastfeeding monitoring form was developed when I was in private practice and needed a way to keep track of my patients’ breastfeeding progress. I realized then that nurses would simply note on the chart that the baby was ‘breastfed’ but not how many times a feeding occurred, or whether there were any feeding problems.  Mothers were too tired to remember how many times they had breastfed in the last 24 hours, or how many times they had changed their baby’s diaper.

The mothers who did bother to write down the information were spending too much time recording too many details.  With the use of this graphic chart, mothers simply had to tick off the right image each time they breastfed, changed a wet diaper, and every time their baby passed stool.

When Team EINC realized that the monitoring of well babies is a challenge in our hospitals, mainly due to the lack of health workers and the large number of patients, we translated the form into Filipino and offered it to our various centers as a monitoring tool.  But this time, we added a column for danger signs, so that mothers themselves would be prompted to check their babies regularly for any signs that may indicate a severe illness or infection, and call the attention of their health worker.

The monitoring form was first used at the Jose Fabella Memorial Hospital’s Potentially-Septic Ward, where babies who are clinically well but have risk factors for sepsis are admitted together with their mothers.  Every mother admitted to the area is provided with a copy of the form and instructed in how to fill it up.  Initially there were concerns that the form would be too complicated for the mothers, or that it would take too much time to do, or that the forms would get lost.  As it turns out, the mothers find the form a very useful tool and have taken on the task of reminding each other to fill up their forms regularly.  Mothers are now more aware of how often they should be breastfeeding, and what signs to look for to know that breastfeeding is going well.  Monitoring mother-infant dyads has become an easier task for the nurses, and doctors going on rounds review the information in the form as part of their routine examination.  A big benefit of the tool is that infants who develop signs of illness are being referred earlier, and mothers are educated regarding the signs of severe illness in newborns, so that they can identify these even if they occur after discharge.  One pleasant surprise to the staff the mothers hold on to the forms and do not lose or misplace them.

How to properly use this form:

• Day 1 begins at the time of birth and ends 24 hours later, and so on.
• Instruct the mother to shade/check one breastfeeding image every time she breastfeeds, one wet diaper image every time her baby passes urine, and one soild diaper image every time her baby passes stool
• Heavy/darker images are mandatory - meaning a mother MUST breastfeed at least 8 times a day on day 2, for example. The lighter images are extras but within normal, meaning if a child has 8 soiled diapers istead of 2, this is still normal and should not be considered diarrhea.
• If a mother and baby are able to fulfill all the “MUST Dos” for each 24 hour period, it is likely that breastfeeding is going well. If however, one or more is insufficient, the health worker should address this by closer monitoring, properly observing a feeding, and identifying underlying problems.
• Also instruct the mother to go through the list of danger signs at least once a day (more often if possible) and to call the attention of a health worker immediately should any of the danger signs be present.