EXPANDED HOSPITAL POLICY #8:

INTERVENTION / MANAGEMENT

RATIONALE

RESOURCES

8.1 Breastfeeding infants should be given only breastmilk, unless specifically ordered for a clinical condition by the physician or with the mother’s informed consent.

8.1 Colostrum and breastmilk completely meet the normal newborn’s nutritional and fluid needs (provides 17-20 kcal/oz).⁵ Colostrum is the least noxious substance if aspirated.4,5

8.1.1Water interferes with breastfeeding and fills the baby with non-nutritive fluid so that the baby is not hungry. There is no medical or nutritional value to water. Water decreases the frequency of breastfeeding, which in turn decreases the mother’s milk supply. 4

Sample patient handouts explaining why babies should be exclusively breastfed

• Southwest Healthcare System: English (PDF, 1.1MB)...Spanish, 1.1MB

Example of a Consent (Word)to supplement to assist in offering patient education

Example of a policy for supplementing a breastfeeding baby

• Kaiser (Word)

See the Academy of Breastfeeding Medicine Protocol on Hypoglycemia (PDF)and Supplementation (PDF)

8.2 When supplementation is medically indicated, an alternate feeding method should be utilized to maintain mother-infant breastfeeding skills. Alternate feeding methods include cup, dropper, gavage, finger or syringe.

8.2.1 Artificial feeding should not exceed the physiologic capacity of the newborn stomach.

8.2 Some infants may have difficulty transitioning between an artificial nipple and the breast. Alternate feeding methods may be helpful in maintaining breastfeeding skills.2,3,6

8.2.1 Care should be taken not to exceed the physiologic capacity of the newborn stomach. In the first few days of life, volumes of less than 20cc should be given at each feeding. 3,7

References and summary of the studies(PDF)on the capacity of the infant's stomach

Information on "Paced Bottle feeding": A Caregivers Guide to the Breastfed Baby (PDF)

Resources for programs used to teach staff about supplementation:

Birth and Beyond – Perinatal Services Network

Bright Futures Lactation Support Centre, Ltd. – Videos and books for patient and staff education.

Professional Education Distance Learning Courses

See resources in policy #4

8.3 Education regarding supplementation should be presented prior to obtaining consent for supplementation Risks of introducing artificial infant milk and/or water to the newborn should be discussed with the mother prior to supplementation.

8.3 Mothers should be made aware of potential risks to the infant who receives artificial infant milk, or water, or is fed by artificial feeding methods. 1,5