Impaired ability of an infant to suck or coordinate the suck/swallow

response resulting in inadequate oral nutrition for metabolic needs


• Inability to coordinate sucking, swallowing, and breathing

• Inability to initiate or sustain effective suck


• Anatomic abnormality

• Oral hypersensitivity

• Neurological delay or impair-

• Prematurity


• Prolonged NPO status

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Fluid and electrolytes

• Nutrition

• Growth and development

• Roles/relationships


The neonate will

• Not lose more than 10% of birth weight within first week of life.

• Gain 4–7 oz (113.5–198.5 g) after first week of life.

• Remain hydrated.

• Receive adequate supplemental nutrition until able to suckle suffi-


• Establish effective suck-and-swallow reflexes that allow for

adequate intake of nutrients.

The parents will

• Identify factors that interfere with neonate establishing effective

feeding pattern.

• Express increased confidence in their ability to perform appropri-

ate feeding techniques.


Breast-Feeding Establishment: Infant; Breast-Feeding Maintenance;

Muscle Function; Nutritional Status: Food & Fluid Intake;

Swallowing Status


Determine: Weigh neonate at the same time each day on the same

scale to detect excessive weight loss early.

Continuously assess neonate’s sucking pattern to monitor for inef-

fective patterns.

Assess parents’ knowledge of feeding techniques to help identify

and clear up misconceptions.

Assess parents’ level of anxiety about the neonate’s feeding diffi-

culty. Anxiety may interfere with the parents’ ability to learn new


Monitor neonate for poor skin turgor, dry mucous membranes,

decreased or concentrated urine, and sunken fontanels and eyeballs

to detect possible dehydration and allow for immediate intervention.

Record the number of stools and amount of urine voided each

shift. An altered bowel elimination pattern may indicate decreased

food intake; decreased amounts of concentrated urine may indicate


Assess the need for gavage feeding. The neonate may temporarily

require alternative means of obtaining adequate fluids and calories.

If neonate requires intravenous nourishment, assess the insertion

site, amount infused, and infusion rate every hour to monitor fluid

intake and identify possible complications, such as infiltration and


Perform: Remain with the parents and neonate during the feeding to

identify problem areas and direct interventions.

For bottle-feeding, record the amount ingested at each feeding; for

breast-feeding, record the number of minutes the neonate nurses at

each breast and the amount of any supplement ingested to monitor

for inadequate caloric and fluid intake.

Provide an alternative nipple, such as a preemie nipple. A preemie

nipple has a larger hole and softer texture, which makes it easier for

the neonate to obtain formula.

For breast-feeding, ensure that the neonate’s tongue is properly

positioned under the mother’s nipple to promote adequate sucking.

Alternate oral and gavage feeding to conserve the neonate’s


Inform: Teach parents to place the neonate in the upright position

during feeding to prevent aspiration.

Teach parents to unwrap and position a sleepy neonate before

feeding to ensure that the neonate is awake and alert enough to

suckle sufficiently.

Attend: Provide positive reinforcement for the parents’ efforts to

improve their feeding technique to decrease anxiety and enhance

feelings of success.

Manage: Assess neonate for neurologic deficits or other pathophysio-

logic causes of ineffective sucking to identify the need for referral

for more extensive evaluation.


Attachment Promotion; Breast-Feeding Assistance; Lactation Coun-

seling; Nonnutritive Sucking


Kelly, M. M. (2006, September–October). Primary care issues for the healthy

premature infant. Journal of Pediatric Health Care, 20(5), 293–299.

Nursing diagnosis – interrupted breastfeeding

Interrupted Breastfeeding
Break in continuity of the breastfeeding process as a result of
inability or inadvisability to put baby to breast for feeding
• Continued desire to maintain lactation and provide breast milk for
infant’s nutritional needs (mother)
• Failure to receive nourishment at breast for some or all feedings
• Lack of knowledge about expressing or storing milk (mother)
• Separation of mother and infant
• Contraindications to
• Infant illness
• Maternal employment
• Maternal illness
• Need to wean infant abruptly
• Prematurity
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Coping
• Communication
• Knowledge
• Values and beliefs
The mother will
• Express her understanding of factors that necessitate interruption
in breastfeeding.
• Express comfort with her decision about whether to resume
• Express and store breast milk appropriately.
• Resume breastfeeding when the interfering factor ceases.
• Have adequate milk supply when breastfeeding resumes.
• Obtain relief from discomfort associated with engorgement.
• Ensure that infant’s nutritional needs are met.
Breastfeeding Maintenance; Knowledge: Breastfeeding; Motivation;
Parent–Infant Attachment; Parenting Performance; Role Performance
Determine: Assess mother’s understanding for interrupting breastfeeding
to evaluate need for further instruction.
Assess mother’s desire to resume breastfeeding when reasons for
interruption are no longer a factor. The mother may not wish to
continue breastfeeding.
Assess mother’s emotional reactions to having to interrupt breastfeeding.
Emotional feelings may affect resumption after interruption.
Perform: Review mother’s daily routine to advise her how to incorporate
breastfeeding into her schedule. Mother must have a plan in
order to carry on usual routine and still make sure the baby is fed
on schedule.
Inform: Instruct mother in methods for expressing and storing breast
milk. Demonstrate the use of a breast pump utilizing the following
– Initiate pumping 24–48 hr after delivery.
– Pump a minimum of 5 times a day.
– Pump a minimum of 100 min a day.
– Pump long enough to soften breasts each time regardless of
Instruct mother in ways to prevent breast engorgement to prevent
discomfort that may keep infant from sucking effectively. Teach the
mother about the use of nipple shield (if appropriate). The shield is
designed to alter flat or inverted nipples.
Attend: Provide emotional support and encouragement to help
improve patient’s confidence and motivation to resume breastfeeding
when possible.
Reassure mother that infant’s nutritional needs will be met
through other methods to allay her anxiety.
If mother must pump for a prolonged period, encourage her to
use a piston-style electric pump. Using an electric pump rather than
a hand pump produces milk with a higher fat content.
Involve patient in planning and decision making. Having the ability
to participate will encourage greater compliance with the plan to
resume breastfeeding.
If mother chooses not to resume breastfeeding, advise her to wear
a supportive bra, apply ice, and take a mild analgesic to alleviate
discomfort associated with engorgement.
Manage: Refer to a lactation support group for continued assistance
in resuming breastfeeding after an interruption.
Provide appropriate educational home assessment. If possible,
have a home health nurse visit the mother and infant to assess
Attachment Promotion; Bottle Feeding; Emotional Support; Infant;
Lactation Counseling; Parent Education; Teaching: Individual
Spatz, D. L. (2006, January–March). State of the science: Use of human milk
and breastfeeding for vulnerable infants. The Journal of Perinatal &
Neonatal Nursing, 20(1), 51–55.

Nursing diagnosis – ineffective breastfeeding

Ineffective Breastfeeding
Dissatisfaction or difficulty a mother, infant, or child experiences
with the breastfeeding process
• Actual or perceived inadequate milk supply (mother)
• Arching and crying when at the breast (infant)
• Evidence of inadequate intake (infant)
• Fussiness and crying within the first hour of feeding (infant)
• Inability to latch on to nipple correctly (infant)
• Insufficient emptying of each breast
• Unsatisfactory breastfeeding process (mother and infant)
• Infant anomaly
• Infant receiving supplemental
feeding with artificial nipple
• Knowledge deficit
• Maternal ambivalence
• Maternal anxiety
• Nonsupportive family
• Nonsupportive partner
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Communication
• Roles and relationships
• Values and beliefs
The mother will
• Express physical and psychological comfort in breastfeeding practice
and techniques.
• Show decreased anxiety and apprehension.
• State at least one resource for breastfeeding support.
The infant will
• Feed successfully on both breasts and appear satisfied for at least
2 hr after feeding.
• Grow and thrive.
Breastfeeding Assistance; Emotional Support; Lactation Counseling;
Nutritional Management; Parent Education; Support Group
Determine: Assess factors that influence mother’s decision to breastfeed.
Assessment information will be used to develop interventions.
Monitor condition of breasts and nipples to identify problems that
might interfere with feeding to pinpoint problem areas.
Assess readiness of mother to breast-feed and ability of infant to
Monitor mother’s breastfeeding technique. Improper technique,
which impedes feeding, will cause the mother to experience anxiety.
Perform: Position mother in Fowler’s position to enhance mother’s
relaxation during feeding. Place infant in proper position for optimal
feeding to produce proper sucking motion.
Inform: Teach mother and selected caregiver the techniques for
encouraging letdown, including warm shower, breast massage, physically
caring for the neonate, and holding the neonate close to the
Teach mother techniques (e.g., lying on her side, positioning the
infant correctly, holding the nipple with C position, talking to and
cuddling the infant) that will help the infant latch on to the breast.
Instruct mother to remove infant from the breast to be burped
midway during the feeding to allow for expulsion of air that is
Attend: Ask frequently during hospitalization whether the mother
has questions while she is attempting to breast-feed. This will give
her the confidence she needs to continue when she gets home.
Provide mother and infant with a quiet, private, comfortable environment
in which to breast-feed. Decreasing stressors will help to
promote successful breastfeeding experience.
Encourage expression of fears and anxieties between the mother
and the infant to reduce anxiety and increase the mother’s sense of
control over the process.
Manage: Offer written information, a reading list, or a referral to a
breastfeeding support group to allow for review of information after
Refer to home health nurse for a follow-up visit in the home.
Refer to a nutritionist for information on good nutrition and fluid
Breastfeeding Assistance; Emotional Support; Lactation Counseling;
Infant; Parent Education; Support Group
Lewallen, I. P., et al. (2006, August). Toward a clinically useful method of
predicting early breastfeeding attrition. Applied Nursing Research, 19(3),

Nursing diagnosis – effective breastfeeding

Effective Breastfeeding
Mother-infant dyad/family exhibits adequate proficiency and satisfaction
with breastfeeding process
• Ability to promote successful latching on through correct positioning
• Adequate elimination pattern for age (infant)
• Appropriate weight pattern for age (infant)
• Eagerness to nurse (infant)
• Effective communication pattern (mother and infant)
• Evidence of contentment after feeding
• Expressed satisfaction with breastfeeding (infant)
• Regular and sustained sucking and swallowing at breast (infant)
• Signs and symptoms of oxytocin release (mother)
• Basic breastfeeding knowledge
• Infant gestational age 34
• Normal breast structure
• Support source
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Coping
• Growth and development
• Knowledge
• Nutrition
• Values and beliefs
The mother will
• Breast-feed infant successfully and will experience satisfaction with
breastfeeding process.
• Continue breastfeeding infant after early postpartum period.
The infant will
• Feed successfully on both breasts and appear satisfied.
• Grow and develop in pace with accepted standards.
Breastfeeding Establishment: Infant; Breastfeeding Establishment:
Maternal; Breastfeeding Maintenance; Breastfeeding: Weaning;
Hydration; Knowledge: Breastfeeding
Determine: Assess mother’s knowledge and experience with
breastfeeding to focus teaching on specific learning needs.
Assess mother’s attitudes and beliefs about breastfeeding to help
plan for interventions.
Monitor height and weight of infant to ensure infant meets the
standards for breastfeeding.
Perform: Weigh and measure the infant. Provide a quiet and private
environment to enhance the development of breastfeeding skills.
Inform: Educate mother and selected support person about
breastfeeding techniques to improve chance of success. Have the
mother perform return demonstration of techniques as appropriate:
• Clean hands and breasts before nursing.
• Position infant for feeding (infant should be able to grasp most of
the areola).
• Change positions to decrease nipple tenderness and use both
breasts at each feeding.
• Remove infant from the breast by breaking suction; avoid setting
time limits in the early stage.
• After breastfeeding, place clean pads on breasts.
Teach mother how to use warm showers and compresses, relaxation
and guided imagery, infant suckling, holding the infant close to the
breasts, and listening to the infant cry in order to stimulate letdown.
Teach mother about nutritional needs including an extra 500 calories
and two additional 8-oz glasses of fluid per day to maintain adequate
milk supply and to limit caffeine and food that causes discomfort.
Teach caregivers to assist patient with self-care activities in a way
that maximizes patient’s potential. This enables caregivers to participate
in patient’s care and encourages them to support patient’s independence.
Teach mother what to expect from a breastfeeding infant to prepare
her for breastfeeding at home. The infant should pass from 1 to 6
stools and wet 6–8 diapers per day. Stools should be soft to liquid and
nonodorous. Infant should feed every 2–3 hr or as needed and appear
content. Explain that the infant also needs nonnutritive sucking.
Getting an upset neonate to breast-feed can be extremely difficult.
Attend: Encourage mother to express concerns about breastfeeding
to reduce anxiety. Assist the mother and family in planning for
home care. The mother needs to rest when the infant sleeps, practice
self-care, learn techniques for expressing and storing breast milk,
and recognize signs of engorgement and infection. A mother who
stops breastfeeding when she returns home and resumes work usually
does so because of fatigue.
Manage: Refer patient to support group for breastfeeding mothers to
help meet emotional and learning needs.
Breastfeeding Assistance; Family Support; Lactation Counseling;
Nutritional Management; Parent Education: Infant
Noel-Weiss, J., et al. (2006, May–June). Developing a pre-natal breastfeeding
workshop to support maternal breastfeeding self-efficacy. Journal of Obstetric,
Gynecologic, and Neonatal Nursing, 35(3), 349–357.