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Feeding - feeding policy in Newborn Services

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Introduction

The Newborn Service at National Women's Health promotes breast milk and breastfeeding as the optimum nutrition for infants. Benefits apply to both the mother and the infant and include nutritional, immunological, psycho-social and financial components.

The cultural, personal and/or physical factors affecting infant feeding are to be respected and staff are to support and assist women in their choice of infant feeding.

This guideline details the policies and recommended best practices to support breastfeeding the preterm or sick infant within the Newborn Service. It also provides policies and recommended best practice for alternative methods of infant feeding including bottle feeding and gastric tube feeding.

Purpose

The purpose of this guideline is to ensure that Newborn Service health professionals protect, promote and support breastfeeding during all stages of the infants association with the service. This policy also seeks to provide information and skills on safe infant feeding regardless of the method used.

Scope

This guideline applies to all Newborn Service health professionals and employees who provide care for, or have contact with, women and infants within Newborn Services. This also applies to both inpatient and outpatient services.This reflects the Global Criteria of WHO/UNICEF to meet accreditation for a Baby Friendly Hospital.

Breastfeeding Policy

Health professionals are to give current, accurate and consistent, non-judgmental breastfeeding information and supportive encouragement to enhance successful breastfeeding. It is essential that feeding of preterm or sick infants is managed in a safe and professional manner that enhances success for the infant, whatever the feeding method.

The respect of, and sensitivity to each woman's personal and psychosexual dignity is to be upheld when assisting her to breastfeed. It is expected that touching the woman's breast will be minimised and the health professional will seek each woman's permission before touching and/or gentle handling of her breasts.

The health professionals breastfeeding practice will be in accordance with the WHO/UNICEF Ten Steps to Successful Breastfeeding (1989), New Zealand College of Midwives Handbook (1992), and the NZ Breastfeeding Authority Incorporated Baby Friendly Hospital Initiative, particularly Part Two: Hospital Level Implementation for Aotearoa New Zealand (2002), and the NWH Breastfeeding Policy (2008).

In order to maintain health professionals' breastfeeding knowledge and skills, ongoing review of practice is expected and will include annual updates of breastfeeding knowledge in accordance with BFHI Aotearoa, 2002.

Feeding challenges and /or difficulties identified

Breastfeeding challenges and/or difficulties are to be identified early and documented in the clinical records with a management plan.

  • If breastfeeding difficulties are unresolved consult with the Clinical Charge Nurse or Nurse Specialist. Appropriate referral will be made to the Speech and Language Therapist or Lactation Consultant, Newborn Services.  
  • The Newborn Services Lactation Consultant is available to provide education to both staff and mothers.

Discharge Planning

Discharge planning is to incorporate written breastfeeding information and referral to appropriate services in the community resources to support continued breastfeeding success.

Artificial Feeding Policy

The health professional has a responsibility to meet the WHO Recommendations for Infant Feeding, Article 4:2. See also ADHB Policy on Artificial Feeding for the non-breastfeeding mother and infant

The health professional's responsibilities to women who choose to artificially feed their babies are to:

  • Ensure they have made an informed choice and are aware of the benefits of breastmilk/breastfeeding. 
  • Ensure they are aware of the financial costs for providing feeding equipment and providing formula until the infant is 12 months old. 
  • Document in the infant's clinical records the feeding choice of the mother. 
  • Initiate a documented feeding plan that includes the appropriate volume and frequency of feeds for age and weight of the baby. 
  • Provide one on one education on the safe administration of artificial feeding including the correct preparation of formula, safe storage, sterilisation techniques, and how to bottle-feed. 
  • The opportunity exists for the mother to provide her own feeding equipment for the infant. 
  • No feeding equipment or formula is to be given to a mother or family unless it is specialised and or prescribed on discharge from Newborn Services. 

Feeding challenges and/or difficulties identified

  • Bottle feeding challenges and/or difficulties are to be identified early and documented in the clinical records with a management plan.
  • Consult with the Clinical Charge Nurse or Family Liaison Nurse. Appropriate referral will be made to the Speech and Language Therapist or Lactation Consultant, Newborn Services.
  • Ongoing bottle feeding challenges will require referral to appropriate community resources including Community Speech and Language Therapist.

Associated documents

Supporting literature

  • Global Strategy for Infant and Young Child Feeding. WHO/UNICEF 2003 
  • Breastfeeding: A Guide to Action. MOH 2002. 
  • Baby Friendly Hospital NZ Breastfeeding Authority 2000 
  • Food and Nutrition Guidelines for Healthy Infants and Toddlers (aged 0-2years) MOH 2012 PHC 
  • Interim Statement on HIV and Breastfeeding WHO Sept. 1999. 
  • Infant Feeding - Guidelines for NZ Health Workers MOH 2008 PHC 
  • Ten Steps To Successful Breastfeeding WHO/UNICEF 1989 
  • Guidelines for Interpretation of the WHO International Code of Marketing of Breastmilk Substitutes in N.Z. MOH PHC 2012. 
  • International Code of Marketing of Breastmilk Substitutes. WHO 1981. 

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Document Control

  • Date last published: 02 September 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Author(s): Lynley Nichols
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years