Synopsis
Assess a complete breastfeed without judgement, recognise effective milk transfer and urgent infant or maternal problems, correct positioning and attachment, protect milk production when supplementation is needed, and provide preference-sensitive ongoing support.
- Ask the parent's feeding goals and preferred language before offering help; informed formula use or mixed feeding should receive the same respectful, safety-focused care.
- NICE recommends observation of a feed within 24 hours after birth and at least one further feed in the first week by a practitioner competent in breastfeeding support.
- First-line assessment is a complete observed feed: infant state and cues, positioning, attachment, rhythmic suck-swallow-breathe pattern, audible swallowing, comfort and behaviour after feeding.
Key red flags
A baby who is difficult to wake, persistently feeds fewer than expected, has weak suck, abnormal tone, respiratory distress, fever or hypothermia needs urgent clinical assessment.
Investigation priorities
Identify modifiable positioning, attachment, transfer, pain and infant coordination problems in real time.
Management branches
A parent reports pain, long feeds, unsettled behaviour or concern about intake.
- Assess infant wellbeing, weight, urine and stool and identify any urgent red flag.
- Observe a complete feed with consent and agree one or two specific positioning or attachment changes.