Is Baby getting Enough Milk?

L-A-T-C-H-E-S *
Breastfeeding Assessment Tool,
for the First 4 weeks

SCORE VALUE 1 2 3 A B C D E F

L
Latch Too sleepy or reluctant
No latch achieved
Repeated attempts.
Holds nipple in mouth.

Stimulated to suck.
Grasps breast.
Tongue down.
Lips flanged
Rhythmic suckling

A
Audible Swallowing None A few with stimulation < 24 hours old
spontaneous and intermittent
>24 hours old
spontaneous and intermittent

T
Type of Nipple Inverted Flat Everted after stimulation.

Shape of nipple
(after feeding) Pinched, creases or blanched white Not round misshapen or change in color Round normal color

C
Comfort Level

- - - Breast Breast engorged, rock hard or large lumps Filling- breast becoming firmer
Small lumps (1 cm) from milk glands Breasts soft
heavy

- - - Nipple Nipples cracked,
Bleeding, Large blister(s) and/ or Bruise(s) Nipples reddened small blister(s) and/or bruise(s) Nipples intact

- - - General feeding Severe discomfort Mild/Moderate Discomfort Nipples Slightly tender

H
Hold
Positioning Full assist (second person latches baby on and holds infant at breast) Minimal assist (Needs help with pillows positioning latch-on) No Assistance (Mother able to position and hold infant)

E
Elimination

- - - Urine
Diaper dry or dark urine Diaper damp.
Urine light yellow. Diaper wet.
Urine light yellow or clear.

- - - Stool

Size
No stool or thick dry stool. Small stool (smaller than quarter sized) Stool (Larger than quarter sized)

- - - - Stool

Color
N/A Less than 3 days: Dark Black
3 to 5 days: tan or brown
> 5 days: yellow and liquid Less than 3 days: Dark Black Green
3 to 5 days: tan or brown

> 5 days: yellow and liquid

S
Satiation Crying, fussy, rooting after feeding, or didn't actively nurse 10 minutes
After 5 days of age takes longer than 45 to 60 min to feed Awake, rooting after feeding.
Few swallows heard or needed to be stimulated to stay awake for feeding Awake for feeding then relaxes and falls asleep at breast after 10 to 15 minutes of active nursing with frequent swallows.

Score this feeding

Score Key

*Adapted from: Jensen, Deborah. Shiela Wallace and Patricia Kelly. "LATCH: A Breastfeeding Charting System and Documentation Tool." JOGNN (1994) 23:27-32.

[Index]

LAst reviewed: Wed, Nov 8, 2006

SCORE VALUE	1	2	3	A	B	C	D	E	F
L Latch	Too sleepy or reluctant No latch achieved	Repeated attempts. Holds nipple in mouth. Stimulated to suck.	Grasps breast. Tongue down. Lips flanged Rhythmic suckling
A Audible Swallowing	None	A few with stimulation	< 24 hours old spontaneous and intermittent >24 hours old spontaneous and intermittent
T Type of Nipple	Inverted	Flat	Everted after stimulation.
Shape of nipple (after feeding)	Pinched, creases or blanched white	Not round misshapen or change in color	Round normal color
C Comfort Level
- - - Breast	Breast engorged, rock hard or large lumps	Filling- breast becoming firmer Small lumps (1 cm) from milk glands	Breasts soft heavy
- - - Nipple	Nipples cracked, Bleeding, Large blister(s) and/ or Bruise(s)	Nipples reddened small blister(s) and/or bruise(s)	Nipples intact
- - - General feeding	Severe discomfort	Mild/Moderate Discomfort	Nipples Slightly tender
H Hold Positioning	Full assist (second person latches baby on and holds infant at breast)	Minimal assist (Needs help with pillows positioning latch-on)	No Assistance (Mother able to position and hold infant)
E Elimination
- - - Urine	Diaper dry or dark urine	Diaper damp. Urine light yellow.	Diaper wet. Urine light yellow or clear.
- - - Stool Size	No stool or thick dry stool.	Small stool (smaller than quarter sized)	Stool (Larger than quarter sized)
- - - - Stool Color	N/A	Less than 3 days: Dark Black 3 to 5 days: tan or brown > 5 days: yellow and liquid	Less than 3 days: Dark Black Green 3 to 5 days: tan or brown > 5 days: yellow and liquid
S Satiation	Crying, fussy, rooting after feeding, or didn't actively nurse 10 minutes After 5 days of age takes longer than 45 to 60 min to feed	Awake, rooting after feeding. Few swallows heard or needed to be stimulated to stay awake for feeding	Awake for feeding then relaxes and falls asleep at breast after 10 to 15 minutes of active nursing with frequent swallows.
			Score this feeding