F9 · Breastfeeding difficulty
Actual Food and fluids
Definition
The mother or baby struggles with latch, milk flow, or comfort during breastfeeding.- Poor latch
- sore nipples
- low milk
- tongue-tie
- stress or lack of support
- Baby fussy at feeds
- poor weight gain
- cracked nipples
- few wet diapers
📋 Scenario
A new mother cries because the baby keeps slipping off the breast and her nipples are sore.
Subjective (S): "It hurts so much when she latches and I'm afraid I'm not feeding her enough."
Objective (O): Nipples cracked and red; baby latches shallowly; baby lost 8% of birth weight by day 4; 4 wet diapers in 24 hours.
Assessment tools for this scenario: CP-FLUID Fluid Balance & Nutrition Score CP-PAIN Pain & Comfort Score CP-SKIN Skin & Wound Score
Validated scales to consider: MUST, fluid chart, glucose, NRS 0–10, FLACC, PAINAD, Braden Scale, TIME wound chart
**CarePath diagnosis:** Breastfeeding difficulty related to poor latch, as evidenced by baby fussy at feeds and poor weight gain.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Teach positions and latch. | A good position and deep latch let the baby take milk well and prevent nipple damage. |
| Encourage skin-to-skin contact. | Skin-to-skin contact calms the baby, triggers feeding cues and supports milk release. |
| Treat soreness. | Treating sore nipples relieves pain so the mother can keep feeding instead of stopping. |
| Refer to a lactation specialist. | A lactation specialist gives skilled, hands-on help with latch and milk supply beyond routine care. |
| Review diapers and weight. | Wet diapers and weight show whether the baby is getting enough milk, which confirms or eases the mother's worry. |
**Expected outcomes**
- Within 1 week: baby latches deeply and feeds 8-12 times per 24 hours.
- At least 6 wet diapers per day by day 5.
- Mother reports less pain and names positions she can use.
**Linking the data to the diagnosis**
The new mother has cracked, red nipples and the baby latches shallowly and keeps slipping off. The baby lost 8% of birth weight by day 4 and had 4 wet diapers in 24 hours. The mother says it hurts and she fears she is not feeding enough. This is an actual problem because the feeding trouble and weight loss are already present. Not eating enough to meet body needs would describe the baby's intake only, while this statement includes the latch and the mother's pain. The plan aims for a deep latch with 8-12 feeds per 24 hours within 1 week, at least 6 wet diapers by day 5, and less pain with positions named.
CarePath diagnosis
Breastfeeding difficulty related to poor latch, as evidenced by baby fussy at feeds and poor weight gain.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Teach positions and latch. | A good position and deep latch let the baby take milk well and prevent nipple damage. |
| 2. Encourage skin-to-skin contact. | Skin-to-skin contact calms the baby, triggers feeding cues and supports milk release. |
| 3. Treat soreness. | Treating sore nipples relieves pain so the mother can keep feeding instead of stopping. |
| 4. Refer to a lactation specialist. | A lactation specialist gives skilled, hands-on help with latch and milk supply beyond routine care. |
| 5. Review diapers and weight. | Wet diapers and weight show whether the baby is getting enough milk, which confirms or eases the mother's worry. |
Expected outcomes
- Within 1 week: baby latches deeply and feeds 8-12 times per 24 hours.
- At least 6 wet diapers per day by day 5.
- Mother reports less pain and names positions she can use.
Linking the data to the diagnosis
The new mother has cracked, red nipples and the baby latches shallowly and keeps slipping off. The baby lost 8% of birth weight by day 4 and had 4 wet diapers in 24 hours. The mother says it hurts and she fears she is not feeding enough. This is an actual problem because the feeding trouble and weight loss are already present. Not eating enough to meet body needs would describe the baby's intake only, while this statement includes the latch and the mother's pain. The plan aims for a deep latch with 8-12 feeds per 24 hours within 1 week, at least 6 wet diapers by day 5, and less pain with positions named.