Indicators of effective breastfeeding and estimates of breast milk intake

The authors tested indicators of effective breastfeeding to identify those that provide reliable estimates of human milk intake. Human milk intake of 82 full-term infants was measured by test weights before and after feeding and compared with commonly used breastfeeding indicators: rooting, length of time before latch-on, latch-on, suckle, observable swallowing, and audible swallowing. Two models were tested: model 1, describing indicators at 96 hours postpartum, and model 2, describing indicators at >96 hours postpartum. Median (interquartile) milliliters of mother's milk consumed per feeding was 26 ml (range, 4-47) at 96 hours and 54 ml (range, 26-73) at >96 hours. Significant predictors of human milk intake in model 1 were rooting and observable swallowing (R2=26%, P<.01). In model 2, audible swallowing alone estimated human milk intake (R2=29%, P<.001). Observed swallowing and rooting during the first 4 days (96 hours) following birth and audible swallowing after that time should be included in the breastfeeding assessment of full-term infants.