Standing feeding orders in a well-baby nursery: "water, water everywhere..."

The objective of this study was to examine standing physician orders affecting healthy breastfeeding newborns for items not in concert with the "Ten Steps to Successful Breast-feeding." All order sets of physicians or physician groups (n = 22) at a mid-sized hospital in central New Jersey (USA) (approximately 1200 deliveries/year) were reviewed. Seventeen orders called for water to be offered routinely as the first feeding. Five order sets called for two or more such feeds. Twelve orders gave infants nothing by mouth (NPO) for more than 2 hours and six mandated 4-hour intervals between feedings. Practices that undermine successful breastfeeding are still ubiquitous. Physician orders, in addition to hospital policy, should be targeted for improvement.