Documentation of Feeding Decision
Practical

Exclusive Breastfeeding Audit Form
Source: Texas Ten Step
Description: A sample audit form for providers to fill out. Documents feeding choice and – if that choice is not exclusive breastfeeding – why the mother is supplementing.
Date of Access: October 2015



Algorithm of Newborn Feeding Choice
Source: Breastfeeding Consortium
Description: Algorithm for providers to follow if a patient demonstrates a desire to supplement or bottle feed her child. Attempts to ensure that all patient decisions are fully informed and documented accurately.
Date of Access: October 2015



Consent Form to Give Formula and/or Artificial Nipples
Source: CDPH
Description: An example consent form for mothers to sign authorizing formula use and/or artificial nipple use. Addresses breastfeeding benefits and potential reasons to formula feed.
Date of Access: October 2015



Guide to Implementing Breastfeeding Documentation in the EMR
Source: USBC
Description: A guide to documenting breastfeeding/feeding choice in the EMR.
Date of Publication: 2014



Baby Feeding Schedule Documentation Form (1 and 2)
Source: Freeprintablemedicalforms.com, NICHQ
Description: Two sample medical forms meant to document infant feeding.
Date of Access: October 2015



Infant Feeding Report Sheet
Source: IL Department of Public Health
Description: A comprehensive report on improving breastfeeding practices. Includes a postpartum questionnaire regarding feeding intent and feeding practice.
Date of Access: October 2015



Assessment and Observation of Breastfeeding
Practical and Educational

Mother-Baby Assessment Tool (MBA)
Source: Journal of Human Lactation
Description: Academic paper describing the creation and use of the MBA, a tool to assess breastfeeding. Includes the tool as well.
Date of Publication: 1992



Mother-Infant Breastfeeding Progress Tool (MIBPT)
Source: JOGNN
Description: A paper describing the creation and use of the MIBPT, a tool to assess breastfeeding.
Date of Publication: 2007



How Can I Tell If Breastfeeding Is Going Well?
Source: ACPHD
Description: A checklist – intended for new mothers – that helps them and their families to assess how breastfeeding is going.
Date of Access: December 2016



Practical

LATCH Assessment Form
Source: CDPH
Description: A breastfeeding assessment form based on the LATCH scoring system.
Date of Publication: 1994



Breastfeeding Assessment Tool
Source: UNICEF
Description: A checklist based tool to assess breastfeeding. Comes in one week postpartum, and two week postpartum varieties for assessing at different postpartum periods. Date of Access: October 2015



Breastfeeding Assessment Form
Source: LLL
Description: A sample breastfeeding assessment form.
Date of Publication: 1999

Breastfeeding Assessment Sample Policy
Source: CDPH
Description: A sample policy supporting breastfeeding assessment.
Date of Publication: 2003



Sample Breastfeeding Evaluation Form for LCs
Source: UNC (mombaby.org)
Description: A sample evaluation form for LCs to use in lactation clinic.
Date of Access: October 2015



Pacifier Use
Practical and Educational

Texas Ten Step Guide to Giving No Artificial Nipples
Source: Texas Ten Step Program
Description: A guide and sample hospital policy for reducing the use of artificial nipples and pacifiers.
Date of Access: October 2015

Practical

Pacifier and Formula Documentation Form
Source: MN Breastfeeding Coalition
Description: A sample form for mother and provider to fill out to document a mother’s preference for a pacifier and/or formula.
Date of Access: October 2015

Sample Pacifier Guideline
Source: University of Minnesota Children’s Hospital
Description: Sample hospital policy on pacifier use.
Date of Access: October 2015

Educational

Pacifier Handout for Mothers
Source: Erlanger
Description: A one-page sample document informing mothers that the hospital does not hand out pacifiers and why that is the case.
Date of Access: October 2015

Are Pacifiers a Problem for the Breastfed Baby?
Source: Lactation Education Resources
Description: Handout for mothers and families showing the research behind pacifier use. Includes a reference page.
Date of Access: October 2015

Breastfeeding Advice and Counseling
Practical and Educational

Your Guide to Breastfeeding
Your Guide to Breastfeeding for African American Women
Source: Womenshealth.gov
Description: A 50-page guide to breastfeeding for new and expectant mothers. Available in English, Spanish, and Chinese. Moreover, there are two English versions, one for a general audience and one specifically intended for African-American mothers.
Date of Publication: 2011

ABM Protocol for Human Milk Storage
Source: ABM
Descriptions: Paper outlining the proper way to store and use human milk.
Date of Publication: Updated in 2010

Guide to Having Meaningful Conversations with Mothers (plus signature sheets)
Source: UNICEF
Description: A provider’s guide to having meaningful conversations about breastfeeding with new moms, along with ”signature sheets” to document when the provider spoke with the mother and what was discussed.
Date of Publication: 2010

Educational

Ten Reasons to Breastfeed Poster
Source: ILCA
Description: Colorful poster with 10 reasons mother should breastfeed (divided into 5 benefits for baby and 5 for mother).
Date of Publication: 2009

Common Breastfeeding Challenges
Source: Womenshealth.gov
Description: A list of common breastfeeding problems and potential solutions for new mothers. Available in English and Spanish.
Date of Publication: Updated in 2013

It’s Only Natural
Source: Womenshealth.gov
Description: Two page handout with pictures that describes the physical process of breastfeeding. Specifically intended for African-American mothers.
Date of Publication: Updated in 2013

FAQs about Breastfeeding
Source: ACOG
Description: List of FAQs – and answers – about the benefits and process of breastfeeding. Source is targeted toward new and expectant mothers.
Date of Publication: 2013

Baby Feeding Cues Poster
Source: Queensland Government, BreastfeedLA.com
Description: A picture-filled poster to help mothers and providers identify when a baby is hungry. Available in English and Spanish.
Date of Publication: 2013

Hand Expression Pictures
Source: South L.A. Health Projects
Description: A visual description of how to self-express breast milk. Available inEnglish and Spanish.
Date of Access: October 2015

Breastfeeding Tips and Products in English or Spanish
Source: LLL
Description: A booklet for new moms containing breastfeeding tips and listing products that can help.
Date of Publication: 2012

Feeding Cues List
Source: LLL
Description: A list of common baby feeding cues to recognize.
Date of Publication: 2012

Infographic of Breastfeeding
Source: BestStart
Description: Infographic addressing the issues of feeding frequency, stomach size, and urination/defecation frequency in newborns.
Date of Publication: 2009

Guideline for Nursing Mothers
Source: University of Virginia Health System
Description: Infographic addressing the issues of feeding frequency, stomach size, and urination/defecation frequency in newborns.
Date of Access: October 2015

Pumping and Storing Breast Milk 
Source: CA WIC
Description: A two-page, colorful document for new mothers describing how to pump and store milk.
Date of Publication: 2011

Getting Started with Breastfeeding
Source: Stanford
Description: A number of breastfeeding videos for mothers.
Date of Access: October 2015

101 Reasons to Breastfeed
Source: Notmilk.com
Description: List – for mothers – of 101 reasons to breastfeed.
Date of Access: October 2015

Breastfeeding Made Simple
Source: breastfeedingmadesimple.com
Description: Multimedia presentation for mothers about how to breastfeed.
Date of Access: October 2015

Women’s Health Breastfeeding Guides
Source: womenshealth.gov
Description: A number of resources (1, 2, and 3) for new and expectant mothers to read. One of the more comprehensive online educational tools for breastfeeding.
Date of Access: October 2015

Erlanger Patient Education Tool
Source: Erlanger
Description: Multimedia educational tool for new and expectant mothers.
Date of Access: October 2015

How Does Formula Compare?
Source: CA WIC, CO WIC
Description: Colorful visuals comparing the contents of breast milk and formula. In English and Spanish.
Date of Publication: 2013



Understanding Breastfeeding Benefits
Source: NWLC
Description: A guide, intended for new mothers, explaining the benefits they will receive under the ACA and other insurance plans in regard to breastfeeding.
Date of Publication: 2014



Resources and Articles for Mothers
Source: LLL
Description: A list of articles (with links) that concern various aspects of working while breastfeeding. Intended for mothers and families.
Date of Access: October 2015



Hand Expression of Breastmilk
Source: Stanford Medicine
Description: Video demonstrating the techniques of hand expression.
Date of Publication:



What to Do When Baby Refuses Breast
Positioning and Latch
Breast Engorgement
Getting Enough to Eat
Hand Expression
Plugged Ducts
Storage and Handling of Milk
Sore Nipples
Signs of a Good Feeding
Hunger Cues
Source: Lactation Education Resources
Description: Various handouts for mothers on important breastfeeding topics. Colorful and brief.
Date of Access: October 2015



​Audio/Video Resources for Mothers
Source: UNICEF
Description: A number of videos for new or expectant mothers covering topics from hand expression to breastfeeding in public to introducing solid foods.
Date of Access: October 2015

Recommendations for Safe Infant Sleeping Environment
Source: AAP
Description: A paper describing the AAP's recommendations for safe infant sleep.
Date of Publication: 2011