Question Correct answer Wrong answer 1 Wrong answer 2

Which item is covered by the Formula marketed for Breast pumps. Nipple shields.
International Code? (PI #1) children up to 3 years.

Which of the following Offering formula in the first Discussing Providing a list of
undermines breastfeeding? (PI few hours after birth. individualized infant community
#2) feeding plans with support groups.
mothers.
How should a direct care Accept scientific and factual Accept materials Accept clinical
provider respond if offered information only about their about topics other tools with
informational materials provided products. than infant feeding. company logos.
by an infant feeding company
representative? (PI #3)

How should a direct care Refuse to accept any Accept supplies for Refuse financial
provider respond if offered gifts financial or material gifts. homeless patients. gifts but can
provided by an infant feeding accept material
company representative? (PI gifts.
#4)
Why should direct care It gives the appearance of It is acceptable if Acceptable if all
providers refuse financial or product endorsement by the parents don't see it. infant feeding
material inducements? (PI #5) provider. companies are
treated equally.
How can direct care providers Prohibit any posters or Display images and Allow products
help or influence facilities to materials with images of posters featuring that fall under the
avoid deliberate or accidental bottles and teats. bottle-feeding Code be visible to
promotion of feeding bottles or infants. parents.
teats? (PI #6)
Which is a key element to Support for all mothers Specific infant Visitation times
include in the facility's infant including those who do not feeding products and guidelines.
feeding policy? (PI #7) breastfeed. used in the facility.

What does a direct care Comply with the infant Determine who is Comply with the
provider need to do regarding feeding policy in all responsible for policy only in
the infant feeding policy? (PI interactions with parents. Code compliance. public.
#8)
As a direct care provider in this Determining who is Informing parents Informing the
facility, which of these aspects responsible for Code about the policy. general public
can you ignore? (PI #8) compliance. about the facility's
policy.
Why are hospital practices To determine whether We have an The higher
monitored? (PI #9) established targets are met. auditing group that administration has
does it to report to to compile data.
authorities.

Which is considered a sentinel Rate of initiation and Maternal Training hours of

(key) indicator for monitoring exclusive breastfeeding. satisfaction with health staff.
BFHI practices? (PI #10) hospital service.
Which is an open-ended What have you heard about Are you planning to Is there someone
question? (PI #11) breastfeeding? breastfeed? who supports your
feeding
decisions?
When discussing the Breastfeeding is healthy for Lactation for many Infant more
importance of breastfeeding you and your baby. months reduces readily progresses
with a pregnant woman, which your risk of breast through the
is the most appropriate cancer. instinctive stages.
language to use? (PI #12)
A mother says "I am afraid that You are afraid it will hurt…did For most women, Unfortunately,
breastfeeding will hurt." Which you witness this with the pain won't last pain is present for
response is likely to increase someone you know? long. many mothers.
her confidence in
breastfeeding? (PI #13)
A mother says "My mother Are you worried that your Grandmothers tend Give her this
didn't breastfeed and doesn't mother won't be able to help to give much pamphlet about
know how to help me." Which you breastfeed? advice. It may be how breastfeeding
suggestion shows that you better if you focus works so she can
understand her concerns? (PI on newer understand.
#14) information.
Why is breastfeeding important Breastfed babies are Breastfed babies I do not believe it
for the baby? (PI #15) healthier. remain closer to is different from
their mothers formula feeding.
throughout their
lives.
Why is breastfeeding important Breastfeeding reduces risk of Breastfeeding Breastfeeding is
for the mother? (PI #15) breast and ovarian cancer. reduces the risk of part of a mother's
high cholesterol. duty.

What is the global Immediately after birth (within Within 12 hours By 24 hours after
recommendation for when the first hour). after birth. birth.
breastfeeding should begin? (PI
#15)
What is the global Two years or longer. As long as At least one year.
recommendation for how long a possible.
baby should be breastfed? (PI
#15)
What is the global Six months. Four to six months. Twelve months.
recommendation for duration of
exclusive breastfeeding? (PI
#15)
Which of the following is a risk Higher risk of diarrhea. Higher risk of not Higher risk of
for babies who are not bonding with father. malaria.
breastfed? (PI #15)
What will you make sure to The importance of The importance of The importance of
discuss with a pregnant woman breastfeeding and exclusivity. preparing her making sure of
about breastfeeding? (PI #16) breasts for her partner's
breastfeeding. approval.

What is an important reason for The baby is colonized with Mother is colonized The health care
immediate and sustained mother's normal and healthy with baby's provider can do all
mother-baby skin-to-skin bacteria, and baby is warmed bacteria. the post-birth
contact after birth? (PI #16) by mother's body. procedures.
What should you discuss with a Early and exclusive How to diaper the What kind of
pregnant woman about breastfeeding.  baby. feeding bottles
breastfeeding? (PI #16) are best.

Name at least one factor that Emotional support from the Requiring mother to Withholding food
improves the mother's childbirth continuous presence of a lie flat on her back and fluid during
experience (PI #17) companion of choice. during labour. labor.

Why is immediate and Breastfeeding is facilitated Mothers like it. Umbilical cord can
uninterrupted skin-to-skin because of the hormones pulsate 60
between mother and newborn involved with skin-to-skin seconds before it
important for the mother at the contact. is cut.
physiological level? (PI #18)
Why is immediate and Bonding is facilitated because Mother recognizes Infant is calmer
uninterrupted skin-to-skin of eye-to-eye contact and her infant. because mother is
between mother and newborn is touch. calmer.
important for the mother at the
psychological level? (PI #18)

Why is immediate and Infant bonds faster with the Infant is less Infant feels more
uninterrupted skin-to-skin mother because of mutual stressed because secure, and so
between mother and newborn is vocalizations. the mother is does mother.
important for the infant at the calmer.
psychological level? (PI #19)

Why is immediate and Glycemia (blood glucose) is Breastfeeding is Skin-to-skin

uninterrupted skin-to-skin maintained within normal facilitated because increases the
between mother and newborn is limits. the infant is close infant’s heart rate.
important for the infant at the to the nipple.
physiological level? (PI #19)

What is the recommended Immediacy of the skin-to-skin First determine the Dry the infant to
sequence when placing the contact; when skin-to-skin, stability of the reduce
infant skin-to-skin with the infant’s head and back are infant before evaporation;
mother? (PI #20) thoroughly dried; determine placing him on the assess the
the stability of the infant while mother; dry the infant’s breathing,
skin-to-skin with mother. infant to reduce coloration,
evaporation; then responsiveness;
place the infant then place the
face-to-face with infant side-lying
the mother. with the mother.

What are key points that should Colour, breathing, free Crying, position, Vocalizations,
be assessed when the newborn movements of head and temperature. opening of eyes,
is skin-to-skin with the mother? neck. oxygen saturation.
(PI #21)
Why should skin-to-skin be Infant’s temperature will Infant’s tone will Infant's glycemia
uninterrupted? (PI #22) decrease. decrease. (blood glucose)
will increase.
When would it be acceptable to In presence of a medical Mother had a For a first
interrupt skin-to-skin within the issue. caesarean section. thorough
first 2 hours after birth? (PI #23) observation of the
infant.
What is the recommended Keep baby skin-to-skin with Place the newborn Place the
sequence for transferring the mother, covered with a skin-to-skin on the wrapped newborn
mother and infant together in dry blanket; make sure the support person, in the support
another room? (PI #24) baby is secure. covered with a dry person’s arms.
blanket.

Why is suckling at the breast Sucking triggers normal onset Infant is fed so Mother can safely
important in the first 2 hours, of milk production. glycemia (blood rest after first
when the baby is ready? (PI sugar) is normal. suckling.
#25)
Which sequence best describes Mother is in semi-recumbent Mother is in Mother is lying flat
at least 3 aspects of safe care position; infant’s breathing, recumbent position; on the bed; infant
of the newborn in the first 2 coloration and infant lies flat on lies flat on the
hours after birth? (PI #26) responsiveness are checked the mother’s mother’s
regularly; infant’s nose and abdomen; infant is abdomen;
mouth are always visible. well covered with mother's blood
two blankets to pressure and
keep temperature pulse are
stable. assessed
regularly.

When the baby is placed skin- Moving to the breast and Slowly going into Crying
to-skin on the mother at birth, touching the mother's body deep sleep then vigourously and
what behaviors should he and breast. starting to move then resting
demonstrate instinctually before hands and feet. without
latching? (PI #27) movement.
What should you discuss with a Respond promptly to infant Advise mother to Recommend
mother to prevent engorged feeding cues. breastfeed every 4 mother to only
breasts? (PI #28) hours. feed for 10
minutes per
breast.
Which statement about Baby will get all the nutrients Mothers do not Some
exclusive breastfeeding is needed by effective exclusive have enough supplementation
correct? (PI #29) breastfeeding. breastmilk in the with artificial milk
first few days. won't alter the
intestinal
microflora.
What information would you Minimum feeding frequency Feeding patterns Mother should
share with a mother about a is 8 times per 24 hours. are determined by only feed the baby
normal baby's typical feeding the mother so that 6 times per 24h.
patterns in the first 36 hours of the infant is
life? (PI #30) correctly trained to
a feeding schedule.
What is a common normal Baby nurses for 10-30 Feeds every 4 Feeds for 10
nursing pattern for a newborn in minutes, at least 8 times a hours for 5-10 minutes then
the first few days? (PI #30) day in the first few months. minutes. needs to be
burped.
Which of the following is a sign Baby passes meconium stool At least 4 stools by Stools are dark for
of adequate transfer of milk in followed by increase in stool Day 2. the first week of
the first few days? (PI #31) output. life.
What are 2 things that should Infant has rhythmic bursts of Infant has sucking Mother supports
be observed when assessing a sucking with brief pauses; movements at the he infant's head;
full breastfeeding session? (PI infant releases the breast at jaw; infant sucks at mother admits her
#32) the end of feed in obvious both breasts. nipples hurt a little
satiation. during feeds.

Name an important aspect that Mother’s nipple is wet with Mother’s nipple is Baby brings fist to
is observed at the end of a full milk, intact, and comfortable. creased at the tip. mouth and begins
breastfeeding assessment. (PI sucking again.
#32)

What is the BEST way to help a Help the mother identify how Encourage a Show the mother
mother achieve a comfortable to hold her baby to best mother to try a by placing her
and safe position for facilitate the baby’s innate number of different baby at the breast
breastfeeding during the reflexes and latching. positions very early for her.
hospital stay? (PI #33) on so she can
choose the one she
prefers.

What are 2 key points for Baby's head and body are in All of mother’s Baby's nose is
effective positioning baby at line; baby is supported. areola is in the buried in the
breast? (PI #33) baby's mouth. breast.
When helping a mother to Observe the mother Ensure the mother Explain that pain
achieve an effective and breastfeeding. brings baby to the is normal for the
comfortable latch, what is the breast and not first few weeks.
FIRST thing to do? (PI #34) breast to baby.

Why does 24-hour rooming-in Mothers learn to recognize Easier for mother to Mother learns to
support breastfeeding? (PI #35) and respond to baby’s tend to baby's cope with
feeding cues. diapers. interrupted sleep.
Which reason to separate a Mother is unconscious or Mother needs to Mother is obese
mother and baby is justified medically unstable. rest/sleep.
because of the mother's
condition? (PI #36)
Name a reason to separate the Baby needs respiratory Baby sleeps better Easier for staff to
baby from the mother because support. alone examine the baby
of the baby's condition. (PI #36)

Which of the following is an Baby is salivating or rooting. Baby is crying. Baby is moving
early feeding cue? (PI #37) around in the bed.

Name the most important Baby opens the mouth and Sucking Baby is crying
newborn feeding cue. (PI #37) turns toward the breast movements on a frantically.
(rooting or seeking). pacifier.
Why is responsive feeding is Babies learn how to self- Responsive feeding Mothers who
important for all mother-baby regulate at the breast or with is for breastfed bottle-feed should
dyads? (PI #38) a bottle. babies not for schedule feeds.
bottle-fed babies.

What does responsive feeding Responding promptly to the Responding to all Ensuring
mean? (PI #39) infant's cues for feeding. baby's behaviours scheduled
by breastfeeding feedings for the
the baby at any baby.
time.
When demonstrating to a Wash her hands. Slide her fingers Massage the
mother how to hand express from breast to areola.
her milk, it is important to areola.
remind her to: (PI #40)
Which statement about the Freshly expressed human Freshly expressed Any plastic
appropriate storage of milk stored in a very warm warm milk could be containers with a
breastmilk is correct? (PI #41) room for more than 4 hours added to already lid are good
should be discarded. cooled or frozen storage
milk to increase the containers.
storage amount.

Which statement about Discard the remaining milk Re-heat human Thawing milk in
handling of thawed expressed within 1–2 hours after the milk to above 60 warm water
breastmilk is accurate? (PI #42) infant's feed. degree C to kill the causes less fat
bacteria in the milk. loss than slow
thawing in the
refrigerator.
What is the key point to discuss Preterm, late preterm, or A stable preterm A preterm baby
with a mother know before she some weaker infants may not infant demonstrates can latch properly
breastfeeds her preterm infant? initially open their mouths the same only after
(PI #43) wide enough to latch. behaviours as a reaching a certain
term baby. gestational age.
If a preterm, late preterm, or Encouragement to use A caution that Encouragement to
low-birth-weight infant is not frequent hand expression and prolonged skin-to- let the baby sleep
sucking effectively at the breast, compression of the breast. skin contact can as along as the
a conversation with the mother stress the baby. baby wants and
should include: (PI #44) avoid waking for
feeds.
Why does a mother need to be Helps her baby heal and Reduces workload Baby is too
with her sick or preterm infant in grow; the mother can for the direct care fragile.
the Intensive Care unit? (PI breastfeed or provide her providers.
#45) milk.
What is unique about Breastfeeding at the breast is Breastfeeding Responsive
responsive feeding for preterm guided by the infant’s should be feeding for
infants? (PI #46) competence and stability scheduled more preterm infants is
rather than a certain frequently because possible only
gestational/postnatal/postme the preterm babies when the baby is
nstrual age or weight. have very small over 36 weeks
stomachs. gestational age.
Which condition is an absolute Baby with galactosemia. Mother with Premature baby
contraindication for COVID-19 with birth weight
breastfeeding or breastmilk infection. 1700gm.
feeding? (PI #47)

When should supplementation Hyperbilirubinemia Mother is Mother has

of a breastfed baby with donor associated with low exhausted or in requested baby
milk or formula be considered? breastmilk intake despite pain. be supplemented.
(PI #48) thorough investigation of
breastfeeding.
A 4 days old exclusively Baby may need Baby should be Infant should not
breastfed full-term infant was supplementation with bottle fed be fed by formula
readmitted to hospital for scant expressed milk, donor milk or immediately in because it will
urine, no stool and dehydration. formula until breastfeeding is order to make sure undermine
Which of the following actions is assessed and corrected. of the milk intake. breastfeeding.
the MOST APPROPRIATE? (PI
#48)

After a skilled assessment and A three-day-old baby did not A five-day-old baby A mother with
management of breastfeeding, have any stool for two days. with body weight eczema over right
which of the following condition His mother had bilateral same as birth breast which
is a medical indication for nipple surgery for inverted weight, 5 heavy wet itches during
supplementing the breastfed nipples in adolescence. diapers per day, 4 breastfeeding.
newborn? (PI #48) yellow brownish Her 7-day-old
stool per day. baby is gaining
Mother has weight.
diabetes mellitus.

Which statements about giving Giving any food or fluids Formula offers Formula does not
a breastfed newborn any food other than breastmilk may complete nutrition, change the
or fluids other than breast milk, interfere with the same as microbiota of the
in the absence of medical establishment of breast-milk breastmilk. It does baby.
indication is CORRECT? (PI production. no harm.
#49)
When a 2-day-old breastfed Mother’s own expressed milk. Oral glucose water. Standard infant
baby with cleft palate needs formula.
supplementation following poor
suckling at breast even after
skillful help, which of the
following is the BEST CHOICE?
(PI #50)

A breastfeeding mother is Assess a breastfeed to Explain to her the Give her a pacifier
concerned about her 2-day old evaluate the presence of risks of introducing to calm the baby.
baby’s frequent crying. She medical indications for formula.
asks to get a bottle of formula supplementation.
so that she and her baby can
have a good sleep. What is
your best action after you have
listened to her concerns? (PI
#51)
A first-time pregnant woman It seems that you are worried You know, early You will have
asks: "I am afraid that I may not about not being able to skin-to-skin contact enough breastmilk
have enough milk for my baby, exclusively breastfeed your and frequent for your baby!
like my sister. I want to make baby. Could you tell me more breastfeeding will Don’t worry.
sure I know about bottle-feeding about that? make enough milk Breastfeeding is
also. How often should I for your baby. natural.
formula feed my baby while
continue breastfeeding?” Which
response of the following is
MOST APPROPRIATE? (PI
#51)

Which step about safe Use boiled water and add Routinely add one Feed the baby
preparation of formula is formula while water is above scoop of formula to immediately after
correct? (PI #52) 70 degrees C. 30cc boiled water. mixing formula
powder with
boiled water.
What is an important element of Baby should be held securely Baby is lying Baby is asleep.
safe cup feeding? (PI #53) upright. supine on a flat
surface.

What is an UNSAFE action Pour the milk in the baby’s When the baby Hold baby fairly
during cup feeding? (PI #53) mouth. closes his/her upright for feeds.
mouth and will not
take any more, stop
cup feeding.
What is a safe manner to feed Look out for and respect Lie the baby down Force the baby to
an infant a supplement? (PI# satiation cues. flat and feed a take a bottle.
54) bottle.
Which method of providing a Cup-feed with small open Feed with bottle Use a dropper in
supplement is MOST likely to cup. and fast-flow teat. the corner of the
preserve breastfeeding? (PI baby's mouth.
#55)
Which feeding device is MOST Open cup. Syringe. Teat.
APPROPRIATE if a preterm
baby cannot yet breastfeed but
can tolerate oral feeds? (PI
#55)
Which statement about the use The use of a pacifier prevents There is no Babies need a
of feeding bottle, teats and the mother from observing difference between pacifier to prevent
pacifiers is correct? (PI #56) the infant’s subtle feeding bottle feeding and sudden infant
cues, which may delay breastfeeding. death syndrome.
feeding.

A breastfeeding mother of a 2- You seem anxious that the It is very common I will bring you a
day old baby asks for a pacifier, frequency of the feeds may for a 2-day-old pacifier. Don’t
saying ”My baby sucks so damage your nipples.... baby to suck every worry.
frequently that my nipple could 2-3 hours. Do you
not stand it anymore!" You have know the risks of
assessed a breastfeeding, and using pacifier?
everything seems as expected.
What will you respond next?
(PI #56)
Which of the following Recommending scheduled Practicing frequent Keeping the baby
contributes to the most common feeds with set duration. skin-to-skin contact in the same room
problems of lactating breasts? between feeds. so that the mother
(PI #57) can respond to
feeding cues.

When a mother says her Observe a full breastfeed, Tell her sore Give her an
nipples are painful, what is the looking for deep attachment nipples are normal ointment to put on
FIRST action that should be at breast. at the start of her nipples.
taken? (PI #57) breastfeeding
If a mother's nipples are flat or Place the baby in skin-to-skin Give her a nipple Help her hand-
inverted, what is the FIRST contact immediately after shield and explain express her milk
important action to take? (PI birth and allow the baby to how to use it. and feed it with a
#57) move to the breast. cup.

On day 3, the mother's breasts Help the mother express Apply cold packs to Apply warm cloths
are full and hard, making it some milk to soften her the breasts. to the breasts.
difficult for the baby to latch. breast before attempting to
Which suggestion is most feed her baby.
helpful? (PI #57)
A baby who is having difficulty Help the mother attempt to Refer the baby for Give the mother a
latching has a short, tight reposition the baby to an oral nipple shield.
frenulum (band under the achieve a deeper latch. examination.
tongue). What is the first thing
to try to help the baby? (PI #57)

A mother is feeding her healthy The baby's effective latch at Mother's Baby's
infant in an appropriately breast and sucking. expectations of temperament.
frequent pattern. She says her baby behavior.
baby is crying frequently. What
should you NEXT assess? (PI
#58)
A mother says her healthy Baby's feeds are limited in Mother is Baby hasn't had
infant is crying frequently. What length and/or frequency. depressed. enough sleep and
is the MOST LIKELY reason for is tired.
the baby's crying? (PI #58)

What to suggest to new parents Mother or partner can hold Let the baby cry it Crying is a good
for calming their infant who the baby in skin-to-skin out. Do not let exercise for baby.
continues crying after an contact. him/her manipulate Do not worry
effective feed? (PI #59) you. about that.
Where do you recommend Breastfeeding clinics or peer A baby-products A help line from
mothers to seek help on infant counselors. store. an infant feeding
feeding once they leave the product company.
hospital? (PI #60)
What are ways that a hospital Sharing similar or same This is not the role There may be
can coordinate breastfeeding materials to be given to of the hospital. meetings, but we
messages with the community? parents. don't know about
(PI #61) them.
What are some of the essential Basic elements of feeding Where to get What kind of
issues related to feeding to patterns and how to know her information about nipple cream to
discuss with a mother before baby is getting enough milk. family planning. get for sore or
she leaves the hospital? (PI cracked nipples.
#62)
Which of the following is a Baby is regularly sleeping for Baby swallows Most feeds last
warning sign of more than 4 hours at a time after every 3–4 only 20 minutes.
undernourishment or in the first week and is sucks.
dehydration in the infant? (PI difficult to arouse.
#63)
What information would you Baby has scant amount of Baby feeds 8 or Baby sleeps less
share with a mother about when urine per day. more times per 24 than 4 hours at a
she should bring her baby to a hours. time.
healthcare professional after
discharge? (PI #63)

Which of the following is normal Full breasts before a feed. Persistent painful Fever that
for a breastfeeding mother after latch. persists for days.
discharge? (PI #64)
Wrong Answer 3 Explanation of correct answer St PI ID
ep
Foods marketed Breast pumps, nipple shields and foods marketed for infants over 6 1 1
for infants over 6 months are not covered by the Code.
months.
Affirming that the Anything that erodes or undermines the mother's ability to breastfeed 1 2
mother is doing a and interfere with building an adequate milk supply should be avoided.
good job.

Accept patient Materials provided by manufacturers and distributors may include 1 3

education subtle biases and lead health care providers to subtly favour infant
materials about feeding company products, thereby undermining breastfeeding.
breastfeeding.

Accept office Health care providers should refuse all financial or material gifts from 1 4
supplies because infant feeding company representatives because doing so may subtly
those do not favour infant feeding company products over breastfeeding.
affect judgment.

Acceptable if Accepting financial or material inducements may unintentionally sway 1 5

budgets are tight the provider to recommend products to patients that are not specific to
their needs.

Allow marketing of Facility should not post any images featuring infants being bottle fed. 1 6
bottles and teats Breastfeeding should be featured as the norm.
to the public.

Medications used An infant feeding policy should include all Ten Steps, the Code, 1 7
for lactation support to all mothers including the ones who decide not to
suppression. breastfeed, and how the facility monitors progress towards the Ten
Steps.
Discipline other Direct care providers are always expected to comply with the entire 1 8
providers who infant feeding policy of the facility.
violate the IFP.

Collecting data Direct care providers are expected to comply with the Code and assist 1 8
about the facility in complying with the Code.
breastfeeding
rates.
Administration Hospitals monitor practices to determine if established targets are met 1 9
wants to make in many aspects of health care.
sure all patients
are treated the
same,
Cesarean section Early and exclusive breastfeeding are sentinel (key) indicators of 1 10
rate health.

Did your mother Open-ended questions solicit more than a 'yes-no" response and lead 1 11
breastfeed? to more conversations and options.
Postpartum Simple, direct sentences and terms are more likely to be understood 1 12
fertility is delayed and accepted by young women or those with less education. The
with exclusive other responses use complex, technical terms.
breastfeeding.

If you listen to An empathetic response that acknowledges the mother's fears 1 13

what I explain to followed by a positive framing is likely to increase the mother's
you, it will not confidence.
hurt.

I hear that from A response that helps her identify workable solutions that are 1 14
many pregnant responsive to her specific concerns and circumstances is likely to build
women. She will her confidence.
find ways to help
you.

Formula feeding Formula-fed babies are more likely to get sick from infections. 3 15
allows the baby’s
father to be more
involved.

Breastfeeding Breastfeeding reduces risk of breast and ovarian cancer, type II 3 15

allows her to get diabetes, and postpartum depression.
pregnant soon
after giving birth.
When the The baby is able to crawl to the breast and begin breastfeeding within 3 15
mother's milk the first hour of birth. Delays of even a few hours are harmful.
comes in.

Until the mother's The World Health Organization recommends exclusive breastfeeding 3 15
milk dries up. for six months and then continued breastfeeding combined with solid
foods for 2 years or as long as mother and baby desire.

At least one The global recommendation is six months of exclusive breastfeeding. 3 15

month.

Higher risk of The major risk of not breastfeeding (formula feeding) is the lack of 3 15
guinea worm immune protection.
infection.
The importance of A protocol for antenatal discussion of breastfeeding includes at a 3 16
her mother's minimum: the importance of breastfeeding; global recommendations
approval. on exclusive breastfeeding for the first 6 months, the risks of giving
formula or other breastmilk substitutes, and the fact that breastfeeding
continues to be important after 6 months when other foods are given;
the importance of immediate and sustained skin-to-skin contact; the
importance of early initiation of breastfeeding; the importance of
rooming-in; the basics of good positioning and attachment; recognition
of feeding cues.

Mother can tell Immediate and sustained skin-to-skin colonizes the baby with mother's 3 16
the gender of the normal and healthy bacteria flora and stabilizes the baby.
baby.
Special foods that Prenatal discussions with mothers should include, at a minimum: the 3 16
will help her make importance of breastfeeding; global recommendations on exclusive
more milk. breastfeeding for the first 6 months, the risks of giving formula or other
breastmilk substitutes, and what to expect after giving birth.

Routine shaving A companion, food & fluid intake, mobility and choice of position, 3 17
of pubic hair and and/or pain relief improve the birth experience
administering an
enema.
Mother’s attention Skin-to-skin facilitates breastfeeding especially when it is immediate 4 18
is on the infant and uninterrupted, because of the hormonal surge it brings in the
and not on the mother.
birthing room
routines.
Mother can Eye-to-eye contact and touch are essential elements for psychological 4 18
stimulate her aspects of mother-baby bonding.
infant.

Infant cries less Babies hear their mother's voice during pregnancy and respond 4 19
so parents are quickly during immediate and uninterrupted skin-to-skin contact after
happy. birth. Mothers respond to their baby's early vocalizations at a deep
psychological level.

Infant’s glycemia Immediate and uninterrupted skin-to-skin contact after birth fosters 4 19
(blood glucose) normalization of the baby's cardiac, respiratory, and blood glucose
increases. levels.

Immediacy of the Immediately after birth, the wet naked baby should be placed on the 4 20
skin-to-skin mother's naked upper body, and the infant's head and back should be
contact for all dried thoroughly.
term infants;
determine the
stability of the
infant while skin-
to-skin with
mother; assess
the infant’s
breathing,
coloration, eye
opening.

Weight of baby, The baby's colour, breathing, and free movements of head and neck 4 21
heart rate, cap or should be checked and monitored while the newborn is in skin-to-skin
hat on baby. contact with mother.

Infant’s cortisol Any interruptions to skin-to-skin contact after birth, even brief ones, 4 22
will decrease. cause stress to the baby including decreased temperature and higher
levels of cortisol.
Mother is Interruption of skin-to-skin contact in the first two hours after birth 4 23
nauseated. should only occur if there is an urgent medical complication of mother
or baby.

Place the Keep the baby skin-to-skin and securely on the mother's body, 4 24
wrapped newborn covered with a dry blanket during any transfer to another room.
vertically between
mother’s breasts;
the mother
crosses her arms
around the baby
for a secure hold.

Prevents infant Sucking at the breast in the first two hours trigger normal onset of 4 25
dehydration. lactation (breastmilk production), increases uterine contractions, and
reduces risk of infant mortality.

Mother is lying flat The mother is semi-recumbent; the baby's breathing, color and 4 26
on the bed; responsiveness are monitored frequently. The baby's nose and mouth
infant’s breathing, always remain visible.
coloration and
responsiveness
are regularly
assessed; blanket
is tight around the
baby, so the
temperature is
stable.

Slowly calming Babies go through nine instinctive stages after birth as they move to 4 27
down so a helper the breast, touch the mother's breast and body, then begin
can assist the breastfeeding. If the baby briefly rests, merely observe until the baby
baby to reach the begins moving again.
breast
Recommend Prompt response to the baby's feeding cues and unrestricted length 5 28
mother limit fluid and letting the baby nurse as often and long as desired is the best
intake. way to prevent breast engorgement.

Mother needs to Frequent effective breastfeeding could provide baby the needed 6 29
exclusively energy and fluid. Even one dose of formula changes the microbiota.
breastfeed every There should be no time limit for exclusive breastfeeding.
3-4 hours to have
enough milk.

Cluster feeding Newborns normally nurse frequently - at least 8 times in 24 hours - in 5 30

indicates low milk the first days of life.
transfer and baby
necessitates
supplementation.
Nurses 4-6 times Normal breastfed babies nurse for about 10-30 minutes per feed, 3 30
a day and sleeps taking one or both breasts, about 8-12 or more times a day.
3-4 hours at a
time.
Baby has a large Passing meconium (dark) stool and increasing stool output, becoming 5 31
stool every day. more yellow, is a reliable sign of adequate milk intake by the baby.

Mother's nipples Behaviours to observe during a full breastfeeding session include 5 32

hurt a little at the infant sucking rhythms, bursts of sucking, and the infant's release of
beginning of the the breast at the end of the session in obvious satiation.
feed; infant has
rhythmic bursts of
sucking.
Milk is spurting At the end of the feed, the nipple should be wet with milk, intact and 5 32
from the mother’s comfortable, and the baby relaxed and showing signs of satiation.
breast and the
breast is still
feeling full.
Use pictures and Observe how the mother holds and positions her baby, gently 5 33
dolls so that reinforcing what is effective and offering any helpful suggestions.
standard advice
on one position is
always given.

Latch is painful for Four key points of effective positioning are: baby's head and body are 3 33
the mother. in line; baby is held close to mother's body; baby is supported; and
baby's nose touches mother's nipple.
Demonstrate to Observation of a full breastfeed is the first step in helping mother and 5 34
the mother how to baby achieve comfortable, effective breastfeeding.
release a latch
that is painful or
shallow without
hurting herself.
Harder for Rooming-in day and night helps mother recognize her baby's feeding 7 35
medical team to cues and to feed frequently and responsively. Rooming-in also
examine baby. improves bonding.
Easier for the staff Mother is medically unstable and unable to safely care for her baby. 7 36
to assess
mother's well-
being
Baby is being A baby with a ventilator needs professional supervision. 7 36
treated with
phototherapy.

Baby is wide Feeding cues are subtle changes in the baby's behaviour showing 8 37
awake. hunger. Cues signal the mother to get ready before the baby becomes
impatient and cries.
Baby is restless The most obvious first feeding cue is baby rooting for the breast. 3 37
and cannot settle. Sucking motions are an early cue but can be masked by pacifier use.
Crying is a late hunger cue.
Babies learn to Responsive feeding teaches trust and self-regulation. 8 38
request a feed
whenever they
want.

Ensuring baby is Responsive feeding is part of nurturing care and means to respond 8 39
fed often and for promptly to the infant's needs.
short periods.

Express for 2 Handwashing before handling her breast prevents any accidental 5 40
minutes at most. contamination of the milk and her breast.

Containers for Freshly expressed human milk may be stored safely at room 6 41
human milk temperature (10–29C, 50–85F) for some period of time. For room
storage must be temperatures ranging from 27C to 32C (29C= 85F), 4 hours may be a
sterilized with reasonable limit according to the present evidence. Containers do not
boiling water need to be sterilized. Complete washing in hot soapy water and
every time they rinsing is enough.
are used. Careful
washing in hot
soapy water and
rinsing are not
enough.

Use the earlier Some bacterial contamination occurs in thawed milk. Current 6 42
expressed milk recommendation is to discard any remaining thawed milk 1-2 hours
instead of fresh after the infant's feed.
milk first so the
older one will not
be wasted.
There is no such Preterm, late preterm or weak infants may be unable to open their 5 43
thing as a shallow mouth enough for a deep, effective latch.
latch for a preterm
baby.

A late preterm Preterm, late preterm or low-birth-weight babies may not be able to 5 44
reacts exactly the effectively obtain milk at breast. Encourage the mother to hand-
same as a term express her milk and use breast compression during feeds to assist
infant. milk transfer.

Mother brings in Sick and preterm babies need their mothers' presence, milk, and touch 7 45
bacteria. even more than healthy babies. Mothers should be enabled to visit the
intensive care unit as often and for as long as they want.

Preterm infants do Breastfeeding at the breast is guided by the preterm infant’s 8 46

not show feeding competence and stability rather than a certain
cues so they have gestational/postnatal/postmenstrual age or weight. And mother has to
to be awakened at learn discrete signs of readiness to feed.
frequent intervals.
Infant with Galactosemia is the only absolute contraindication to breastmilk or 6 47
congenital heart breastfeeding in WHO “Acceptable reasons” document. Considering
disease. the benefits of breastfeeding and the insignificant role of breast milk in
the transmission of other respiratory viruses, a mother could continue
breastfeeding if she gets COVID-19 infection.

Baby needs A thorough breastfeeding evaluation should be done before 6 48

phototherapy. supplementation is considered.

Infant should be Scant urine and no stool are signs of inadequate milk intake, which is 6 48
exclusively a medical indication for supplementation while breastfeeding is
formula fed improved.
because mother's
milk is
inadequate.

The mother feels The baby did not have adequate intake. Mother's previous nipple 6 48
tired because her surgery may damage the nerve supply and influence the milk
4-day-old baby production.
could not sleep
longer than 4
hours at night.

It can prevent When there is no medical indication, adding any food or fluid other 6 49
infants' than breastmilk, does not show any effect as the statement.
dehydration,
jaundice or
hypoglycemia.

Hydrolysate infant Expressed breast milk from the infant’s mother is the first choice for 6 50
formula. extra feeding for the breastfed infant.

Reassure her that First, health workers need to evaluate the breastfeeding and other 6 51
it’s common for a relevant condition to explore the reason of baby’s crying. Only after
baby to cry at the then, they can give the right timely help.
second night and
give her a bottle
so that they both
can sleep for a
while.
The answer This response accepts the feeling of the woman, also uses an open 6 51
depends on question to explore the underlying cause of the feeling.
whether you could
get help from
different direct
care providers.

Use reconstituted Allow the water to cool to not less than 70 °C because powdered 6 52
formula within 4 formula may contain pathogens which may be killed if the temperature
hours. is above 70C.

Cup is rocked During safe cup feeding, the baby should be held securely upright, 9 53
quickly back and awake and alert, and the feed should progress at a pace comfortable
forth to maximize for the baby.
baby’s intake.
Ensure the baby Pouring milk into the baby's mouth may cause aspiration and does not 9 53
is fully awake, actively involve the baby in feeding.
alert and
interested in
feeding.
Insist on having A safe feeding manner includes: holding the baby fairly upright for 6 54
the baby finish a feeds, allowing the baby to drink at his/her own pace, and responding
bottle. to the baby's satiation cues.
Jiggle the bottle A small open cup is the safest way to supplement a baby, and most 6 55
and teat for faster likely to preserve breastfeeding.
intake.

Tube against a If an infant cannot feed from the breast, then the safest alternative is 9 55
finger. to feed from a cup. Even low-birthweight and premature babies can
cup feed.

Bottles/teats/pacifi Baby's sucking cues can be masked by pacifier use. Teats may alter 9 56
ers can help the baby's sucking response at the breast.
mothers
overcome the
difficulties of
breastfeeding.
Transient nipple Accept the mother’s feeling and reflect back with empathy, which will 9 56
pain is very make it easier for mother to take your further suggestion.
common in the
first few days. It
will pass very
soon.
Keeping the baby Scheduled feeds often cause too much milk to remain in the breast 5 57
at her breast for which causes pain and other breast problems. Frequent unrestricted
as long as baby breastfeeding prevents many problems of lactating breasts.
desires.

Tell her to shorten When a mother says her nipples are sore, first observe a full 5 57
the length of the breastfeed. Then, if needed, help her to reposition the baby with a
feed. deeper latch.

Suggest that the Immediate skin-to-skin contact and allowing the baby to find the breast 5 57
mother pull and is the FIRST action to take. Many babies can nurse effectively even if
stretch the nipples the mother's nipples are flat or inverted.
before trying to
feed.
Give her a nipple If the mother's breasts are so full and hard that the baby has difficulty 5 57
shield to put over latching, expressing some milk to soften the breast is often helpful.
the nipples.

Have mother Attempting direct breastfeeding by repositioning the baby for a deeper 5 57
express milk and latch is the first strategy. If that is unsuccessful, then other actions can
feed with a cup. be taken.

Mother's anxiety After assuring appropriate feeding frequency and length, the next 8 58
level observation is whether the baby is in a deep, comfortable position at
the mother's breast during the entire feed.

Her milk Frequent crying in an exclusively breastfed, healthy is most likely due 8 58
composition is too to hunger. Encourage the mother to feed more often and as long as
low in calories the baby desires.
and fat.

You should wait Skin-to-skin contact and holding could help to calm the baby. 9 59
until the baby
cries before
feeding it.
Always call her Mothers should be given information about Code compliant, locally 10 60
mother first. known local resources in the community.

Each organization To get a seamless transition for this population, discussions, 10 61

has different meetings, communications should be coordinated.
functions.

How to correctly Discussions during hospital stay should have been about knowledge, 10 62
use her breast skills the mother could acquire to be confident in what she is doing
pump. and to prevent most common complications such as engorgement,
sore or cracked nipples, mastitis.
Stools are A normal healthy newborn has short (60-90 minute) sleep cycles in the 5 63
mustard-coloured early weeks. Sleeping longer than 4 hours and difficulty arousing are
and the signs of undernourishment.
consistency of
yogurt.
Baby has Scant urine is a warning sign of dehydration. 10 63
yellowish stool
more than three
times a day.

Aversion to the Mother's breasts are usually fuller before a feed, and less full after an 10 64
child. effective feed throughout the breastfeeding period.