Quality statement 2: Breast‑fed infants – feeding assessment

Quality statement

Breast‑fed infants with frequent regurgitation associated with marked distress have their feeding assessed.

Rationale

A breastfeeding assessment should be the first step in supporting parents and carers with managing frequent regurgitation of feeds associated with marked distress. Correcting the breastfeeding technique for breast‑fed infants (for example, positioning and attachment) can improve or eliminate the symptoms.

Quality measures

Structure

Evidence of local arrangements to ensure that breast-fed infants with frequent regurgitation associated with marked distress have their feeding assessed before other treatments are offered.

Data source: Local data collection.

Process

Proportion of breast‑fed infants with frequent regurgitation associated with marked distress who have a breastfeeding assessment.

Numerator – number in the denominator who have a breastfeeding assessment.

Denominator – number of breast‑fed infants presenting with frequent regurgitation associated with marked distress.

Data source: Local data collection.

Outcome

Breast‑fed infants with frequent regurgitation associated with marked distress presenting in healthcare settings.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (community care providers, secondary care, women's trusts) ensure that healthcare professionals carry out a breastfeeding assessment and offer advice if breast‑fed infants have frequent regurgitation associated with marked distress, before other treatments are offered.

Healthcare professionals (health visitors, midwives, paediatric nurses or GPs) carry out a breastfeeding assessment and offer advice if breast‑fed infants have frequent regurgitation associated with marked distress, before they offer any other treatments.

Commissioners (clinical commissioning groups, local authorities) ensure that services they commission support parents and carers with guidance and assessments on infant feeding technique.

What the quality statement means for breastfeeding mothers

Breastfeeding mothers receive support and advice about correct breastfeeding techniques for breast‑fed babies with reflux (regurgitating, bringing up or vomiting feeds) who are very distressed, for example, if they cry inconsolably and seem to be in pain.

Source guidance

Definitions of terms used in this quality statement

Breastfeeding assessment

Breastfeeding assessments should be carried out by a health professional with appropriate expertise and training, for example a midwife, health visitor, breastfeeding specialist or paediatric nurse.

[Gastro-oesophageal reflux disease in children and young people (2015) NICE guideline NG1, recommendation 1.2.2]

Marked distress

There is very limited evidence, and no objective or widely accepted clinical definition, for what constitutes 'marked distress' in infants and children who are unable to adequately communicate (expressively) their sensory emotions. NICE guideline NG1 describes 'marked distress' as an outward demonstration of pain or unhappiness that is outside what is considered to be the normal range by an appropriately trained, competent healthcare professional, based on a thorough assessment. This assessment should include a careful analysis of the description offered by the parents or carers in the clinical context of the individual child.

[Gastro-oesophageal reflux disease in children and young people (2015) NICE guideline NG1]

Regurgitation

The voluntary or involuntary movement of part or all of the stomach contents up the oesophagus at least as far as the mouth, and often emerging from the mouth. Regurgitation is, in principle, clinically observable, so is an overt phenomenon, although lesser degrees of regurgitation into the mouth might be overlooked.

[Gastro-oesophageal reflux disease in children and young people (2015) NICE full guideline NG1]

Equality and diversity considerations

Breastfeeding assessments should be carried out in a culturally appropriate manner and any messages communicated in a sensitive way.