Quality standard

Quality statement 4: Supporting breastfeeding during supplementation with formula

Quality statement 4: Supporting breastfeeding during supplementation with formula

Quality statement

Mothers are supported to continue breastfeeding if their baby is given supplementation with formula because of concerns about faltering growth.

Rationale

Breastfeeding is recognised as the best way to feed babies under 6 months because it meets their energy and nutrient requirements and provides health benefits for the mother, and immunological and other benefits for the baby. If a breastfeeding baby is given formula to supplement breast milk because of concerns about faltering growth, their mother should be encouraged to breastfeed before giving formula, at every feed, to stimulate her breast milk supply. Mothers should also be encouraged to express breast milk and to give any available breast milk before the formula is given. Supplementation with formula is usually a short-term measure, and providing sympathetic, non-judgemental support and reassurance to mothers will help to ensure that they can resume exclusive breastfeeding whenever possible.

Quality measures

Structure

Evidence of local arrangements to ensure that mothers receive practical support to continue breastfeeding if there are concerns about faltering growth and supplementation with formula is recommended.

Data source: Local data collection, for example local care pathways for midwives, health visitors and lactation consultants to provide support to breastfeeding mothers, breastfeeding support staff numbers and availability.

Process

Proportion of mothers who are supported to continue to breastfeed if their baby is given supplementation with formula because of concerns about faltering growth.

Numerator – the number in the denominator who are supported to continue to breastfeed.

Denominator – the number of breastfeeding mothers whose baby is given supplementation with formula because of concerns about faltering growth.

Data source: Local data collection, for example local audit of patient records.

Outcome

Proportion of mothers who are satisfied with the support they receive to continue breastfeeding if their baby has faltering growth.

Numerator – the number in the denominator who are satisfied with the support they receive to continue breastfeeding.

Denominator – the number of breastfeeding mothers whose babies have faltering growth.

Data source: Local data collection, for example patient surveys.

What the quality statement means for different audiences

Service providers (such as maternity services, GP practices and health visiting services) ensure that practical, sympathetic and non-judgemental breastfeeding support can be provided to mothers when formula is prescribed because of concerns about faltering growth. This includes ensuring that sufficient numbers of staff have the expertise to provide this support and that the support is provided quickly to reduce the risk of the mother stopping breastfeeding. Other support, such as loaning breast pumps, should also be given.

Healthcare professionals (such as midwives, health visitors, GPs, and breastfeeding support workers) provide practical, sympathetic and non-judgemental breastfeeding support to mothers when formula is prescribed because of concerns about faltering growth. This includes, for example, reassuring mothers that they are not at fault for their baby's faltering growth, encouraging them to feed their baby with any available breast milk before giving the formula, advising them to express breast milk to promote their milk supply and loaning them breast pumps if needed.

Commissioners (such as clinical commissioning groups and local authorities) commission services that ensure sufficient numbers of staff have the expertise to provide practical breastfeeding support quickly to mothers if there are concerns about faltering growth in their babies.

Mothers of babies who are given formula milk to supplement breast milk are encouraged and helped to continue breastfeeding their baby. They are advised to give their baby any available breast milk before giving formula and to express breast milk to prevent their milk supply from stopping. They are loaned breast pumps if needed.

Definitions of terms used in this quality statement

Concerns about faltering growth

This can include healthcare professionals being concerned about a baby or preschool child's growth, for example if they, or the parents or carers, think the baby or preschool child appears to be:

  • not feeding or eating

  • not growing expected

  • thin or seem unwell.

Healthcare professionals may also have concerns about faltering growth in babies and preschool children if:

  • they lose more than 10% of their birthweight in the early days of life

  • they do not return to their birth weight by 3 weeks of age

  • there is a fall across 1 or more weight centile spaces, if birthweight was below the 9th centile

  • there is a fall across 2 or more weight centile spaces, if birthweight was between the 9th and 91st centiles

  • there is a fall across 3 or more weight centile spaces, if birthweight was above the 91st centile

  • the current weight is below the 2nd centile for age, whatever the birthweight.

[NICE's guideline on faltering growth: recognition and management of faltering growth in children, recommendations 1.1.5 and 1.2.1 and expert opinion]