Breastfeeding assessment instruments and their use in clinical practice

This is an integrative review of literature obtained from six databases and an online library, conducted from August 2014 to December 2015, without a temporal delimitation.

Results

We identified 19 assessment tools, of which 12 were validated and five were cross-culturally adapted. In terms of adaptation, the tools were used to assess the risk of early weaning (BAPT) and the perception/behaviour of mothers during nursing (BSES-SF and IIFAS).

Conclusions

The identification of the available instruments and their indications for breastfeeding assessments can help health workers choose the ideal instrument, and qualify maternal and child care.

Breast feeding; Evolution; Postpartum period

Instrument/Author/Year	Objective
Category 1 – Risk assessment of early weaning
Breastfeeding Attrition Prediction Tool (BAPT)/Janke, 1991^(13-18)	Identify women who have a tendency toward early weaning.
Breastfeeding Assessment Score (BAS)/Hall et al., 2002^(19-20)	Identify women who have a higher risk of weaning in the first ten days of the child’s life.
Category 2 – Assessment of the perception and behaviour of nursing women
Breastfeeding Personal Efficacy Beliefs Inventory (BPEBI)/Cleveland and McCrone, 2005 (21)	Measure the confidence of women regarding their ability to manage their thoughts, emotions, motivation, action and environment to successfully breastfeed for one year.
Breastfeeding Self-Efficacy Scale (BSES)/Dennis and Faux, 1999^(22-28)	Assess maternal behaviour in relation to breastfeeding from the perspective of self-efficacy.
Breastfeeding Self-Efficacy Scale – Short Form (BSES-SF)/Dennis, 2003^(29-46)
H & H Lactation Scale (HHLS)/Hill and Humenick, 1996^(47-48)	Measure maternal perception of insufficient milk production.
Iowa Infant Feeding Attitudes Scale (IIFAS)/De la Mora et al., 1999^{(40, 49 -60)}	Measure maternal attitudes towards lactation and identify factors that influence decisions related to infant feeding methods.
Maternal Breastfeeding Evaluation Scale (MBFES)/Leff, Jefferis and Gagne, 1994^(61-64)	Evaluate maternal perception of success in breastfeeding.
Category 3 – Assessment of maternal behaviour/attitude and infant sucking skills in breastfeeding
B-R-E-A-S-T-FEED Observation Form (BREAST)/Armstrong, 1992⁽⁸⁾	Guide the observation and assessment of mother and child behaviour during breastfeeding.
Lactation Assessment Tool (*LAT ™*)/Cadwell et al., 2004/Blair et al., 1999^(65-66)	Document breastfeeding, suggest corrective interventions to optimise holding and positioning for lactating women with pain associated with nipple trauma.
LATCH Scoring System (LATCH)/Jensen, Wallace and Kelsay, 1994^{(63, 67-73)}	Systematically document the assessment of breastfeeding during individual sessions.
Mother-Baby Assessment Tool Scoring System (MBA)/Mulford, 1992^{(67-68, 73)}	Evaluate the learning process in breastfeeding (mother and child).
Mother-Infant Breastfeeding Progress Tool (MIBPT)/Johnson, Mulder and Strube, 2007⁽⁷⁵⁾	Guide the continued support and education for the mother-baby dyad.
Category 4 – Assessment of the infant’s sucking skills in breastfeeding
Avaliação da Sucção do RN na Alimentação no Seio Materno/Mosele et al., 2014⁽⁷⁶⁾	Evaluate the sucking of newborns during breastfeeding.
Bristol Breastfeeding Assessment Tool (BAAT)/Ingram et al., 2015⁽⁷⁷⁾	Evaluate breastfeeding as a measure of proficiency and allow the before/after comparison of a procedure such as frenotomy.
Breastfeeding Evaluation an Education Tool(BEET)/Tobin, 1996⁽⁷⁸⁾	Evaluate the adequacy of breastfeeding the baby.
Infant Breastfeeding Assessment Tool (IBFAT)/Matthews, 1988^{(63, 67, 73, 79)}	Evaluate and measure the competence of the breastfeeding infant.
Neonatal Oral-motor Assessment Scale (NOMAS)/Palmer, Crawley and Blanco, 1993 / Braun and Palmer, 1990⁽⁸⁰⁾	Identify and quantify oral-motor patterns in premature and term neonates during the non-nutritive and nutritive sucking.
Systematic Assessment of the Infant at Breast (SAIB)/Shrago and Bocar, 1990⁽⁸¹⁾	Identify criteria that can be used to assess the infant’s contribution during breastfeeding.

Instrument	Scoring method	Application method
Category 1 – Risk assessment of early weaning
BAPT	Likert method with 66 items (1 to 6 points each)	Self-applied
BAS	5 items (0 – 2 each) and 3 items (-2 each) = -6 to 10 points	Self-applied
Category 2 – Assessment of the perception and behaviour of nursing women
BPEBI	7 items of 0% to 100% (100 mm outline)	Self-applied
BSES	Likert method with 33 items (1 to 5 points each)	Self-applied
BSES-SF	Likert method with 14 items (1 to 5 points each)	Self-applied
HHLS	Likert method with 20 items (1 to 7 points each)	Self-applied
IIFAS	Likert method with 17 items (1 to 5 points each)	Self-applied
MBFES	Likert method with 30 items (concordance and discordance with 5 variations)	Self-applied
Category 3 – Assessment of maternal behaviour/attitude and infant sucking skills in breastfeeding
BREAST	6 subcategories with 2 to 7 items each/No score	Health workers
LAT^TM	9 items with related intervention/No score	Health workers
LATCH	Score by item (0 – 2), totalling 10 points	Self-applied
MBA	Score by item (0 – 2), totalling 10 points	Health workers
MIBPT	8 items (1 point each) = totalling 8 points	Health workers
Category 4 – Assessment of the infant’s sucking skills in breastfeeding
Suction of the newborn during breastfeeding	Score by item (0 – 2), totalling 8 points	Health workers
BBAT	Score by item (0 – 2), totalling 8 points	Health workers
BEET	None	Health workers
IBFAT	Score by item (0 – 3), totalling 12 points	Self-applied
NOMAS	None	Qualified health workers
SAIB	None	Health workers

Instrument	Country/Language of publication	Instrument validated in the country of the author	Information about cross-cultural adaptation
Category 1 – Risk assessment of early weaning
BAPT	USA/English^(13-17)	Yes^{(13-15, 17)}/No⁽¹⁶⁾	Yes^{(13-15, 17)}/No⁽¹⁶⁾
BAPT	Turkey/Turkish⁽¹⁸⁾	Yes⁽¹⁸⁾	Yes⁽¹⁸⁾
BAS	USA/English⁽¹⁹⁾, Spanish⁽²⁰⁾	Yes^(19-20)	No^(19-20)
Category 2 – Assessment of the perception and behaviour of nursing women
BPEBI	USA/English⁽²¹⁾	Yes⁽²¹⁾	No⁽²¹⁾
BSES	Canada/English⁽²²⁾	Yes⁽²²⁾	No⁽²²⁾
	China/Chinese⁽²³⁾	Yes⁽²³⁾	Yes⁽²³⁾
	Porto Rico/Spanish⁽²⁴⁾	Yes⁽²⁴⁾	Yes⁽²⁴⁾
	Australia/English⁽²⁵⁾	Yes⁽²⁵⁾	Yes⁽²⁵⁾
	Brazil/Portuguese^(26-27)	Yes^(26-27)	Yes^(26-27)
	Turkey/Turkish⁽²⁸⁾	Yes⁽²⁸⁾	Yes⁽²⁸⁾
BSES-SF	Canada/English^(29-31)	Yes^(29-31)	Yes^(29-31)
	Poland/Polish⁽³²⁾	Yes⁽³²⁾	Yes⁽³²⁾
	UK/English⁽³³⁾	Yes⁽³³⁾	Yes⁽³³⁾
	Turkey/Turkish⁽³⁴⁾	Yes⁽³⁴⁾	Yes⁽³⁴⁾
	Brazil/Portuguese^(35-38)	Yes^(35-37)/No⁽³⁸⁾	Yes^(35-37)/No^{(36, 38)}
	USA/English^(39-40)	Yes^(39-40)	No⁽³⁹⁾/Yes⁽⁴⁰⁾
	Spain/Spanish^(41-43)	Yes^(41-43)	Yes^(41-42)/No⁽⁴³⁾
	Croatia/Croatian⁽⁴⁴⁾	Yes⁽⁴⁴⁾	Yes⁽⁴⁴⁾
	China/Chinese⁽⁴⁵⁾	Yes⁽⁴⁵⁾	Yes⁽⁴⁵⁾
	Sweden/Swedish⁽⁴⁶⁾	Yes⁽⁴⁶⁾	Yes⁽⁴⁶⁾
HHLS	USA/English⁽⁴⁷⁾	Yes⁽⁴⁷⁾	No⁽⁴⁷⁾
HHLS	Thailand/Unspecified⁽⁴⁸⁾	No⁽⁴⁸⁾	No⁽⁴⁸⁾
IIFAS	USA/English^(40,49-50)	Yes^{(40, 49)}/No⁽⁵⁰⁾	Yes^{(40, 49)}/No⁽⁵⁰⁾
	Romania/Romanian⁽⁵¹⁾	Yes⁽⁵¹⁾	Yes⁽⁵¹⁾
	Scotland/English⁽⁵²⁾	Yes⁽⁵²⁾	No⁽⁵²⁾
	China/Chinese^(53-54)	Yes^(53-54)	Yes^(53-54)
	UK/English⁽⁵⁵⁾	No⁽⁵⁵⁾	No⁽⁵⁵⁾
	Japan/Japanese^(56-57)	Yes^(56-57)	Yes^(56-57)
	China-Australia/Chinese⁽⁵⁸⁾	Yes⁽⁵⁸⁾	Yes⁽⁵⁸⁾
	Hawaii/English⁽⁵⁹⁾	Yes⁽⁵⁹⁾	Yes⁽⁵⁹⁾
	Saudi Arabia/Arabic⁽⁶⁰⁾	Yes⁽⁶⁰⁾	Yes⁽⁶⁰⁾
MBFES	USA/English^(61-63)	Yes^(61-62)/No⁽⁶³⁾	Yes^(61-62)/No⁽⁶³⁾
MBFES	Japan/Japanese⁽⁶⁴⁾	Yes⁽⁶⁴⁾	Yes⁽⁶⁴⁾
Category 3 – Assessment of maternal behaviour/attitude and infant sucking skills in breastfeeding
BREAST	Brazil/Portuguese⁽⁸⁾	No⁽⁸⁾	No⁽⁸⁾
LAT^TM	Latvia/Unspecified^(65-66)	No^(65-66)	No^(65-66)
LATCH	USA/English^{(63, 67-70)}	No^(63,67-68)/Yes^(69-70)	No^(63,67-70)
LATCH	Spain/Spanish⁽⁷¹⁾	Yes⁽⁷¹⁾	No⁽⁷¹⁾
	Italy/Unspecified⁽⁷²⁾	Yes⁽⁷²⁾	No⁽⁷²⁾
	Turkey/English⁽⁷³⁾	Yes⁽⁷³⁾	No⁽⁷³⁾
MBA	USA/English^(67-68)	No^(67-68)	No^(67-68)
MBA	Turkey/English⁽⁷⁴⁾	Yes⁽⁷⁴⁾	No⁽⁷⁴⁾
MIBPT	USA/English⁽⁷⁵⁾	No⁽⁷⁵⁾	No⁽⁷⁵⁾
Category 4 – Assessment of the infant’s sucking skills in breastfeeding
Avaliação da Sucção do Recém-Nascido na Alimentação no Seio Materno	Brazil/Portuguese⁽⁷⁶⁾	No⁽⁷⁶⁾	No⁽⁷⁶⁾
BBAT	UK/English⁽⁷⁷⁾	Yes⁽⁷⁷⁾	No⁽⁷⁷⁾
BEET	USA/English⁽⁷⁸⁾	No⁽⁷⁸⁾	No⁽⁷⁸⁾
IBFAT	Canada/English⁽⁷⁹⁾	Yes⁽⁷⁹⁾	No⁽⁷⁹⁾
	USA/English^{(63, 67)}	No^(63,67)	No^(63,67)
	Turkey/Turkish⁽⁷³⁾	Yes⁽⁷³⁾	No⁽⁷³⁾
NOMAS	Unspecified/English⁽⁸⁰⁾	No⁽⁸⁰⁾	No⁽⁸⁰⁾
SAIB	USA/English⁽⁸¹⁾	No⁽⁸¹⁾	No⁽⁸¹⁾

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[1] Corresponding author: Kelly Pereira Coca. E-mail: kcoca@unifesp.br