7.0 Infant Challenges
Infant risk factors
Being able to identify and target your expertise to the mothers and babies who are at most risk of problems has become increasingly more important as nurse/midwife workload increases. The ideal would be to have mothers who:
- are educated in breastfeeding skills and normal baby behavior,
- have a healthy pregnancy and a normal labor without interventions, and
- whose newborn is cared for with extended skin-to-skin contact.
However, that scenario isn't possible for every mother and therefore it is very important that you can quickly identify those mothers and infants who are going to require additional assistance from you to establish breastfeeding.
Consider the infants who fall into the following categories, and allot additional time to assist their mothers.
Identified during pregnancy
- twins, triplets or more
- neuromotor problems (eg. Down Syndrome)
- facial abnormalities (eg cleft lip or palate)
Identified during birthing
- mother received intrapartum analgesics and/or anesthetics
- birth trauma, assisted delivery (vacuum, forceps or emergency c/section)
- low Apgar Scores, required resuscitation
- no or short skin-to-skin care following birth
- preterm or late-preterm birth
Identified postpartum
- small or large for gestational age
- breast refusal or inconsistent ability to latch-on
- hypoglycemia
- hyperbilirubinemia
- ankyloglossia
- excessive sleepiness or irritability

When a referral is needed
Don't endanger breastfeeding by delaying referral.
Some conditions identified will require expertise beyond your own, or for a continuing period of time. Refer these mothers and babies as early as possible to give them the best chance for breastfeeding success.

Early identification ensures assistance is directed where most needed.