The Ten Steps for Successful Breastfeeding, adapted for NICU Settings

BFUSA recognizes that, while the core principles of the Ten Steps to Successful Breastfeeding apply to the NICU, the exact wording of the Ten Steps and associated recommended practices must differ to some extent for the NICU population due to the challenges of providing appropriate feeding support for parents and their premature and/or sick infants. Thus, BFUSA’s Ten Steps, modified for the NICU, are:

Step 1:

Have a written infant feeding policy and protocols for the NICU that include the use of human milk and breastfeeding that are routinely communicated to all health care staff involved in the care of NICU parents and infants. (Recommended practices include data monitoring and compliance with The Code.)

Step 2:

Educate and train all staff working with NICU infants and their families in the knowledge, competence and skills necessary to implement the NICU-related infant feeding policy and protocols.

Step 3:

As early as possible, discuss with families whose infants are at risk for admission to the NICU the initiation and management of lactation, and the benefits of human milk and breastfeeding.

Step 4:

Place stable infants skin-to-skin on their mothers as soon as feasible. Facilitate and support extended, ongoing skin-to-skin care by parents or support persons without unjustified restrictions.

Step 5:

Show parents how to initiate and maintain lactation at the earliest possible time and initiate breastfeeding with infant readiness and stability as the only criteria.

Step 6:

Give infants no food or drink other than human milk, unless medically indicated.

Step 7:

Allow and encourage parents and support persons to be with their infants and participate in their feeding and care, with unrestricted access, 24 hours a day, unless there are justifiable reasons for separation.

Step 8:

Encourage cue-based infant-driven oral feeding with breastfeeding as early as possible, with no weight or gestational age restrictions.

Step 9:

For infants who are expected to breastfeed, use alternatives to bottle feeding whenever possible until the infants have been given the opportunity to develop some breastfeeding skills. Use nipple shields and pacifiers only for therapeutic reasons.

Step 10:

Prepare parents for continued lactation and breastfeeding after NICU discharge by having written follow-up plans and ensuring access to specialized clinical lactation support services and groups knowledgeable about the needs of post-NICU infants.