Breastfeeding Assessment Tool; Preliminary Report on A Breastfeeding Domains-Based Examination Scoring System: The Eregie Breastfeeding Assessment Tool Examination Score (EBATES)

Abstract

Several ‘Breastfeeding Assessment Tools’ exist but they individually or collectively, in some clusters, have a plethora of differential deficits and encumbrances in their Quality of Breastfeeding Assessments. The LATCH Score is attractive for being an ‘Objective Scoring Scheme’ but lacks reasonable ‘Breastfeeding Domains Coverage’ while the WHO/ UNICEF B-R-E-A-S-T-Feed Observation Form which reportedly has a fairly reasonable coverage lacks the objectivity of an ‘Objective Scoring Scheme’. The new Eregie Breastfeeding Assessment Tool Examination Score (EBATES) is an innovative Intervention to disentangle this ‘Programmatic Knot’ in Breastfeeding, and Breastfeeding Assessment, as a component of Optimal Infant and Young Child Feeding (OIYCF).

Keywords: Breastfeeding, Breastfeeding assessment, Breastfeeding domains, Breastfeeding assessment tool, Eregie BREAST Score, Eregie Breastfeeding Assessment Tool Examination Score, LATCH Score

Abbreviations: BAS: Breastfeeding Assessment Score; BEET: Breastfeeding Evaluation and Education Tool; BFHI: Baby-Friendly Hospital Initiative; EBF: Exclusive Breastfeeding; EBATES: Eregie Breastfeeding Assessment Tool Examination Score; EBS: Eregie BREAST Score; IBFAT: Infant Breastfeeding Assessment Tool; NOMAS: Neonatal Oral-Motor Assessment Scale; OIYCF: Optimal Infant and Young Child Feeding; SAIB: Systematic Assessment of the Infant at Breast.

Introduction

Breastfeeding and Exclusive Breastfeeding (EBF) confer a plethora of benefits on the Baby-Mother Dyad with short-term and long-term Survival, Health, Nutritional, Growth and Developmental, Psychological, Economic and Genomic-Epigenetic implications [1-5]. From Genomics-Epigenetics perspectives, Breastmilk is more than Food and Breastfeeding is more than Feeding with Nutrigenomics- Nutrigenetics and Nutritional Epigenetics shaping the Baby- Mother Dyadic Holistic Trajectory [1,2]. Only proper practice of Breastfeeding assures the Baby-Mother Dyad derive the numerous benefits of this feeding Intervention. It is, therefore, necessary to examine the Breastfeeding Practice to be sure the skills and techniques are appropriately deployed for ‘Successful Breastfeeding’ to optimize the benefits to the Baby-Mother Dyad. A proper Breastfeeding Assessment or Examination will be consistent with being the first ’Programmatic Step’ of an appropriate ‘Triple-A Process’ in addressing ‘Breastfeeding Difficulties’: Assessment, Analysis and Action in that Programmatic Order [6]. There are several Breastfeeding Assessment Tools, but they have different comparative Advantages and Disadvantages and Applicability and Limitations bordering on Breastfeeding Domains covered, Breastfeeding Outcomes evaluated and Objectivity and Quality of Assessment7. There is no ‘Gold Standard’8 as a ‘Breastfeeding Assessment Tool’ and, with comparative differential strengths and weaknesses, more research are advocated to improve on the value of new ‘Breastfeeding Assessment Tools [7,8]. This Preliminary Report disposes a New Breastfeeding Domains-based Assessment Tool as an ‘Objective Scoring System’: The Eregie Breastfeeding Assessment Tool Examination Score (EBATES).

Breastfeeding Domains and Breastfeeding Assessment

The essence of Breastfeeding Assessment is to facilitate the identification of specific aspects of the feeding process, if encumbered by some difficulties, in order to be able to deploy Interventions that will be useful for addressing the identified specific aspects: The ‘Breastfeeding Domains’ [7,8]. Some ‘Breastfeeding Domains’ identified include, among others: Baby’s behaviour, Mother’s behaviour, Positioning, Attachment, Effective feeding, Health of the breast, Health of the baby and Mother’s perception of the feed [8]. Also, other ‘Domains Covered’ include: Simplicity, Acceptability, Cost, Time, Sensitivity and Specificity, Community Relevance, Hospital Relevance, Developed and Developing Locale-applicability, Skilled and Unskilled Worker-Usefulness among others [7,8]. There reportedly appears to be agreement on the ubiquitous inclusion of ‘Attachment’ and ‘Effective feeding’ as determinant ‘Breastfeeding Domains’ that should be evaluated in ‘Breastfeeding Assessment’ [8]. Several evaluated ‘Breastfeeding Assessment Tools’ do not cover many important ‘Breastfeeding Domains’ and are, therefore, limited in their applicability and usefulness [9].

Breastfeeding Assessment Tools

Predicated on the recognized ‘Breastfeeding Domains’, there are several ‘Breastfeeding Assessment Tools’ of which a few are reflected in this Communication: WHO/UNICEF BFHI Forms [10,11], CARE Training Packages [12], Breastfeeding Assessment Score (BAS) [13], Breastfeeding Evaluation and Education Tool (BEET) [14], Infant Breastfeeding Assessment Tool (IBFAT) [15], LATCH Score [16], Neonatal Oral-Motor Assessment Scale (NOMAS) [17], Systematic Assessment of the Infant at Breast (SAIB) [18], WHO/ UNICEF B-R-E-A-S-T-Feed Observation Form [19], Eregie BREAST Score (EBS) [20] etc. It is reportedly suggested that several ‘Breastfeeding Assessment Tools’ have not been independently validated against external measurable variables, lack good scope and coverage of ‘Breastfeeding Domains’, not related to ‘Breastfeeding Outcomes’ with some having their ‘Development Study Designs’ reportedly flawed [9]. The LATCH Score is reportedly lacking in reasonable coverage of important ‘Breastfeeding Domains’ but its attraction lies in its being disposed as a fairly ‘Objective Scoring System’ [20] and likened to the APGAR Scoring System [21] valuable in Newborn Medical Practice. The WHO/ UNICEF B-R-E-A-ST- Feed Observation Form [19] is reported to have many positive attributes [7,8] but lacks an ‘Objective Scoring Scheme’ which the Eregie BREAST Score (EBS) [20] addresses as a Programmatic Interventional Improvement but both are limited by the same inherent ‘Breastfeeding Domains Coverage’. The new Eregie Breastfeeding Assessment Tool Examination Score (EBATES) is developed to address the ‘Breastfeeding Domains’ issue in addition to its being an ‘Objective Scoring Scheme’.

A New Breastfeeding Domains-Based Examination Scoring System: Eregie Breastfeeding Assessment Tool Examination Score (Ebates)

Guided by the reportedly identified ‘Breastfeeding Domains’ [8] listed previously in this Communication as Baby’s behaviour, Mother’s behaviour, Positioning, Attachment, Effective feeding, Health of the breast, Health of the baby and Mother’s feel of the feed and, with some modifications reflecting ‘Positioning’ and ‘Effective feeding’ for both Baby and Mother and also broadening the ‘Domains’ further with the addition of ‘Length of feed’ and ‘Mother’s comfort level’ with a new total of 12 ‘Modified and Expanded Breastfeeding Domains’, the new ‘Breastfeeding Assessment Tool’ is disposed as an ‘Objective Scoring System’: The Eregie Breastfeeding Assessment Tool Examination Score (EBATES)’. It is developed from a ‘Critical Review of the Literature’ intertwined with longstanding years of Clinical Experience/ Expertise, Research and Practice of Child Health, Neonatal Medicine and Breastfeeding Medicine coupled with extensive Publications and National and International Programmatic Engagements and Interventions in Breastfeeding Initiatives. In Research Governance Principles, and as a Research Strategy, this is a ‘Non-Clinical Tool Development Research’ with ‘No Contacts or Interventions between Patients/ Subjects and Researchers; in fact, No Patients/ Subjects Involvement’. In (Table 1), the ‘Breastfeeding Domains’ are disposed with their ‘Definitions and Scored Alternatives’. A ‘Reference Guide’, gleaned from previous Communications [7,8] but ‘Conceptually Elevated as New Signposts’, is the ‘Assessment Marker’ for the ‘Defined and Scored Alternatives’ for facilitating the ‘User-friendliness’ of the ‘New Tool’. The ‘Defined and Scored Alternatives’ are simple and clear enough to command ‘User-Friendliness’ and Simplicity. The least score is zero and the highest possible score is 24 with a Total Score interpreted as, and implying, the following: 0-10 (Breastfeeding Poor; much help needed), 11-19 (Breastfeeding Fair; Moderate help needed) and ≥20 (Breastfeeding Good; Little or no help needed). The included ‘Breastfeeding Domains’ are easily observable and can be scored and purposely avoid History-related Domains and Questionnaire- based Documentations which constitute part of the bane of some other reportedly less useful ‘Breastfeeding Assessment Tools’. It shares the objectivity of an ‘Objective Scoring System’ of the LATCH Score [16] and the Eregie BREAST Score (EBS) [20] but is superior in having a broadened coverage of relevant determinant ‘Breastfeeding Domains’; a desired attribute of a useful, widely applicable and User-friendly ‘Breastfeeding Assessment Tool’.

Conclusion

Assuring the myriads of benefits of Breastfeeding to the Baby- Mother Dyad is determined by the Quality of Breastfeeding Practice. Good ‘Breastfeeding Assessment Tools’ guarantee that specific aspects of ‘Breastfeeding Practice Difficulties’ are identified and specifically addressed. Several extant ‘Breastfeeding Assessment Tools’ are encumbered by various and varied documented deficits and there is, in fact, no ‘Gold Standard’ necessitating the strongly advocated continued search for ‘New Breastfeeding Assessment Tools’. There is some attraction to Tools which reflect ‘Objective Scoring Schemes’ and have a reasonable ‘Breastfeeding Domains Coverage’. This is the essence of the newly developed Eregie Breastfeeding Assessment Tool Examination Score (EBATES) to assure successful Breastfeeding, through developed and improved ‘Breastfeeding Assessment Tool’, as an integral component of Optimal Infant and Young Child Feeding (OIYCF).

Table 1: EREGIE BREASTFEEDING ASSESSMENT TOOL EXAMINATION SCORE (EBATES).

Note*: BREASTFEEDING DOMAINS adapted, modified and scored from Moran VH et al. A critical analysis of the content of the tools that measure breast-feeding interaction. Midwifery. 2000 Dec;16(4):260-8. [8]. KEY/ LEGEND EBATES/ Score Interpretation: 0 to 10: Breastfeeding is Poor; Much Intervention and Help needed 11 to 19: Breastfeeding is Fair; Moderate Intervention and Help needed ≥20: Breastfeeding is Good; Little or no Intervention and Help needed.

Acknowledgement

None.

Conflict of Interest

None.

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