Transition to at-breast feeding – NICU lactation QI Phase 2

Appropriate evidence-based breastfeeding supportive practices lead to higher breastfeeding rates and better long-term infant health outcomes.

Newborn on mother’s chest, mother feeding baby with help of feeding tool.


Supporting practices such as oral therapy, skin-to-skin care and non-nutritive sucking (NNS) are of critical importance to the infants’ development and relationship with their parents.

Research has shown that these practices support maternal milk volumes and the infant’s transition from enteral feeds to at-breast feeding, thus leading to higher breastfeeding rates and long-term health benefits.1-3

Two nurses are performing oral therapy with enteral feeding on a NICU baby

Oral therapy with own mother’s milk (OMM)– Transition to at-breast feeding interventions

The application of colostrum/OMM to the inside of NICU infants’ cheeks as oral care is considered immune therapy. This oral therapy motivates NICU mothers to initiate pumping early and often and empowers parents in their relationship with their infants.

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Woman with a headscarf has a newborn on her chest which is fed enterally

Skin-to-skin care – Transition to at-breast feeding interventions

Skin-to-skin care supports transition to breastfeeding by offering access and early opportunities for non-nutritive and nutritive sucking at the breast. Skin-to-skin care in the NICU enhances breastfeeding outcomes and also improves attachment and parental self-esteem

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NICU baby being made familiar with feeding at breast

Transition to direct feeding – Transition to at-breast feeding interventions

As infants mature, the stimuli received at the breast during non-nutritive sucking interventions help them to latch and extract milk from the breast, so the mother can switch from non-nutritive to nutritive breastfeeding sessions.

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Mother kissing baby on the hand

Breastfeeding rates  –  Transition to at-breast feeding results

NICU breastfeeding rates help create a clearer picture of how many NICU infants are receiving OMM in the volumes they need and are an indicator of lactation care during the hospital stay.

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1 Spatz DL. Ten steps for promoting and protecting breastfeeding for vulnerable infants. J Perinat Neonatal Nurs. 2004; 18(4):385–396.

2 Meier PP et al. Human milk in the neonatal intensive care unit. In: Family Larsson-Rosenquist Foundation, editor. Breastfeeding and breast milk - From biochemistry to impact: A multidisciplinary introduction. 1st ed. Stuttgart: Thieme; 2018.

3 UNICEF, WHO. Protecting, promoting and supporting breastfeeding: The baby-friendly hospital initiative for small, sick and preterm newborns. Geneva, New York: WHO; UNICEF; 2020. 42 p.