Milk Transfer/Weighted Feed Assessment Note

Date/Time of Assessment: [Date and time of encounter]

Setting: [inpatient postpartum / NICU / outpatient clinic / home visit]

Reason for Assessment

[Clinical question driving this encounter] (One to two sentences stating why milk transfer is being evaluated, such as adequacy to support growth/hydration, supplementation needs, or potential reduction of supplementation. If unclear from encounter, document that assessment was performed due to clinician concern for feeding adequacy or growth monitoring.)

Dyad Snapshot

• Infant: [Chronologic age]; [Gestational age at birth]; [Corrected age if preterm]; [Current weight with date]; [Relevant medical context affecting feeding/transfer] (Include only items that materially affect interpretation, such as prematurity, jaundice risk, hypoglycemia risk, or known oral anomalies.)
• Lactating parent: [Postpartum day]; [Factors affecting supply or transfer] (Include only materially relevant items such as prior breast surgery, endocrine conditions, postpartum hemorrhage, medications, or current nipple pain/trauma.)

Interval Feeding and Output History

[Summary of feeding patterns since last assessment] (Specify time window, typically past 24 hours.)

• At-breast feeds: [Frequency]; [Typical duration]; [Infant feeding behaviors observed/reported]
• Bottle/other feeds: [Frequency]; [Approximate volume per feed]; [Daily total]; [Method]
• Pumping/Expression: [Frequency]; [Typical volumes] (Include if applicable.)
• Supplementation: [Type: expressed milk / donor milk / formula]; [Volume per feed]; [Daily total]; [Method]; [Indication if known] (Include if any supplementation is occurring.)
• Output: [Urine count past 24h]; [Stool count past 24h]; [Stool character if relevant]
• Parent-reported concerns: [Key concerns in caregiver's own words] (Include if present.)

(If output counts were not tracked and there are concerns for intake/hydration, explicitly note this gap and address in monitoring plan.)

Pre-Feed Observation

• Infant readiness: [State regulation]; [Feeding cues]; [Tone]
• Oral exam: [Relevant findings] (Include only if examined this encounter; avoid diagnostic labels without supporting examination.)
• Parent comfort/positioning: [Comfort with positioning]; [Pain rating if relevant]; [Nipple/areolar condition]

Observed Feeding Assessment

[Narrative description of observed feeding sequence] (Two to four sentences describing how infant responded to latching, overall feeding pattern, and notable events.)

• Position and alignment: [Position used]; [Body alignment and stability]; [Adjustments made]
• Latch quality: [Depth/seal]; [Maternal comfort/pain]; [Nipple shape post-feed if noted]
• Milk transfer cues: [Audible swallowing frequency]; [Suck-swallow-breathe pattern]; [Satiety vs persistent hunger cues]
• Duration and laterality: [Time at first breast]; [Time at second breast if offered]; [Total duration]
• Interruptions/adverse events: [Coughing / frequent unlatching / spillage / emesis / other] (Include only if observed.)

(If infant did not latch or feeding was not directly observed, document reason and what proxy data inform the assessment.)

Weighted Feed Results

(Include this section only when pre/post weights were obtained; omit entirely if not performed.)

• Measurement conditions: [Scale type]; [Same scale for both weights: yes / no]; [Clothing/diaper status identical: yes / no]; [Timing of post-weight relative to feed completion]; [Spillage/emesis observed: yes / no]

Pre-feed weight: [Value] g

Post-feed weight: [Value] g

Net change: [Value] g

Estimated intake: [Value] mL (1 g ≈ 1 mL; this is an estimate.)

(If protocol integrity was compromised by spillage, emesis, diaper change, or delayed post-weight, either omit numeric estimate or flag as low confidence with explanation. If weights were attempted but unusable, document "Attempted—invalid for intake estimate" with reason.)

Interpretation

Transfer adequacy statement: [Synthesis of observed feeding and test weight to characterize transfer adequacy for infant's age and clinical context]

Confidence and limitations: [Statement acknowledging single-encounter limitations; need for corroboration with weight trajectory, output trends, and clinical status] (Note any protocol compromises affecting reliability.)

Likely contributors: [Factors contributing to transfer concerns] (Include only if transfer concerns exist. List only factors supported by documented findings—such as ineffective latch/positioning, features suggesting low supply or delayed lactogenesis, infant stamina limitation, or maternal pain limiting feeding. Avoid diagnostic labels without evidence.)

Assessment

1. [Problem]: [Working impression]
   • [Supporting evidence from observed feeding, weighted feed, output, or risk factors]

(List problems in order of urgency. Add additional numbered problems as needed. If transfer appears adequate and assessment is confirmatory, a single problem statement may suffice.)

Plan

Feeding at Breast

• [Target frequency and cue-based guidance]
• [Technique adjustments as indicated: positioning changes, deeper latch strategies, breast compressions, switch nursing]

Supplementation

(Include when supplementation is recommended or already in use.)

• Indication: [Link to assessment findings]
• Type: [expressed milk / donor milk / formula]
• Volume: [Volume per feed]; [Maximum daily if relevant]
• Method: [SNS / cup / bottle with paced feeding / other]
• Criteria to reduce/stop: [Specific thresholds or milestones]

(If supplementation is parent-requested without medical indication, document shared decision-making discussion.)

Pumping/Expression

(Include when applicable.)

• [Frequency and duration]; [Timing relative to feeds]

Monitoring

• Parameters to track: [Weights / diaper counts / stool transition / jaundice signs / feeding behavior]
• Tracking method: [Log / app / clinic phone follow-up / other]
• Urgent evaluation thresholds: [Poor feeding / decreased output / worsening jaundice / excessive sleepiness / inability to arouse for feeds / other concerns]

Follow-Up

• [Timeframe for next assessment]; [Venue: clinic / home visit / telehealth / inpatient bedside]
• [Shorter interval or escalation pathway if high-risk] (Include if applicable.)

Referrals

(Include only when indicated.)

• [Referral type and indication]; [Care coordination or direct communication performed]

Counseling and Education

(Include when supplementation changes are made, when caregivers must perform technical steps, or when specific education was provided.)

• [Topics covered and key teaching points]
• [Materials provided]
• [Parent understanding and agreement]

Signature: [Name], [Credentials] — [Date/Time]