Standard Operating Procedures for Infant Feeding
2
Version
Ratified by (Business Unit or Formal Committee) ICS Business Unit
Date ratified
June 2015
Author
Nicola Duncanson
Responsible Officer (Director or Head)
Richard Palfreeman
Responsible Service Manager
Victoria Jones/Maria Collins
Review date
June 2017
Review and Amendment Log
Version No
2
Type of
Change
Date
Description of change
Update
23.4.15
SOP updated to incorporate new
UNICEF Baby Friendly standards
Contents
Page
Page 1 of 15
1.
2.
3.
4.
5.
6.
7.
1
Introduction
Purpose
Target Population
Explanation of Terms
Duties
5.1 Individual staff responsibilities
5.2 Management responsibilities
5.3 Responsible committee
5.4 Chief Executive
Process
6.1 Locala Community Partnerships Committment
6.2 Care Standards
6.3 Antenatal Care
6.4 Responsive Feeding
6.5 Support with Continued Breastfeeding
6.6 Exclusive Breastfeeding
6.7 Modified Feeding Regimes
6.8 Support for Formula Feeding
6.9 Introducing Solid Food
6.10 Support for Parenting and Close Relationships
6.11 Recommendations for Health Professionals on
discussing Bed-Sharing with Parents
6.12 Communicating the Infant Feeding Stand Operating
Procedure
6.13 Monitoring the Implementation of the Standards
6.14 Monitoring Outcomes
References
Introduction
Breastfeeding has a major role to play in promoting public health and reducing health
inequalities. Breastfeeding, especially if sustained exclusively for the first six months
of life can make a major contribution to an infant’s health and development and is
associated with better health outcomes for the mother. Breastfeeding is also
associated with reducing healthcare costs as well as having a positive impact upon
society as a whole. ¹
2
Purpose
The purpose of this standard operational procedure is to ensure that all staff at Locala
Community Partnerships understand their role and responsibilities in the supporting of
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expectant and new mothers and their partners to feed and care for their baby in ways
which support optimum health and wellbeing. The operational procedure aims to
ensure that the care provided improves outcomes for children and families, specifically
to deliver:




3
Increases in breastfeeding rates at 6-8 weeks (Public Health Outcomes
Framework 2013-2016) ²
For parents who choose to formula feed, increases in those doing so as safely
as possible in line with Department of Health guidelines.
Increases in the population of parents who introduce solid food to their baby in
line with Department of Health guidelines.
Improvements in parents’ experiences of care as assessed through UNICEF
Baby Friendly audit and patient opinion feedback
Target Population
These procedures are aimed at, and must be followed by, all staff working within
Locala Community Partnerships (LCP). This includes those on secondments,
temporary or honorary contracts, bank staff and pre and post registration students.
The operational procedure is applicable to all expectant and new mothers and their
partners who are served by staff working within LCP.
All mothers have the right to receive clear and impartial information to enable them to
make a fully informed choice as to how they feed and care for their babies.
Health care staff will not discriminate against any woman in her chosen method of
infant feeding and will fully support her when she has made that choice.
4
Explanation of terms
There are no terms that require explanation.
5
Duties
5.1
Individual staff member’s responsibility.
It is mandatory that all staff involved with the care of expectant and new
mothers and their families adhere to this operational procedure. This is
to avoid conflicting advice and to offer the optimal standard of care in
line with the UNICEF Baby Friendly Initiative standards which informs
Locala’s Infant Feeding agenda. Any deviation from this procedure must
be discussed with the infant or mother’s medical attendants
(Paediatrician, General Practitioner), midwife, if appropriate, and/or a
member of Locala’s Infant Feeding Team.
5.2
Manager’s responsibility
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It is the responsibility of all line managers to ensure that they and the
people they manage are conversant with this policy and its contents.
5.3
Responsible committee
It is the responsibility of the Locala Senior Management Team to ratify
clinical procedures.
5.4
Chief Executive
The Chief Executive is ultimately accountable for the implementation of
these organisation-wide processes.
6
Process
6.1
Locala Community Partnerships is committed to:
 Providing the highest standard of care to support expectant and new
mothers and their partners to feed their baby and build a strong and
loving parent-infant relationship. This is in recognition of the
profound importance of early relationships to future health and
wellbeing and the significant contribution that breastfeeding makes
to good physical and emotional health outcomes for children and
mothers.

Ensuring that all care is mother and family centred, non-judgemental
and that mothers’ decisions are supported and respected.

Working together across disciplines and organisations to improve
mothers’/parents’ experiences of care.
As part of the commitment Locala Community Partnerships will ensure that:

All new Health Visiting, Health Visiting students and Community Nursery
Nursing staff are orientated to the SOP during their induction training upon
commencement of employment with Locala.

All Health Visiting and Community Nursery Nursing staff receive Locala Infant
Feeding training to enable them to implement the SOP as appropriate to their
role. New staff receive this training within 6 months of commencement of
employment. Yearly one day updates are essential for all Health Visiting and
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Community Nursery Nursing staff. The full three day training must be completed
every three years or as staff feel they require it.

The International Code of the Marketing of Breastmilk Substitutes ³ is
implemented throughout Locala Community Partnerships and our partner
agencies.

All documents fully support the implementation of these standards.

Parents’ experiences of care will be listened to through audit as set out by
UNICEF Baby Friendly audit procedure and annual audit of Locala Baby Cafés
and Baby Bistro breastfeeding support services.
6.2
Care Standards
This section of the policy sets out the care that the Health Visiting service
is committed to giving each and every expectant and new mother. It is
based on the UNICEF UK Baby Friendly Initiative standards for Health
Visiting
the relevant NICE Guidance
and The Healthy Child
Programme ⁶
6.3
Antenatal Care
All pregnant women will have the opportunity to discuss feeding and
caring for their baby with a member of the Health Visiting Team. That
may be a home visit, a telephone contact or a virtual contact. This
discussion will include the following topics:

The value of connecting with their growing baby in utero.

The value of skin contact for all mothers and babies.

The importance of responding to their babies needs for comfort and
closeness, feeding after birth and the role that keeping their baby
close has in supporting this.

Feeding, including an exploration of what parents already know
about breastfeeding, the value of breastfeeding as protection,
comfort and food and getting breastfeeding off to a good start.
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6.4
Responsive Feeding
The term responsive feeding is used to describe a feeding relationship
which is sensitive, reciprocal and about more than nutrition. Staff should
ensure that mothers have the opportunity to discuss this aspect of
feeding and reassure mothers that: breastfeeding can be used to feed,
comfort and calm babies; breastfeeds can be long or short, breastfed
babies cannot be overfed or ‘spoiled’ by too much feeding and
breastfeeding will not, in and of itself, tire mothers any more than caring
for a new baby without breastfeeding.
6.5
Support with Continued Breastfeeding

A formal breastfeeding assessment using the UNICEF Breastfeeding
Assessment Tool must be carried out at the birth visit approximately
10-14 days postnatally to ensure effective feeding and the wellbeing
of mother and baby. This includes recognition of what is going well
and the development of an appropriate care plan to address any
issues identified.

For those mothers who require additional support for more complex
breastfeeding challenges, a referral to the specialist service will be
made. Locala’s specialist service is the Baby Café. Details of this
service are available on the Locala Infant Feeding website. Staff are
aware of the process of referral into the specialist service as
documented within the Locala Breastfeeding pathway (see appendix
D).

Mothers will be informed of the breastfeeding support services that
are available to them including the Baby Cafés, Baby Bistros, Health
Visiting service and online organisations. This information can be
found on the Locala Infant Feeding website. This site will be
continuously kept up to date to ensure accuracy of the information.

For mothers who do not have access to the internet. Staff should
ensure that mothers are aware they can contact their Health Visiting
service by phone to access this information.

Mothers will be made aware of the social support for breastfeeding
available to them via our network of Baby Bistros.

Mothers will have the opportunity for a discussion about their options
for continued breastfeeding (including responsive feeding,
expression of breastmilk and feeding when out and about and going
back to work) according to individual need.

Mothers will have the opportunity to discuss normal feeding patterns
including ‘cluster feeding’ and ‘growth spurts’.
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
6.6
6.7
Mothers will have the opportunity to learn about the importance of
night feeding for milk production and ways to cope with the
challenges of night-time feeding. Staff should refer parents to the
UNICEF publication Caring for your Baby at Night available on
UNICEF and Locala Infant Feeding websites (see later in SOP for
discussions on bed sharing).
Exclusive Breastfeeding

Mothers who breastfeed will be provided with information about why
exclusive breastfeeding leads to the best outcomes for their baby,
and why it is particularly important during establishment of
breastfeeding, which is up to 6 weeks in most cases.

When exclusive breastfeeding is not possible, the value of continuing
partial breastfeeding will be emphasised and mothers will be
supported to maximise the amount of breastmilk their baby receives.

Mothers who give other feeds in conjunction with breastfeeding will
be enabled to do so as safely as possible and with the least possible
disruption to breastfeeding. This will include appropriate information
and a discussion regarding potential impact of the use of a teat when
a baby is learning to breastfeed.
Modified Feeding Regimes
There are a small number of clinical indications for a modified approach
to responsive feeding in the short term. Examples include: pre-term or
small for gestational age babies, babies who have not regained birth
weight and babies who are gaining weight slowly. In such cases, staff
should discuss such regimes with the baby’s midwife, GP or
Paediatrician or member of the Infant Feeding Team as appropriate.
6.8
Support for Formula Feeding
There will be no routine group instruction on the preparation or formula
feeds within the antenatal period as evidence suggests that information
given at this time is less well retained and may serve to undermine
confidence in breastfeeding.
At the Birth Visit mothers who formula feed will have a discussion about
how feeding is going; recognising that this information will have been
discussed with maternity service staff, but may need revisiting or
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reinforcing and being sensitive to a mother’s previous experience, staff
will check that :



6.9
Mothers who are formula feeding have the information they need to
enable them to do so as safely as possible. Staff may need to offer
a demonstration and/or discussion about how to prepare infant
formula.
Mothers who formula feed understand about the importance of
responsive feeding and how to respond to cues that their baby is
hungry, invite baby to draw in the teat rather than force the teat into
their baby’s mouth, pace the feed so that their baby is not forced to
feed more than they want.
Mothers will be encouraged to only give newborn infant formula.
Introducing Solid Food
All parents will have a timely discussion about when and how to
introduce solid foods including:

That solid foods should be introduced at around 6 months

Babies signs of developmental readiness for solid foods

Appropriate foods for babies
This discussion should be had very briefly at the birth visit, with staff
informing parents that they should feed their baby on breastmilk,
newborn formula milk or a mixture of both until around 6 months of age.
A more thorough discussion should happen detailing the above at the
three month contact.
6.10
Support for Parenting and Close Relationships

All parents will be supported to understand a baby’s needs (including
encouraging frequent touch and sensitive verbal and visual
communication, keeping babies close, responsive feeding and safe
sleeping practices)

Mothers who bottle feed are encouraged to hold their baby close
during feeds and offer the majority of feeds to their baby themselves
to help enhance the mother-baby relationship.

Parents will be given information about any local parenting support
that is available. This includes support from local Sure Start Centres,
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support from Baby Bistros and Baby Cafés, Locala Health Visiting
and Locala Infant Feeding Facebook pages.
6.11
Recommendations for Health Professionals on Discussing Bedsharing with Parents
Simplistic messages in relation to where a baby sleeps should be
avoided; neither blanket prohibitions nor blanket permissions reflect the
current research evidence.
The current body of evidence
overwhelmingly supports the following key messages which should be
conveyed to all parents:



The safest place for your baby to sleep is in a cot by your bed
Sleeping with your baby on a sofa puts your baby at greatest risk
Your baby should not share a bed with anyone who:
o Is a smoker
o Has consumed alcohol
o Has taken drugs ( legal or illegal) that make them sleepy
The incidence of Sudden Infant Death Syndrome ‘SIDS’ (often called
“cot death”) is higher in the following groups:




Parents in low socio-economic groups
Parents who currently abuse alcohol or drugs
Young mothers with more than one child
Premature infants and those with low birthweight
Parents within these groups will need more face to face discussion to
ensure that these key messages are explored and understood, they may
need some practical help, possibly from other agencies, to enable them
to put them into practice.
6.12
Communicating the Infant Feeding Standard Operating Procedure
This operating framework is to be communicated to all Health Care Staff
who have any contact with new and expectant mothers. Staff will have
access to this SOP via SharePoint.
Staff will inform clients that the SOP exists and can be viewed through
the Locala Infant Feeding website.
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6.13
Monitoring the Implementation of the Standards
Locala Community Partnerships requires that compliance with the
Operating Procedure is audited at least annually using the UNICEF UK
Baby Friendly audit tool (2013) edition
Staff involved in carrying out
this audit require training on the use of the audit tool. Audit results will
be reported to the Operational Manager for Integrated Children’s
Services and an action plan will be agreed to address any areas of noncompliance that have been identified.
6.14
Monitoring Outcomes
Outcomes will be monitored by:



Monitoring breastfeeding initiation rates
Monitoring breastfeeding rates at 6-8 weeks
Monitoring improvements in parents’ experience of care via UNICEF
UK Audit tool, Baby Café and Baby Bistro annual evaluations.
Outcomes will be reported to:


7.
Operational Manager
Kirklees Infant Feeding Strategy Group which report to the Starting
Well Strategic Group
References
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1.
UNICEF UK (2012) Preventing disease and saving resources: the potential
contribution of increasing breastfeeding rates in the UK October 2012,
accessed 23.4.15,
http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-Health
Professionals/Writing-policies-and-guidelines/Preventing-disease-and-savingresources/
2.
Public Health Outcomes Framework 2013 to 2016, accessed 23.4.15,
https://www.gov.uk/government/publications/healthylives-healthy-peopleimproving-outcomes-and-supporting-transparency
3.
The WHO Code for Marketing of Breastmilk Substitutes, accessed 23.4.15,
http://www.unicef.org.uk/BabyFriendly/Health-Professionals/The-Code/
4.
Updated Baby Friendly standards (2012)
www.unicef.org.uk/babyfriendly/standards
5.
NICE Guidance on Maternal and Child Nutrition (2008), accessed 23.4.15,
http://www.nice.org.uk/ph11
6.
Healthy Child Programme (2009), accessed 23.4.15,
https://www.gov.uk/government/publications/healthychildprogrammepregnancy-and-the-first-5-years-of-life
7.
UNICEF Breastfeeding Assessment Tool (2008), accessed 23.4.15,
http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-HealthProfessionals-Forms-and-checklists-Breastfeeding-assessment-form/
8.
UNICEF Sample Infant Feeding Policy (2015), accessed 20.03.15,
http://www.unicef.org.uk/BabyFriendly/Resources/Guidance-for-HealthProfessionals/Writing-policies-and-guidelines/Sample-infant-feeding-policies/
Page 11 of 15
Appendix A – Consultation Process with Key Stakeholders
Stakeholders are people with specialist knowledge of the subject or who potentially
will be affected by it.
Stakeholder name
and designation
Date
Date
feedback feedback
requested received
Details of
feedback
received
Sandie Bunyard
17/04/2015
22/04/2015
Some grammatical
corrections.
Applied to the SOP
Richard Palfreeman
23/04/15
23/04/15
Some grammatical
corrections.
Clarification
of
which colleagues
the
essential
training applied to.
Applied to the SOP
Emma Dickens
23/04/15
27/04/15
No changes
Comments should go back to the author to consider.
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Action taken
Appendix B
Sign Off Sheet
Please complete and sign to confirm you have read and understood this Standard Operating
Procedure for state full SOP name and ratification date
NAME
POSITION
SIGNATURE
Page 13 of 15
DATE
Appendix C
Help with defining what the document is
Strategy: A detailed plan for achieving organisational success
Policy: A statement of the Board’s agreed position and governing principles relating
to particular issues or situations
(Most of our clinical procedural documents will not be policy, this is usually reserved
for things like HR and legal documents)
Guidance: A document setting out a preferred method of operation. Other methods
are not prohibited but a reason for deviation from guidance should be fully justifiable
and line management agreement sought in all cases of any doubt.
(The majority of our clinical procedural documents will be guidelines)
Standard Operating Procedures (SOP): A set of actions which is the official or
accepted way of doing something. A SOP specifies in writing what should be done
by whom, where and when.
In general, strategy and policy define what an organisation wants to do whilst
SOPs and guidance define how the organisation wants to do it.
(NB Moved SOP paragraph to bottom of the hierarchy – in an attempt to move peoples
thought processes away from a SOP meaning a clinical guideline…)
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Appendix D
Locala Breastfeeding Pathway.
Breastfeeding Pathway
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