How to write an infant feeding or lactation protocol

 

 

In the world of lactation consulting, creating your own protocols is one of the most important things you will do. As an IBCLC, your protocols need to be based on your clinical training, your continuing education, and your evaluation of research, literature, and studies. While protocols cannot be bought or taken from someone else, this article will provide an example of how protocols can be written in response to a common clinical situation.

Why you need to create your own protocols

Developing your protocols is one of the most important things you’ll do as an IBCLC. Your protocols need to be developed by you based on three key components:

• your clinical training

• your continuing education

• your evaluation of research, literature, and studies

I’m constantly reworking my own protocols to make sure they are up-to-date, and I rarely provide a client with a protocol that isn’t personalized in some way based on their particular situation.

Protocols can’t be bought or taken from someone else—that kind of shortcut could end up being harmful for your clients. By writing your own protocols, you take ownership over your own practice by implementing what you know into templates that can be modified, adapted, and adjusted to fit each individual clinical situation.

4 critical elements of an effective protocol

Client-centered language

When I write my protocols, I write them as if I’m talking directly to a client. I want them to sound conversational and I always say “you” or “your baby.” I use the pronouns they/them so that the protocol can apply to any gender. My protocols go in the care plans, but I also use them to reply to client questions that come in by secure messaging, email, or text.

References to outside sources

I always, always include links to blog posts or articles written directly to parents. I often joke with my clients that “I’ve read the internet so you don’t have to.” They appreciate that I’m aware of the time suck that Dr. Google can become, and that I care enough to provide them with other resources to back up what i’m saying. I also use these links as a way to funnel my clients towards websites where they will end up in a beneficial rabbit hole, where they will learn more about responsive parenting and normal infant development.

You can embed the links or just paste the URL, I find that the former looks pretty but the latter shows the parents what they’re getting (video or article).

Action items for the client

Always give the client something specific to do and invite them to respond to you. This could mean asking them to report back to you after a certain time period with a log of feedings/diapers, or as general as asking them “how do you feel about all of this?” I never want my protocols to just go out into the void—I always want to make sure I’m inviting my client to stay in contact with me.

Self-efficacy framework

Even though I’m asking my clients to respond to me, my goal with my protocols is for them to be able to implement them on their own. I make my care plans detailed enough to cover the bases for what happened during the consult, and even if I never hear from them again I can feel confident that my protocols address everything the client needs to know and do based on our time together.

Sample protocols

While I’m not going to give you protocols for clinical situations like triple feeding or managing oversupply, I am going to provide you with an example of how I write my protocols.

Normal feeding patterns after 6 weeks

This particular one would be given to a family with an older baby where breastfeeding has been going well, and normal infant behavior is throwing them for a loop. I might also send this in response to a question about sleep training or whether it’s okay to nurse your baby to sleep.

Almost all babies this age have difficulty sleeping on their own–and this is actually a good thing! We like when babies rouse easily because that protects them from the super deep sleep that is a risk factor for SIDS. I love this article which explains how babies sleep:

Also, as your baby is growing and developing, their feeding patterns are going to change. They are waking up to the world, and that means that they will probably want to nurse more frequently because of how it meets all of their needs. Brand new (or sub “preterm”) babies tend to sleep a lot in the early weeks to conserve energy, and that means feeding intervals may be long. Now that they are getting so big, they are now going to be more active, and not sleep as long during the day, and also need lots of physical attention so that they can process everything that’s going on in their brain.

A common pattern for babies after 6 weeks is this:

• sleep

• eat

• play

• eat

• sleep

They eat themselves awake, then have calories to use to interact and play and work on their physical and cognitive milestones. All this work is really intense for babies, and when they are done, they need help relaxing and calming down their brains. This is where nursing to sleep comes in–the nursing meets so much more than just a caloric need. It also calms the brain down and floods your baby with good hormones that reinforce all the learning they’ve just done. And then your baby will want to keep nursing for the first portion of their sleep cycle as a way to “multitask.” There aren’t enough hours in the day for them to do everything they need and want to do, so they combine nursing and sleeping so they can get it all in.

So to your question about whether he will go back to what he was doing before–probably not, because babies as babies grow, they change. Feedings are no longer separate events like they were in the newborn stage, but more just woven into daily life. Here’s one more article that may help–it’s kind of long but makes some excellent points:

How do you feel about all of this?

I would probably then add a tummy time and/or infant movement protocol if I haven’t already provided them with instructions on that.

Using apps to track feedings/diapers

All my clients get this in an email that goes out to them the day after their first visit.

There are many apps out there that families find helpful to keep track of things during the newborn period. I do not recommend a specific app or solution, and do encourage you to “graduate” from the app as soon as your baby’s weight gain is well established.  A close relationship with your baby including physical connection, eye contact, and responsive parenting will tell you exponentially more than any app. I also want to make you aware of some privacy concerns with these apps, which are unregulated: https://www.propublica.org/article/privacy-not-included-federal-law-lags-behind-new-tech

Cold/allergy meds

This is a super quick response I can send if a client asks about allergy medication or if they’re coming down with a cold.

This link has everything you need to know if you get a cold or have seasonal allergies—feel better! http://kellymom.com/bf/can-i-breastfeed/meds/cold-remedy/

Protocol storage

You are going to want to keep your protocols in a form that make them easy for you to access. I don’t recommend using Word or Google Docs—those programs are so big that you might find yourself annoyed at the extra effort involved in pulling them up. You want something that’s going to be flexible and that can sync to your mobile devices and your computer. Here are some options:

• I use PhraseExpress to manage my protocols. It integrates with my keyboard so that I can pull them up while in any program where I can enter text, and I can also access it through a menu on my laptop.

• G-Suite Keep can be integrated with your G-Suite email and accessed with one click while you’re in your inbox replying to emails. The phone and tablet apps are easy to use and you get a ton of storage.

• iCloud Notes syncs across all your devices, and as long as you’re not using it for any client information it’s a great tool for your protocols

• Workflowy is the solution used to maintain the Resource Collection of Client Friendly Links for Breastfeeding Professionals, a tool that aggregates the best of what clinicians like you are writing to help clients feed their babies and reach their breastfeeding/chestfeeding goals. I love the way it’s organized.

Conclusion

If you’re an IBCLC, then you have what it takes to create excellent and effective protocols. With these tips, you can save yourself time and also improve health outcomes—because that’s what it’s all about.

Resource Collection of Client Friendly Links for Lactation Professionals