Neifert and Seacat identified certain findings that could indicate that a woman may be producing insufficient milk for successful breastfeeding. The authors are from the University of Colorado.


Risk factors:

(1) Does the patient have a history of previous breast surgery with altered nipple sensation postoperatively?

(2) Does the patient have a past history of unsuccessful breast feeding?

(3) Is there a family history of a close relative with unsuccessful breast feeding?

(4) Is there marked asymmetry or an abnormal appearance to the breasts?

(5) Is there marked asymmetry or an abnormal appearance to the nipples?

(6) Was breast enlargement during pregnancy absent or minimal?

(7) Was "milk coming in" or postpartum engorgement absent or minimal?

(8) Did the patient fail to initiate nursing or breastpumping during postpartum engorgement?

(9) Did the mother nurse less than 8 times per day in the first week postpartum?

(10) Are the breast not full prior to feeding or after a 4 hour interval without nursing?

(11) Does the patient fail to have a sensation of milk let-down or leaking from the contralateral breast during feedings?

(12) Did menses return within 3 months of the delivery?








total number of risk factors =

= SUM(points for all 12 risk factors)



• minimum number: 0

• maximum number: 10

• A single risk factor is indeterminate for a problem with adequate lactation.

• The presence of 2 or more risk factors warrants further workup of the mother.

• If there is any doubt about the adequacy of infant nutrition, then the infant should be monitored for evidence of adequate feeding.


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