Journal of Obstetric, Gynecologic, and Neonatal Nursing, Vol 23 Issue 1 27-32

LATCH: a breastfeeding charting system and documentation tool

D. Jenson, S. Wallace and P. Kelsey

Maternal Newborn Unit, Sacred Heart Hospital, Eugene OR 97440

Nurses most often use a subjective "well/poor/fair" system to assess and document breastfeeding. LATCH is a breastfeeding charting system that provides a systematic method for gathering information about individual breastfeeding sessions. The system assigns a numerical score of 0, 1, or 2, to five key components of breastfeeding. Each letter of the acronym LATCH denotes an area of assessment. "L" is for how well the infant latches onto the breast. "A" is for the amount of audible swallowing noted. "T" is for the mother's nipple type. "C" is for the mother's level of comfort. "H" is for the amount of help the mother needs to hold her infant to the breast. The system is visually represented in the same form of the Apgar scoring grid, and the numbers are handled in the same way. With the LATCH system, the nurse can assess maternal and infant variables, define areas of needed intervention, and determine priorities in providing patient care and teaching.

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We started using this assessment tool a couple of days ago in my hospital, so I have not yet had much of a chance to evaluate how effective I think it is. Just as the article states, we used to use a "well/fair/poor" system. How many of you L&D, post partum, nursery and NICU nurses have heard of the LATCH system and currently use it? If you have used it, what do you think of it?

Ah yes, we use it where I work. It's "ok".......but, I Usually end up charting narratively on top of it, anyhow. It's a real pain, sometimes, scoring it----if less than 8, I usually end up explaining the problems specifically in a narrative note ----and outlining what interventions are being taken to overcome the problems. We did all that anyhow, before applying "LATCH" to our charting.

So, no, I do not think it's "all that", but I suppose it meets our ever-increasing need assign some sort of a number to quantify something clearly. Like the pain scale, I suppose. The onus is still on nursing to address the numbers we assess, anyhow.

The one good thing I can say, is it does standardize the language somewhat as to how well (or not) nursing is going. We are on the same page, so to speak.

Our previous way of evaluating breastfeeding was fine and the doctors liked it. We had a guideline to follow and everyone could see when a feeding did not take place or if breastfeeding was attempted, fair, good or excellent. The LATCH system seems almost too simple...

We use it; it's not the best tool in the world, but it's better than the "well, fair, good" way, IMO.

Aside from backing up your evaluation with a narrative/progress note, which I can see will still be needed with the LATCH system, do any of you use or know of a better way or to assess breastfeeding progress?

Our previous way of evaluating breastfeeding was fine and the doctors liked it. We had a guideline to follow and everyone could see when a feeding did not take place or if breastfeeding was attempted, fair, good or excellent. The LATCH system seems almost too simple...

OMG-I saw the "doctors liked it" and I had to re-read. I have to tell you, I don't think our docs even realize what goes on once the babe is born (unless they are getting a circ, LOL!)-I'm talking about our OB's here. I think with the initial OB appointment they do the standard "do you plan to BF" and nothing further. If they went a little more indepth at least assessing or have the mother assess her nipples so some preparedness is done. I, honest to God, had a patient deliver shortly after I went to L&D and, blah, blah baby is transitioned and I go to bring her the baby as the doc is suturing her and she is lifting her gown looking at her breasts-so I am waiting and I kindly say, "are you ready to feed?" and she says (again, I am not kidding) "Do they pop out shortly after delivery or does it take awhile?" -I said 'what pops out?"-"my nipples!" and, honestly, there was a dimple there where a nipple should be. (BTW, with persistance and nipple shields, and pumping to draw the nipple out, that baby breastfed amazingly-but it took a lot to get there).

So, basically, our doc's do not at all even notice how the child is fed. And as for the Peds-they just want to know that the baby is being fed.

We use LATCH at our hospital, but as some other posters said, it is just okay. We just had our unit meeting today, and there were some RN's giving a LATCH score for attempts. Our LC's came up with their own flowsheet and we are going to give it a try and see if we get better results with that.

We use LATCH and have for at least 5 years. I also fill in the LATCH score and then narrate on top of it. Not very useful in my opinion.

We use the latch scoring system, it is ok...It is nice to see the assessment broken down into specific parts as opposed to just fair, good, poor.

Another poster mentioned giving a score for an atempt, We do that here. say the baby is licking and rooting but does not latch, you dont hear any swallows, the mom has great nipples, she is a little sore, and she needs some help with positioning. this was an attempt, but the latch score would be 4 out of ten.

(latch)-L=0

(audible swallow)A=0

(type of nipple)T=2

(comfort)C=1

(hold)H=1

Also we chartthe number for each section, not just the total score, that would probably make a differnce.