PRINCIPLES & PRACTICE
LATCH:A Breastfeeding charting system and documentation Tool

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Nurses most often use a subjective "well/fair/poor" 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, 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 as the Apgar scoring grid, and the numbers are handled in the same way. With the LA TCH 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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Background

Early in 1986, the authors became aware, while evaluating patient response questionnaires, that the "well/ fair/poor" standard of breastfeeding documentation did not effectively identify problem areas or encourage communication among the staff about those areas. Instructions given to new mothers also varied greatly, according to the experience of each staff person. As one mother said, "Everyone who helps me says something different. It's so confusing. 'Do 5 minutes on each side.' 'It doesn't

Explanation of the System

LATCH is a documentation tool for breastfeeding charting and assessment. The LATCH tool was modeled on the Apgar scoring system. A composite score of 0–10 is possible, depending upon the identified criteria met in each of the key areas of breastfeeding (see Table 1). It is not a judgment of the breastfeeding dyad or staff member helping; rather, it is a method to identify interventions needed and to facilitate charting.

Each letter of the acronym LATCH denotes a key component of breastfeeding

The LATCH Assessment Score

To obtain an observed LATCH score, the caregiver assesses the breastfeeding session at bedside. The scores for each area of assessment are added together to achieve a total for each breastfeeding session. LATCH scores can vary from one feeding to the next. For example, a mother with previous breastfeeding experience, everted nipples, and an alert, vigorous infant could have a score of 9 or 10 for the initial feeding immediately after the birth. This score would reflect that mother and infant

Documentation of the LATCH score

The LATCH grid was incorporated into the nursery flow sheets (see Figure 1), with space for up to four breastfeeding sessions per shift and the individual assessment of each session. Space is available for intervention documentation associated with any defined problems. The time of the breastfeeding is entered with the LATCH score, method of reporting, and initials of the documenting nurse. Comments of "slept" if no attempt was made to waken the infant, "right side only," or "left side only,"

Clinical Implications

As an assessment tool, the LATCH system focuses on specific criteria that include the key components of breastfeeding. The repeated and consistent identification of these key assessment areas requires an increasingly objective answer to the question, "How is the infant feeding?" As a communication tool, LATCH scores identify areas of needed intervention and report these areas in a framework that is easy to understand and remember. The nursing staff or lactation consultant can then assign

Research Implications

Research is needed to evaluate the LATCH system's continuing value inside and outside the hospital setting. Longitudinal studies are needed to evaluate the relationship between in-hospital scores and actual or perceived breastfeeding success. Research also is needed on the relationship between the LATCH scores, the patient teaching needs, and the success of the breastfeeding experience for the mother.

Conclusion

LATCH was created to provide a systematic method for breastfeeding assessment and charting. As an assessment tool, it is used to direct appropriate and timely interventions to assist the new mother in establishing successful breastfeeding.

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The authors won an Outstanding Poster award for their presentation of this tool at the 1992 Annual Meeting.

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