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步驟1.A.充分遵守《國際母乳代用品銷售守則》和世界衛生大會的有關決議
步驟1.A.充分遵守《國際母乳代用品銷售守則》和世界衛生大會的有關決議

1. 列出至少 3 種本準則涵蓋的產品。

問題或案例研究

母乳代用品（包括嬰兒配方奶粉，即專門銷售用於餵養 3 歲以下嬰幼兒的任何配方奶粉或奶製品（或可用於替代母乳的產品），包括特殊需要配方奶粉、後續配方奶粉和成長配方奶粉）。

在建議純母乳餵養的情況下，推廣適合在嬰兒出生後前六個月餵養的其他食品和飲料。這將包括嬰兒茶，果汁和水。
在建議純母乳餵養的情況下，推廣適合在嬰兒出生後前六個月餵養的其他食品和飲料。這將包括嬰兒茶，果汁和水。

餵養奶瓶和奶嘴。
餵養奶瓶和奶嘴。

2. 描述直接護理提供者在實踐中保護母乳餵養的至少 3 種方式

問題或案例研究

避免給母配方奶粉樣品，以防萬一。

避免在出生後的最初幾個小時內提供配方奶粉。

避免告訴母親，如果不先進行徹底的母乳餵養評估，她就沒有產生足夠的乳汁。

向母親解釋引入部分奶瓶餵養（混合餵養）的負面影響。

向母親解釋配方奶粉的社會和經濟影響。

避免使用由產品屬於《守則》規定的公司製作或分發的與醫療機構中母乳餵養的嬰兒在一起的圖片、海報、圖表等。

3. 如果製造商和/或分銷商在準則範圍內提供資訊，請至少描述直接護理提供者應以何種方式做出回應。

問題或案例研究

只接受科學和事實資訊。

確保資訊不受商業利益的影響。
確保資訊不受商業利益的影響。

拒絕接受促進商業利益的資訊。
拒絕接受促進商業利益的資訊。

確保所有資訊都說明母乳餵養的優越性。
確保所有資訊都說明母乳餵養的優越性。

確保資訊並不意味著母乳餵養和母乳代用品之間存在等同性。

4. 描述至少 1 種類型的財務或物質誘因，這些誘因可能由本準則範圍內的產品製造商和/或分銷商提供給直接護理提供者。

問題或案例研究

促銷品（例如鋼筆、記事本、咖啡杯、捲尺、帶有公司標誌的海報、滑鼠墊、徽章夾）。

免費餐點。

免費研討會，有或沒有繼續教育學分。

獎學金/助學金/酬金。

免費供個人使用或分發給患者、孕婦、嬰幼兒的母親或其家庭成員的產品或樣品。

5. 描述直接護理提供者接受經濟或物質誘惑的至少 1 種傷害。

問題或案例研究

產品背書的外觀。

可能有義務偏袒該公司的產品而非其他產品。

作為直接護理提供者的道德利益衝突。

可能會受到誘因的微妙影響，無意中破壞母乳餵養。

6. 至少解釋 2 種方式，確保醫療機構在提供孕產婦和新生兒服務的醫療機構的任何部分或任何直接護理提供者不宣傳嬰兒配方奶粉、奶瓶或奶嘴。

問題或案例研究

沒有帶有嬰兒用奶瓶餵養圖片的海報或教育材料。
沒有帶有嬰兒用奶瓶餵養圖片的海報或教育材料。

母乳餵養嬰兒的圖片和海報。

屬於該準則規定的產品被排除在父母的視線之外。

嬰兒餵養產品公司沒有向未來或實際的父母提供書面或電子材料。

該機構的某人被要求定期檢查父母可以看到的材料，例如在候診室、醫療機構內的精品店。

屬於該準則規定的產品不會提供給母親。

嬰兒餵養產品公司的代表不應尋求與醫院的母親和家庭進行任何形式的直接或間接接觸。

步驟 1.B.制定書面的嬰兒餵養政策，並定期傳達給工作人員和父母。

7. 描述設施的嬰兒餵養政策中至少 2 個要素。

問題或案例研究

All Ten Steps.
所有十個步驟。

The Code.
守則。

Support to all mothers, including the ones who decide not to breastfeed.
支援所有母親，包括那些決定不母乳餵養的母親。

How the facility monitors progress towards the Ten Steps.
設施如何監控十個步驟的進展情況。

8. Explain at least 3 ways that the infant feeding policy affects a direct care provider’s work at this facility.
8. 至少解釋嬰兒餵養政策影響直接護理提供者在該機構的工作的 3 種方式。

Question or case study
問題或案例研究

Policy drives practice.
政策推動實踐。

Mandatory compliance with the Code.
強制遵守本準則。

Practice according to the Ten Steps.
按照十個步驟進行練習。

Inform everyone about the policy (staff, parents, general public).
將政策告知所有人（員工、家長、公眾）。

Know where someone can get a copy of the policy.
瞭解某人可以在哪裡獲得保單的副本。

Support is given to pregnant women and mothers to make informed decisions on infant feeding.
為孕婦和母親提供支援，幫助他們在嬰兒餵養方面做出明智的決定。

Practices are monitored in the facility.
在設施中對實踐進行監控。

Step 1.C. Establish ongoing monitoring and data management systems.
步驟 1.C. 建立持續的監測和數據管理系統。

9. Explain at least 2 reasons why monitoring of hospital practices is important to ensure quality of care.
9. 至少解釋 2 個原因，說明為什麼監測醫院實踐對於確保護理品質很重要。

Question or case study
問題或案例研究

Identify where the standards are not being met to facilitate correct implementation of practices
確定哪些地方未達到標準，以促進實踐的正確實施.

Everyone in the facility is impacted.
設施中的每個人都會受到影響。

To assess progress in implementation of evidence-based practices.
評估 實施循證實踐的進展情況。

Use as an incentive towards achievement of goals
用作實現目標的激勵措施.

10. Explain at least 2 ways practices are monitored in this facility.
10. 解釋至少 2 種在該設施中監控實踐的方法。

Question or case study
問題或案例研究

Regular audits, including competency verification.
定期審核，包括能力驗證。

Breastfeeding initiation and exclusivity rates are collected, compiled and shared with everyone concerned.
收集、彙編母乳餵養開始率和排他性率，並與所有相關人員分享。

Use of supplements and justifications are monitored.
對補充劑和理由的使用情況進行監控。

Each step has specific elements that are regularly or periodically monitored and communicated.
每個步驟都有特定的元素，這些元素會定期或定期進行監控和溝通。

Foundational skills: communicating in a credible and effective way
基本技能：以可信和有效的方式進行溝通

11. Demonstrate at least 3 aspects of listening and learning skills when talking with a mother.
11. 在與母親交談時，至少展示 3 個方面的傾聽和學習技巧。

Observation
觀察

Ask open ended questions.
提出開放式問題。

Use responses and gestures which show interest (smile, nod head, etc.).
使用表現出興趣的回應和手勢（微笑、點頭等）。

Reflect back what the mother says.
回想一下母親說的話。

Empathize – express that you understand how she feels in a culturally appropriate manner.
同理心 – 表達您以文化上適當的方式理解她的感受。

Avoid words which sound judgmental (good-bad-normal-wrong).
避免使用聽起來帶有判斷力的詞語（好-壞-正常-錯誤）。

12. Demonstrate at least 3 ways to adapt communication style and content when talking with a mother.
12. 展示至少 3 種在與母親交談時調整溝通方式和內容的方法。

Observation
觀察

Use helpful non-verbal communication (sit down with the mother, avoid crossing arms over chest, use or avoid eye contact as culturally appropriate, etc…).
使用有益的非語言交流（與母親坐下，避免雙臂交叉放在胸部，在文化上適當時使用或避免眼神交流等）。

Respond to the particular barriers that the individual mother faces.
對個別母親面臨的特定障礙做出回應。

Use sensitivity and care to address challenges that the mother may be facing.
用敏感和關懷來解決母親可能面臨的挑戰。

Respond to the individual mothers’ and families’ needs, preferences and values.
對個別母親和家庭的需求、偏好和價值觀作出回應。

13. Demonstrate at least 2 ways to encourage a mother to share her views, taking time to understand and consider these views.
13. 展示至少 2 種鼓勵母親分享她的觀點的方法，花時間理解和考慮這些觀點。

Observation
觀察

Give time to the mother to explain her concerns to get the clear picture of what to emphasize.
給母親時間解釋她的擔憂，以便清楚地瞭解要強調什麼。

Acknowledge what she thinks and feels.
承認她的想法和感受。

Address her concerns with factual information provided in a sensitive and respectful manner.
以敏感和尊重的方式提供事實信息，解決她的擔憂。

Assist her to identify workable solutions responsive to her specific concerns and circumstances.
説明她找到針對她的具體關注點和情況的可行解決方案。

14. Describe at least 3 aspects of building confidence and giving support when talking with a mother.
14. 描述在與母親交談時建立信心和提供支援的至少 3 個方面。

Observation
觀察

Elicit respectfully what she knows.
恭敬地引出她所知道的。

Recognize and affirm what is going well for the dyad.
認識並肯定二元組進展順利的事情。

Give positive feedback and emotional support to support the mothers’ confidence and self-efficacy in breastfeeding.
給予積極的反饋和情感支援，以支援母親在母乳餵養中的自信心和自我效能感。

Determine with her what needs improvement.
與她一起確定需要 改進的地方。

Enable a mother to achieve her goals for breastfeeding.
使母親能夠實現母乳餵養的目標。

Give practical help.
提供實際説明。

Step 3. Discuss the importance and management of breastfeeding with pregnant women and their families.
第 3 步。與孕婦及其家人討論母乳餵養的重要性和管理。

15. Engage in a conversation with a pregnant woman on 3 aspects of the importance of breastfeeding.
15. 與孕婦就母乳餵養重要性的 3 個方面進行對話。

Observation
觀察

Use Foundational Skills to discuss the following:
使用基礎技能討論以下內容：

Global recommendations on early initiation of breastfeeding and skin-to-skin immediately following birth and for at least one hour.
關於早期開始母乳餵養和出生後立即進行至少一小時的皮膚接觸的全球建議。

Global recommendations on exclusive breastfeeding for the first 6 months.
關於頭6個月純母乳餵養的全球建議。

Global recommendations on breastfeeding until 2 years old or more.
關於母乳餵養至2歲或2歲以上的全球建議。

Risks of non-breastfeeding for both mother and baby.
母親和嬰兒非母乳餵養的風險。

For baby
對於嬰兒:

The microbiota of non-exclusively breastfed infants is different from exclusively breastfed ones.
非純母乳餵養嬰兒的微生物群與純母乳餵養嬰兒的微生物群不同。

Supplementation with artificial milk significantly alters the intestinal microflora.
補充人造奶可顯著改變腸道菌群。

Higher risk of the following:
以下情況的風險較高：

– Acute diseases (respiratory infections, diarrhoeas, otitis, dermatitis.
– 急性疾病（呼吸道感染、腹瀉、中耳炎、皮炎。

– Allergies and infections.
– 過敏和感染。

– Chronic diseases (asthma, diabetes, obesity).
– 慢性疾病（哮喘、糖尿病、肥胖症）。

– Cancers during infancy, leukaemia.
– 嬰兒期癌症，白血病。

– Death before 2 years old from all causes.
– 2歲前因各種原因死亡。

– Necrotizing enterocolitis.
– 壞死性小腸結腸炎。

– SIDS (sudden infant death syndrome).
– SIDS（嬰兒猝死綜合症）。

– Decreased cognitive development.
– 認知發育下降。

For mother, using formula means:
對於母親來說，使用配方奶粉意味著：

Offering unneeded supplements may endanger adequate milk production.
提供不需要的補充劑可能會危及足夠的產奶量。

Higher risk of the following:
以下情況的風險較高：

– Postnatal depression.
– 產後抑鬱症。

– Breast cancer.
–乳腺癌。

– Ovarian cancer.
– 卵巢癌。

– Hypertension.
–高血壓。

– Type 2 diabetes.
– 2型糖尿病。

16. Assess at least 3 aspects of a pregnant woman’s knowledge about breastfeeding in order to fill the gaps and correct inaccuracies.
16. 評估孕婦關於母乳餵養知識的至少 3 個方面，以填補空白並糾正不準確之處。

Observation
觀察

Use Foundational Skills to discuss additional information on breastfeeding according to her needs and concerns including:
使用基礎技能根據她的需求和關注點討論有關母乳餵養的其他資訊，包括：

– advantages of exclusive breastfeeding.
– 純母乳餵養的優勢。

– how to initiate and establish breastfeeding after birth.
– 如何在出生後開始和建立母乳餵養。

– the importance of skin-to-skin contact immediately after birth.
– 出生後立即進行皮膚接觸的重要性。

– typical breastfeeding patterns.
– 典型的母乳餵養模式。

– responsive feeding and feeding cues.
– 反應靈敏的餵養和餵養提示。

– rooming-in.
– 同室安置。

– the importance of colostrum.
– 初乳的重要性。

– healthcare practices and the help that mother will receive after birth.
– 醫療保健實踐和母親出生後將獲得的説明。

Support in a respectful manner a woman who may not be considering breastfeeding to make an informed decision about feeding her infant.
以尊重的方式支援可能不考慮母乳餵養的婦女，以做出餵養嬰兒的明智決定。

17. Engage in a conversation with a pregnant woman about at least 4 care practices a mother/infant dyad will experience at the birthing facility that will support breastfeeding.
17. 與孕婦進行對話，了解母嬰二人組在分娩機構將經歷的至少 4 種護理實踐，這些護理實踐將支援母乳餵養。

Observation
觀察

Use Foundational Skills to discuss the following:
使用基礎技能討論以下內容：

Importance of a positive childbirth experience.
積極的分娩體驗的重要性。

Immediate and uninterrupted skin-to-skin.
立即和不間斷的皮膚接觸。

Breastfeeding initiation within the first hour.
在第一個小時內開始母乳餵養。

Recognition of feeding cues.
識別進食信號。

Prompt response to feeding cues.
對餵食提示做出及時反應。

Basics of good positioning and attachment.
良好定位和連接的基礎知識。

How breastfeeding functions.
母乳餵養如何運作。

breast milk expression (why, how, practice touching her breast, get familiar with massage etc.)
母乳表達（為什麼、如何、練習觸摸乳房、熟悉按摩等）

29. Engage in a conversation with a mother regarding at least 3 reasons why effective exclusive breastfeeding is important.
29. 與母親進行對話，瞭解至少 3 個原因，為什麼有效的純母乳餵養很重要。

Observation
觀察

Use Foundational Skills to discuss the importance of exclusivity:
使用基礎技能來討論排他性的重要性：

For baby
對於嬰兒.

Baby will learn to breastfeed more quickly.
寶寶會更快地學會母乳餵養。

Baby will learn how to self-regulate.
寶寶會學習如何自我調節。

Provides all the nutrients needed for physical and neurological growth and development.
提供身體和神經生長髮育所需的所有營養物質。

The effects of breastfeeding are greater when breastfeeding is exclusive.
當母乳餵養是排他性的時，母乳餵養的影響更大。

Colostrum is rich in protective factors.
初乳含有豐富的保護因數。

The microbiota (intestinal flora) of non-exclusively breastfed infants is different from exclusively breastfed ones.
非純母乳餵養嬰兒的微生物群（腸道菌群）與純母乳餵養嬰兒不同。

Even one dose of formula changes the microbiota.
即使是一劑配方奶粉也會改變微生物群。

For mother
為了母親.

Frequent, exclusive breastfeeding helps build up a mother’s milk supply.
頻繁的純母乳餵養有助於增加母親的乳汁供應。

Less risk of engorgement.
降低充血風險。

Breasts will feel more comfortable due to regular emptying.
由於定期排空，乳房會感覺更舒適。

Step 4. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth.
第 4 步。促進立即和不間斷的皮膚接觸，並支援母親在出生後儘快開始母乳餵養。

18. Explain at least 3 reasons why immediate and uninterrupted skin-to-skin is important for the mother.
18. 至少解釋 3 個原因，為什麼立即和不間斷的皮膚接觸對母親很重要。

Question or case study
問題或案例研究

Temperature within normal limits.
溫度在正常範圍內。

Placenta expulsed in a timely manner following the surge of maternal oxytocin, so less postnatal anaemia.
胎盤在母體催產素激增后及時排出，因此產後貧血較少。

Surge of oxytocin resulting in adequate uterine involution, secured milk production.
催產素激增導致子宮充分退化，確保產奶。

Serum gastrin remains low, meaning less stress for the mother.
血清胃泌素水準仍然低，這意味著母親的壓力較小。

Breastfeeding is facilitated because of the hormones involved with skin-to-skin contact.
由於皮膚與皮膚接觸有關的激素，因此促進了母乳餵養。

Bonding is facilitated (visual contacts, touch, en-face position, affectionate behaviours).
促進了聯繫（視覺接觸、觸摸、面對面位置、深情行為）。

Mother’s voice and movements are soft, she shows patience in her attempts to latch or to stimulate her baby.
母親的聲音和動作都很柔和，她在嘗試銜乳或刺激嬰兒時表現出耐心。

Maternal feeling of well-being (oxytocin and endorphins are elevated).
母親的幸福感（催產素和內啡肽升高）。

Fewer postnatal depressive symptoms.
減少產後抑鬱癥狀。

Less maternal negligence and baby abandonment.
減少產婦疏忽和遺棄嬰兒。

Mutual reciprocity; maternal sensitivity is increased.
互惠互利;產婦敏感性增加。

Mother can calm her baby more easily.
媽媽可以更容易地讓寶寶平靜下來。

19. Explain at least 3 reasons why immediate and uninterrupted skin-to-skin is important for the infant.
19. 至少解釋 3 個原因，為什麼立即和不間斷的皮膚接觸對嬰兒很重要。

Question or case study
問題或案例研究

Microbiota is colonized with mother’s flora.
微生物群與母親的菌群一起定植。

Temperature is maintained within normal limits.
溫度保持在正常範圍內。

Oxygenation and arterial gases are maintained within normal limits.
氧合和動脈氣體保持在正常範圍內。

Heart rate is maintained within normal limits and initial tachycardia is reduced soon after birth.
心率保持在正常範圍內，出生後不久最初的心動過速會減少。

Stress of being born is reduced (plasma gastrin remains low).
出生壓力減輕（血漿胃泌素保持低水準）。

Glycemia is maintained within normal limits.
血糖保持在正常範圍內。

Cortisol level is low, promoting low stress post-birth and pre-feeding behaviours.
皮質醇水準低，促進出生後和餵養前行為的低壓力。

Normal neuromotor organization is promoted.
促進正常的神經運動組織。

Breastfeeding is facilitated following hormonal surge, proximity to breast (odours, breast massage with baby’s fists, placement of the tongue) and facility to follow instinctive 9 stages (pre-feeding behaviours leading to adequate milk production, efficient sucks, exclusivity, smooth transition to breastfeeding).
荷爾蒙激增、靠近乳房（氣味、用嬰兒拳頭按摩乳房、放置舌頭）和遵循本能 9 個階段（餵養前行為導致足夠的乳汁分泌、高效吸吮、排他性、順利過渡到母乳餵養）后，可以促進母乳餵養。

Initial weight loss and gain are within normal limits in the early postnatal period.
在產後早期，最初的體重減輕和增加都在正常範圍內。

Pain reduced during painful procedures such as heel stick and intramuscular injections.
在足跟棒和肌肉注射等痛苦的手術中疼痛減輕。

Baby is not in distress (cries less after the initial cry).
嬰兒沒有痛苦（初次哭泣後哭聲減少）。

Bonding is facilitated (visual contacts, en-face position, alertness, vocalizations, calm).
促進了聯繫（視覺接觸、面對面位置、警覺性、發聲、冷靜）。

20. Explain at least 3 points of how to routinely implement immediate, uninterrupted and safe skin-to-skin between mother and infant, regardless of method of birth.
20. 至少解釋 3 點，說明如何常規地在母親和嬰兒之間實施立即、不間斷和安全的皮膚接觸，無論分娩方法如何。

Question or case study
問題或案例研究

Naked baby is immediately placed prone on the mother’s bare chest and not placed under the warmer or elsewhere before this contact.
裸體嬰兒立即俯臥在母親裸露的胸部上，而不是在接觸之前放在保溫器下或其他地方。

Baby is not dried before being placed on the mother. When the baby has been placed skin-to-skin, his head and back are well dried to prevent evaporation.
嬰兒在被放在母親身上之前沒有乾燥。當嬰兒被皮膚接觸放置時，他的頭部和背部要充分乾燥，以防止蒸發。

Valid for vaginal births or caesareans under regional anaesthesia.
適用於陰道分娩或局部麻醉下的剖腹產。

Baby is assessed while on his mother as the skin-to-skin contact will reduce his stress of being born.
嬰兒在母親身邊接受評估，因為皮膚與皮膚的接觸將減輕他出生的壓力。

Stability of the baby (e.g. absence of apnoea, desaturation and bradycardia) is assessed after it is placed on the mother.
嬰兒的穩定性（例如，沒有呼吸暫停、血飽和度下降和心動過緩）在將嬰兒放在母親身上後進行評估。

21. Explain at least 3 safety aspects to assess when mother and baby are skin-to-skin during the first 2 hours postpartum, regardless of method of birth.
21. 至少解釋 3 個安全方面，以評估母親和嬰兒在產後頭 2 小時內何時皮膚接觸，無論出生方法如何。

Question or case study
問題或案例研究

Observation of the newborn (colour, breathing and free movement of head and chest).
觀察新生兒（顏色、呼吸以及頭部和胸部的自由運動）。

Observation of the mother (well-being, alertness, pain level).
觀察母親（健康情況、警覺性、疼痛程度）。

Description to parents of what to observe and who to contact.
向父母說明要觀察什麼以及與誰聯繫。

Observation is done regularly by one designated healthcare professional according to written procedure (may be called policy, protocol, procedure or guideline).
一名指定的醫療保健專業人員根據書面程式（可能稱為政策、協定、程式或指南）定期進行觀察。

Support of the baby in case of caesarean section, to avoid falls.
在剖腹產的情況下支持嬰兒，以避免跌倒。

22. List at least 3 reasons why skin-to-skin should NOT be interrupted.
22. 列出至少 3 個原因，說明為什麼皮膚對皮膚不應該被打斷。

Question or case study
問題或案例研究

If skin-to-skin is interrupted:
如果皮膚對皮膚中斷：

Hormonal secretion of oxytocin and endorphins has to be re-started later on.
催產素和內啡肽的荷爾蒙分泌必須在以後重新開始。

Baby’s cortisol will be higher indicating a higher level of stress.
嬰兒的皮質醇會更高，表明壓力水準更高。

Temperature is not maintained within normal limits, especially if ambient room temperature is cold which will then affect the baby’s glycemia (blood glucose level).
溫度不能保持在正常範圍內，特別是如果環境室溫很冷，這會影響嬰兒的血糖（血糖水準）。

There is a risk of microbiome being “contaminated” by germs other than the mother’s
微生物組有被母親以外的細菌「污染」的風險.

The human innate sequence of the newborn (instinctual pre-feeding behaviours) will be affected.
新生兒的人類先天順序（本能的餵養前行為）將受到影響。

There will be a delay in the completion of this innate process (instinctual pre-feeding behaviours).
這個先天過程（本能的預攝食行為）的完成會有一個延遲。

23. Explain at least 2 reasons when skin-to-skin could be interrupted for medically justifiable reasons.
23. 至少解釋 2 個原因，當皮膚對皮膚的交流可能因醫學上合理的原因而中斷時。

Question or case study
問題或案例研究

In presence of a critical medical issue.
在存在重大醫療問題的情況下。

Mother is not well (fainting, dizziness, etc).
媽媽身體不舒服（昏厥、頭暈等）。

Baby is unstable as per WHO/UNICEF definitions (e.g. apnoea, desaturation and bradycardia).
根據世界衛生組織/聯合國兒童基金會的定義，嬰兒不穩定（例如呼吸暫停、血飽和度下降和心動過緩）。

If a delay or interruption of early skin-to-skin has been necessary, ensure that mother and infant are placed skin-to-skin as soon as clinically possible.
如果需要延遲或中斷早期皮膚接觸，請確保在臨床上儘快將母親和嬰兒進行皮膚接觸。

All of the above should be explained in the chart.
以上所有內容都應在圖表中解釋。

24. *WHERE APPLICABLE* Explain how to maintain skin-to-skin during transfer of mother and infant to another room or other recovery area.
24. *在適用的情況下* 解釋在將母親和嬰兒轉移到另一個房間或其他恢復區域時如何保持皮膚接觸。

Question or case study
問題或案例研究

OPTION 1
選項1
1. Keep baby skin-to-skin with the mother, covered with a dry blanket.
1.讓寶寶與媽媽肌膚接觸，蓋上乾燥的毯子。
2. Make sure the baby is secure.
2. 確保寶寶安全。

OPTION 2
選項 2
1. Place baby skin-to-skin on the support person, covered with a dry blanket.
1. 將嬰兒皮膚貼在支撐者身上，用乾燥的毯子蓋住。
2. Return infant skin-to-skin with the mother when the mother is able.
2.當母親有能力時，將嬰兒與母親進行皮膚接觸。

25. Engage in a conversation with a mother including at least 3 reasons why suckling at the breast in the first hour is important, when the baby is ready.
25. 與母親進行對話，包括至少 3 個原因，為什麼在嬰兒準備好的第一個小時內吸吮乳房很重要。

Observation
觀察

Use Foundational Skills to discuss reasons why it is important:
使用「基礎技能」來討論它很重要的原因：

Triggers the production of breast milk.
觸發母乳的產生。

Facilitates the progress of lactogenesis.
促進泌乳生成的進展。

Increases uterine contractions.
增加子宮收縮。

Reduces risk of infant mortality.
降低嬰兒死亡風險。

Mother learns how to recognize her infant’s cues and effective latch.
母親學會了如何識別嬰兒的信號和有效的銜乳。

26. Demonstrate at least 3 aspects of safe care of the newborn in the first 2 hours post-birth.
26. 在出生後的前 2 小時內展示至少 3 個安全護理新生兒的方面。

Observation
觀察

Mother is in a semi-recumbent position (elevate the head of the mother’s bed/stretcher to 30 degrees or more to avoid the baby's flat prone position).
母親處於半臥位（將母親的床頭/擔架抬高至 30 度或更多，以避免嬰兒平躺姿勢）。

Position the newborn on the mother to facilitate visual contact and recognition of the baby’s awakening and hunger cues by the mother.
將新生兒放在母親身上，以促進視覺接觸和識別母親對嬰兒的覺醒和饑餓信號的識別。

Ensure the infant can spontaneously lift his head at all times to facilitate optimal breathing and first sucking.
確保嬰兒可以始終自發地抬起頭部，以促進最佳呼吸和首次吸吮。

Visually check the infant’s breathing, colour, responsiveness to stimulation when checking the mother’s vital signs and without removing the blanket to avoid a decrease in temperature.
在檢查母親的生命體征時，目視檢查嬰兒的呼吸、顏色、對刺激的反應，而不取下毯子以避免溫度下降。

Ensure the infant’s nose and mouth are visible at all times.
確保嬰兒的鼻子和嘴巴始終可見。

Ensure the mother is responsive.
確保母親有反應。

Ensure both mother and support person know what to assess and how to get help if needed.
確保母親和陪護人員都知道要評估什麼以及如何在需要時獲得説明。

27. Describe to a mother at least 3 pre-feeding behaviours babies show before actively sucking at the breast.
27. 向母親描述嬰兒在積極吸吮乳房之前至少表現出的 3 種餵養前行為。

Observation
觀察

The pre-feeding behaviours of the baby include:
嬰兒的餵養前行為包括：
• a short rest in an alert state to settle to the new surroundings
• 在警覺狀態下短暫休息，以適應新環境
• bringing their hands to their mouth and making sucking motions and sounds
• 將手放在嘴邊，做出吸吮的動作和聲音
• touching the nipple with the hand
• 用手觸摸
• focusing on the dark area (areola) of the breast, which acts like a target
• 專注於乳房的黑暗區域（乳暈），它就像一個目標
• moving towards the breast and rooting
• 向乳房移動並生根
• finding the nipple area and attaching with a wide-open mouth.
• 找到區域並用張大的嘴巴連接。

Step 5. Support mothers to initiate and maintain breastfeeding and manage common difficulties.
第 5 步。支持母親開始和維持母乳餵養，並管理常見的困難。

28. Describe at least 6 essential issues that every breastfeeding mother should know or demonstrate.
28. 描述每個母乳餵養的母親都應該知道或展示的至少 6 個基本問題。

Question or case study
問題或案例研究

Importance of exclusive breastfeeding for the first 6 months.
前 6 個月純母乳餵養的重要性。

Mother-infant eye-to-eye and body contact while feeding.
母嬰在餵養時眼對眼和身體接觸。

Feeding cues and signs of an adequate latch, swallowing, milk transfer and infant satisfaction and how to recognize all of them.
充分銜乳、吞咽、母乳轉移和嬰兒滿意度的餵養線索和體征，以及如何識別所有這些。

Average feeding frequency (at least 8 times per 24h) with some infants needing more frequent feedings.
平均餵養頻率（每 24 小時至少 8 次），一些嬰兒需要更頻繁的餵養。

How to breastfeed in a comfortable position and without pain.
如何以舒適的姿勢進行母乳餵養，而不會感到疼痛。

Infants should be fed in response to feeding cues, offered both breasts per feeding and fed until they seem satisfied.
嬰兒應根據餵養信號進行餵養，每次餵養都給予雙側乳房，並餵養直到他們看起來滿意為止。

How to ensure/enhance milk production and let down.
如何確保/提高產奶量並降低奶量。

Why and how to hand express colostrum/breast milk.
為什麼以及如何用手擠出初乳/母乳。

How to correctly use and care for her breast pump (for a mother who needs to pump).
如何正確使用和護理她的吸奶器（對於需要吸乳的母親）。

Effects of pacifiers/ artificial teats on breastfeeding and why to avoid them until lactation is established.
安撫奶嘴/人造奶嘴對母乳餵養的影響，以及為什麼在建立泌乳期之前避免使用它們。

Very few medications or mother’s illnesses contraindicated during breastfeeding.
在母乳餵養期間，很少有藥物或母親的疾病是禁忌的。

Accurate information resources.
準確的信息資源。

Reasons for a breastfeeding mother to avoid tobacco, alcohol and other drugs.
母乳餵養的母親避免吸煙、酗酒和其他藥物的原因。

Safe sleeping instructions (how to make co-sleeping safer).
安全睡眠說明（如何使同睡更安全）。

Recognize signs of undernourishment or dehydration in the infant and warning signs for calling a health professional management of most common breastfeeding difficulties.
識別嬰兒營養不良或脫水的跡象，以及呼籲衛生專業人員處理最常見母乳餵養困難的警告信號。

30. Engage in a conversation with a mother regarding 2 elements related to infant feeding patterns in the first 36 hours of life.
30. 與母親就嬰兒出生後前 36 小時內的餵養模式相關的 2 個要素進行對話。

Observation
觀察

Using Foundational Skills, explain that:
使用基礎技能，解釋：

Minimum feeding frequency is 8 times per 24 hours.
最小餵食頻率為每 24 小時 8 次。

Cluster feeding (many cue-based feedings close together in time) is common and normal in the first 24-36 hours and is not an indication of inadequate supply.
在最初的 24-36 小時內，聚集性餵養（許多基於提示的餵養在時間上相近）是常見且正常的，並不表明供應不足。

31. Describe to a mother at least 4 signs of adequate transfer of milk in the first few days.
31. 向母親描述在最初幾天內至少 4 個充分轉移乳汁的跡象。

Observation
觀察

Using Foundational Skills, explain that:
使用基礎技能，解釋：

Baby sucks regularly, rhythmically at the breast with occasional pauses.
寶寶有規律地、有節奏地吸吮乳房，偶爾有停頓。

Rhythmic swallowing is seen or heard.
看到或聽到有節奏的吞咽。

No clicking sounds when feeding.
餵食時沒有咔噠聲。

Breasts can feel softer after feeds and regain fullness in-between feeds.
乳房在餵奶後會感覺更柔軟，並在兩次餵奶之間恢復豐滿。

Urine output is progressively increasing to at least 4 heavy diapers/nappies per day and is pale yellow.
尿量逐漸增加，每天至少 4 片厚尿布/尿布，呈淡黃色。

Number of stools is progressively increasing after the first day.
第一天后，大便數量逐漸增加。

Stools changing from meconium (dark) to yellow.
糞便從胎糞（深色）變為黃色。

Baby appears satisfied, not crying.
寶寶看起來很滿意，沒有哭泣。

Weight stabilizes by day 4.
體重在第4天穩定下來。

32. Evaluate a full breastfeeding session observing at least 5 points.
32. 評估完整的母乳餵養過程，至少要注意 5 分。

Observation
觀察

Using Foundational Skills, assess the following:
使用基礎技能，評估以下內容：

Infant is able to latch and transfer milk.
嬰兒能夠銜乳和轉移乳汁。

Infant has rhythmic bursts of suckling with brief pauses.
嬰兒有節奏的吸吮，有短暫的停頓。

Infant releases the breast at the end of feed in obvious satiation.
嬰兒在餵養結束時釋放乳房，明顯感到飽腹。

Infant shows similar behaviours if he takes the second breast.
如果嬰兒接受第二個乳房，他會表現出類似的行為。

Mother’s hand supports the baby's neck and shoulders, without pushing the baby’s head onto the breast.
母親的手支撐著嬰兒的脖子和肩膀，而不將嬰兒的頭推到乳房上。

Mother ensures the baby's postural stability.
母親確保嬰兒的姿勢穩定性。

Mother’s breasts and nipples are comfortable and intact after the feed.
餵奶后，母親的乳房和舒適且完整。

Mother admits no breast or nipple pain.
母親承認沒有乳房或疼痛。

Signs/symptoms that could require further evaluation and monitoring as assessed.
可能需要進一步評估和評估監測的體征/癥狀。

33. Demonstrate at least 3 aspects of how to help a mother achieve a comfortable and safe position for breastfeeding within the first 6 hours after birth and later as needed during the hospital stay.
33. 至少展示 3 個方面，即如何説明母親在出生後的前 6 小時內達到舒適和安全的母乳餵養姿勢，並在住院期間根據需要實現母乳餵養。

Observation
觀察

Using Foundational Skills:
使用基礎技能：

Make sure the mother understands why it’s important to adopt a comfortable and safe position.
確保母親理解為什麼採取舒適和安全的姿勢很重要。

Explain why to remove blankets or clothes that are in-between mother and infant.
解釋為什麼要取下夾在母親和嬰兒之間的毯子或衣服。

Help the mother identify how to hold her baby to best facilitate the baby’s innate reflexes and latching.
幫助母親確定如何抱著嬰兒，以最好地促進嬰兒的先天反射和銜乳。

Explain principles of position or holding baby (baby faces breast, close to mother, whole body supported).
解釋姿勢或抱嬰兒的原則（嬰兒面向乳房，靠近母親，全身得到支撐）。

Use a hands-off (or hands-on-hands) approach to promote a mother’s empowerment. Hands-on is only used after asking permission and when additional help is necessary.
使用不干涉（或動手）的方法來促進母親的賦權。只有在徵得許可和需要額外説明時，才使用動手操作。

Offer additional help to a mother who had a caesarean to attain a comfortable position.
為剖腹產的母親提供額外説明，以獲得舒適的體位。

Help the mother identify useful positions for a weaker baby.
幫助母親為較弱的嬰兒確定有用的姿勢。

34. Demonstrate how to help a mother achieve an effective and comfortable latch, noting at least 5 points.
34. 演示如何幫助母親實現有效和舒適的銜乳，至少要注意 5 點。

Observation
觀察

Using Foundational Skills:
使用基礎技能：

First observe mother breastfeeding before recommending changes.
首先觀察母親的母乳餵養，然後再建議改變。

Make sure the mother brings the baby to the breast and not the breast to the baby.
確保母親將嬰兒帶到乳房前，而不是將乳房帶到嬰兒身邊。

Infant’s mouth is wide open.
嬰兒的嘴巴張得大大的。

Infant’s chin is touching the breast.
嬰兒的下巴接觸乳房。

More areola visible above the baby's mouth than below.
嬰兒嘴巴上方可見的乳暈多於下方。

Lower lip is everted.
下唇外垂。

Infant’s cheeks are full, and no dimpling is evident.
嬰兒的臉頰飽滿，沒有明顯的凹陷。

Nipples are intact and not pinched after the feeding.
完好無損，餵奶后不會被擠壓。

Absence of maternal pain.
沒有產婦疼痛。

Explain/demonstrate to mother how to release a latch that is painful or shallow without hurting herself.
向母親解釋/演示如何在不傷害自己的情況下釋放疼痛或淺的銜乳。

Inform the mother to release or remove the baby from the breast when the latch is painful or shallow.
當銜乳疼痛或較淺時，通知母親將嬰兒從乳房中釋放或取出。

40. Demonstrate to a mother how to hand express breast milk, noting 8 points.
40. 向母親演示如何用手擠奶，注意 8 點。

Observation
觀察

Use Foundational Skills to discuss the importance of:
使用基礎技能來討論以下方面的重要性：

1. Creating a comfortable environment to facilitate the let-down reflex
1. 創造一個舒適的環境，以促進排泄反射

2. Washing hands.
2.洗手。

3. Having a clean bowl/container to catch the milk.
3. 有一個乾淨的碗/容器來接住牛奶。

4. Massaging the whole breast gently.
4. 輕輕按摩整個乳房。

5. Shaping a “C” around the breast with fingers, push back toward the chest wall away from the areola.
5. 用手指在乳房周圍形成一個“C”形，向後推，遠離乳暈的胸壁。

6. Pushing fingers towards the chest and squeeze fingers together rhythmically, then pause.
6. 將手指推向胸部，有節奏地將手指擠壓在一起，然後停頓。

7. Expressing milk from both breasts.
7. 從雙側乳房擠出乳汁。

8. Expecting that a session will last 10-20 minutes as milk flow decreases.
8. 隨著乳汁流量的減少，預計一個療程會持續 10-20 分鐘。

43. Help a mother achieve a comfortable and safe position for breastfeeding with her preterm, late preterm, or weak infant at the breast, noting at least 4 points.
43. 説明母親在早產兒、晚期早產兒或虛弱嬰兒的乳房下達到舒適和安全的母乳餵養姿勢，至少要注意 4 分。

Observation
觀察

Using Foundational Skills:
使用基礎技能：

First observe a mother breastfeeding before recommending changes.
首先觀察母親的母乳餵養情況，然後再提出改變建議。

Preterm, late preterm, or some weaker infants will require more time, more patience as they may not open mouth upon stimulation or may not open their mouths wide enough.
早產兒、晚期早產兒或一些較弱的嬰兒將需要更多的時間和更多的耐心，因為他們可能在受到刺激時無法張開嘴巴，或者可能無法張開足夠大的嘴巴。

Guide a mother to bring baby to the breast and not breast to baby.
引導母親將嬰兒帶到乳房中，而不是將乳房帶到嬰兒身邊。

Help a mother identify the most useful positions for weaker babies.
幫助母親確定對較弱嬰兒最有用的姿勢。

Show how to do breast compression which may be useful with preterm, low tone or babies with a weak suck.
展示如何進行乳房按壓，這可能對早產、低張力或吸吮力較弱的嬰兒有用。

Show a mother how to express milk into the baby’s mouth.
向媽媽展示如何將乳汁擠入嬰兒的嘴裏。

Help a mother identify how and when to release a latch that is painful or shallow (more frequent with preterm infants) without hurting herself.
説明母親確定如何以及何時釋放疼痛或淺的銜乳（早產兒更常見），而不會傷害自己。

44. Engage in a conversation with a mother of a preterm, late preterm, or low-birth-weight infant not sucking effectively at the breast, including at least 5 points.
44. 與早產兒、晚期早產兒或低出生體重兒的母親進行對話，這些嬰兒不能有效吸吮乳房，包括至少 5 分。

Observation
觀察

Using Foundational Skills, discuss the following:
使用基礎技能，討論以下內容：

Facilitate prolonged skin-to-skin (Kangaroo Mother Care) to improve stabilization of temperature, breathing and heart rate.
促進長時間的皮膚接觸（袋鼠媽媽護理），以改善溫度、呼吸和心率的穩定性。

Engage in a conversation with a mother about why it may be necessary to wake up the baby within 3-4 hours if he doesn’t demonstrate cues.
與母親進行對話，了解為什麼如果嬰兒沒有表現出暗示，為什麼有必要在 3-4 小時內叫醒嬰兒。

Observe the baby latch + suck + swallow.
觀察嬰兒銜乳 + 吸吮 + 吞咽。

Monitor closely for frequently encountered problems such as hypoglycaemia, poor feeding, hyperbilirubinemia.
密切監測經常遇到的問題，如低血糖、餵養不良、高膽紅素血症。

Engage in a conversation with a mother about how to avoid excessive neonatal weight loss (more than 7% on day 3) and adjust feeding plan accordingly.
與母親討論如何避免新生兒體重過度減輕（第3天超過7%），並相應地調整餵養計劃。

Suggest frequent hand expression and compression of the breast to a mother.
建議母親頻繁用手擠奶和按壓乳房。

Explain how to hand express milk (see below).
解釋如何用手擠奶（見下文）。

Explain/demonstrate how to cup feed the expressed breast milk.
解釋/演示如何用杯子餵養擠出的母乳。

Explain the negative effects of pacifiers and teats while breastfeeding is being established.
解釋安撫奶嘴和奶嘴在建立母乳餵養期間的負面影響。

Describe medications that can affect breastfeeding.
描述可能影響母乳餵養的藥物。

Explain safe sleeping.
解釋安全睡眠。

Explain the signs of undernourishment or dehydration in the infant.
解釋嬰兒營養不良或脫水的跡象。

Explain appropriate storage and handling of expressed breast milk.
解釋擠出的母乳的適當儲存和處理。

Describe maintenance of lactation during separation or illness of mother or baby.
描述在母親或嬰兒分離或患病期間維持哺乳的情況。

57. Engage in a conversation with a mother regarding at least 4 different ways to facilitate breastfeeding in order to prevent or resolve most common conditions of the lactating breasts (sore nipples, engorgement, mother who thinks she doesn’t have enough milk, infants who have difficulty sucking).
57. 與母親就至少 4 種促進母乳餵養的不同方法進行對話，以預防或解決哺乳期乳房最常見的情況（疼痛、腫脹、母親認為自己沒有足夠的乳汁、嬰兒吸吮困難）。

Observation
觀察

Use Foundational Skills to discuss:
使用基礎技能進行討論：

Frequent skin-to-skin.
頻繁的皮膚接觸。

24h rooming-in.
24小時房間。

Importance of skin-to-skin and rooming-in for both parents.
皮膚對皮膚接觸和母嬰同室對父母雙方的重要性。

Infant’s cues, signs of a good latch and milk transfer, infant swallowing, and how to remove a baby from the breast if in pain.
嬰兒的提示、良好銜乳和乳汁輸送的跡象、嬰兒吞咽，以及如果嬰兒感到疼痛，如何將嬰兒從乳房中取出。

Baby can remain at her breast for as long as he desires.
只要寶寶願意，他就可以留在她的乳房上。

Unrestricted frequency and responsive feeding.
無限制的頻率和回應式飼喂。

Avoidance of pacifiers/dummies and/or bottles during the first weeks.
在最初的幾周內避免使用安撫奶嘴/安撫奶嘴和/或奶瓶。

Typical feeding patterns: day and night for the first weeks and at least 8 times per 24h, expecting more often during the first week.
典型的餵養模式：第一周白天和黑夜，每 24 小時至少 8 次，第一周預期更頻繁。

Mother’s perception of adequate milk supply (also versus colostrum).
母親對充足乳汁供應的看法（也與初乳相比）。

How the mother can confirm reliable and adequate milk production by observing specific signs in the baby.
母親如何通過觀察嬰兒的特定體徵來確認可靠和充足的產奶量。

Breastfeeding takes practice, patience, and persistence.
母乳餵養需要練習、耐心和毅力。

Step 6. Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated.
第 6 步。除非有醫學指征，否則不要為母乳餵養的新生兒提供母乳以外的任何食物或液體。

29. Engage in a conversation with a mother regarding at least 3 reasons why effective exclusive breastfeeding is important.
29. 與母親進行對話，瞭解至少 3 個原因，為什麼有效的純母乳餵養很重要。

Observation
觀察

Use Foundational Skills to discuss the importance of exclusivity:
使用基礎技能來討論排他性的重要性：

For baby
對於嬰兒.

Baby will learn to breastfeed more quickly.
寶寶會更快地學會母乳餵養。

Baby will learn how to self-regulate.
寶寶會學習如何自我調節。

Provides all the nutrients needed for physical and neurological growth and development.
提供身體和神經生長髮育所需的所有營養物質。

The effects of breastfeeding are greater when breastfeeding is exclusive.
當母乳餵養是排他性的時，母乳餵養的影響更大。

Colostrum is rich in protective factors.
初乳含有豐富的保護因數。

The microbiota (intestinal flora) of non-exclusively breastfed infants is different from exclusively breastfed ones.
非純母乳餵養嬰兒的微生物群（腸道菌群）與純母乳餵養嬰兒不同。

Even one dose of formula changes the microbiota.
即使是一劑配方奶粉也會改變微生物群。

For mother
為了母親.

Frequent, exclusive breastfeeding helps build up a mother’s milk supply.
頻繁的純母乳餵養有助於增加母親的乳汁供應。

Less risk of engorgement.
降低充血風險。

Breasts will feel more comfortable due to regular emptying.
由於定期排空，乳房會感覺更舒適。

41. Explain at least 3 aspects of appropriate storage of breast milk.
41. 至少解釋適當儲存母乳的 3 個方面。

Question or case study
問題或案例研究

Labelling and dating of the expressed milk.
擠出的牛奶的標籤和日期。

Container options for storage (bags, plastic or glass bottles).
用於存儲的容器選項（袋子、塑膠瓶或玻璃瓶）。

Hygienic storage.
衛生的存儲。

Temperature and duration of storage.
儲存溫度和持續時間。

Signs of improper storage and spoilage.
儲存不當和變質的跡象。

42. Explain at least 3 aspects of handling of expressed breast milk.
42. 至少解釋處理擠出母乳的 3 個方面。

Question or case study
問題或案例研究

Proper care of containers and feeding devices.
妥善保管容器和飼餵設備。

Order of milk use:
牛奶使用順序：

1. Fresh before stored.
1.新鮮後儲存。

2. If using stored/frozen milk, use oldest stored milk first.
2. 如果使用儲存/冷凍的牛奶，請先使用最早儲存的牛奶。

Thawing and heating techniques.
解凍和加熱技術。

Handling of previously frozen and thawed human milk (do not refreeze).
處理以前冷凍和解凍的母乳（不要重新冷凍）。

When to discard any remaining milk.
何時丟棄剩餘的牛奶。

47. List at least 2 potential contraindications to breastfeeding for a baby and 2 for a mother.
47. 列出至少 2 個嬰兒母乳餵養的潛在禁忌症和 2 個母親的母乳餵養禁忌症。

Question or case study
問題或案例研究

Maternal contraindications.
孕產婦禁忌症。

HIV, when mothers could not adhere to treatment throughout the breastfeeding period or national health authorities do not recommend breastfeeding for HIV-infected mothers.
愛滋病毒，當母親在整個母乳餵養期間不能堅持治療，或者國家衛生當局不建議感染愛滋病毒的母親進行母乳餵養時。

Ebola virus.
埃博拉病毒。

Herpes simplex virus type 1 - active and on breast.
單純皰疹病毒 1 型 - 活躍且在乳房上。

Specific maternal medications, substances and illnesses (see WHO “Acceptable medical reasons…”).
特定的孕產婦藥物、物質和疾病（見世衛組織“可接受的醫療原因......”）。

Infant contraindications
嬰兒禁忌症.

Galactosemia.
半乳糖血症。

Congenital lactase deficiency.
先天性乳糖酶缺乏症。

Some inborn errors of metabolism may require supplementation (phenylketonuria, maple syrup disease).
一些先天性代謝錯誤可能需要補充（苯丙酮尿症、楓糖漿病）。

48. Describe at least 4 medical indications for supplementing breastfed newborns: 2 maternal indications and 2 newborn indications, when breastfeeding is not improved following skilled assessment and management.
48. 描述至少 4 種補充母乳餵養新生兒的醫學適應症：2 種母乳適應症和 2 種新生兒適應症，當母乳餵養在經過熟練評估和管理后沒有改善時。

Question or case study
問題或案例研究

Infant indications
嬰兒適應症.

Hypoglycaemia.
低血糖。

Signs or symptoms that may indicate inadequate milk intake (significant dehydration, weight loss or delayed bowel movements).
可能表明牛奶攝入不足的體征或癥狀（嚴重脫水、體重減輕或排便延遲）。

Hyperbilirubinemia associated with poor breast milk intake despite appropriate intervention.
高膽紅素血症與母乳攝入不足相關，儘管進行了適當的干預。

Some inborn errors of metabolism.
一些先天性的新陳代謝錯誤。

Maternal indications
孕產婦適應症.

Delayed lactogenesis resulting in inadequate intake by the infant).
泌乳延遲導致嬰兒攝入不足）。

Insufficient milk production related to insufficient gland tissue.
產奶量不足與腺體組織不足有關。

Breast pathology or prior breast surgery resulting in poor milk production.
乳腺病變或既往乳房手術導致產奶量不良。

Temporary mother-infant separation and no expressed milk available.
暫時母嬰分離，沒有吸出的乳汁。

Temporary suspension of breastfeeding.
暫停母乳餵養。

Intolerable pain during feedings.
餵食時難以忍受的疼痛。

49. Describe at least 3 risks of giving a breastfed newborn any food or fluids other than breast milk, in the absence of medical indication.
49. 描述在沒有醫學指征的情況下，給母乳餵養的新生兒提供母乳以外的任何食物或液體的至少 3 種風險。

Question or case study
問題或案例研究

It may interfere with the establishment of milk production.
它可能會干擾牛奶生產的建立。

It decreases the infant’s suckling at breast, potentially creating a cycle of insufficient milk and supplementation.
它減少了嬰兒對乳房的吸吮，可能會造成乳汁和補充劑不足的迴圈。

Even one dose of formula significantly alters the intestinal microbiota.
即使是一劑配方奶粉也會顯著改變腸道微生物群。

It increases the risks of diseases and allergies.
它增加了患疾病和過敏的風險。

Prelacteal feeds reduce importance of colostrum.
催乳前餵養會降低初乳的重要性。

50. For those few health situations where infants cannot, or should not, be fed at the breast, describe, in order of preference, the alternatives to use.
50. 對於嬰兒不能或不應用母乳餵養的少數健康情況，應按優先順序說明可使用的替代方法。

Question or case study
問題或案例研究

1. Mother’s own expressed milk.
1.母親自己擠出的乳汁。

2. Donor human milk.
2.捐贈母乳。

3. Infant formula.
3.嬰幼兒配方奶粉。

51. Engage in a conversation with a mother who intends to feed her baby formula, noting at least 3 actions to take.
51. 與打算餵養嬰兒配方奶粉的母親進行對話，注意至少要採取 3 項行動。

Observation
觀察

Use Foundational Skills to:
使用基礎技能：

Elicit information about why she intends to mixed feed.
詢問她為什麼打算混合飼料。

Assess a breastfeed to evaluate the presence of medical indications for supplementation.
評估母乳餵養，以評估是否存在補充的醫學指征。

Manage common breastfeeding difficulties.
管理常見的母乳餵養困難。

Respond to the individual mother’s and family’s needs, concerns, preferences and values related to mixed feeding.
回應個別母親和家庭對混合餵養的需求、擔憂、偏好和價值觀。

Encourage mother to continue exclusive breastfeeding in the first 6 months.
鼓勵母親在頭 6 個月內繼續進行純母乳餵養。

52. Demonstrate at least 3 important items of safe preparation of infant formula to a mother who needs that information.
52. 向需要這些資訊的母親展示至少 3 個安全製備嬰兒配方奶粉的重要專案。

Observation
觀察

Using Foundational Skills, demonstrate:
使用基礎技能，演示：

Cleaning and sterilizing feeding and preparation equipment.
飼餵和製備設備的清潔和滅菌。

Use of boiled water.
使用開水。

Add powdered formula while water is above 70 degrees C.
當水溫高於 70 攝氏度時加入配方奶粉。

Exact amount of formula as instructed on the label.
按照標籤上的指示準確添加配方奶粉的量。

Cool the feed quickly to feeding temperature.
將飼料快速冷卻至飼料溫度。

Check temperature of formula before feeding.
餵食前檢查配方奶粉的溫度。

Discard formula not used within 2 hours.
丟棄 2 小時內未使用的配方奶粉。

For using liquid formula concentrate: follow manufacturer’s instructions
對於使用液體配方濃縮物：follow 製造商的說明

54. Describe to a mother at least 4 steps to feed an infant a supplement in a safe manner.
54. 向母親描述至少 4 個步驟，以安全的方式餵養嬰兒補充劑。

Observation
觀察

Using Foundational Skills, explain the following:
使用基礎技能，解釋以下內容：

Hold the baby fairly upright for feeds.
在餵奶時將嬰兒完全直立地抱住。

Allow the baby to drink at his/her own pace.
讓寶寶按照他/她自己的節奏喝水。

Baby may need short breaks during the feed and may need to burp sometimes (paced feeding).
寶寶在餵奶過程中可能需要短暫的休息，有時可能需要打嗝（有節奏的餵養）。

When the baby ends the feed in satiation, hold the baby upright and gently rub or pat his back to bring up any wind.
當嬰兒滿足地結束餵養時，將嬰兒直立抱起，輕輕摩擦或拍打他的背部，以引起任何風。

Look out for and respect satiation cues.
留意並尊重飽腹感的暗示。

Step 7. Enable mothers and their infants to remain together and to practice rooming in 24 hours a day.
第 7 步。使母親和她們的嬰兒能夠在一起，並每天24小時練習母嬰育女。

35. Engage in a conversation with a mother regarding 2 aspects related to the importance of rooming-in 24h/day.
35. 與母親就與每天 24 小時母嬰同室的重要性相關的 2 個方面進行對話。

Observation
觀察

Using Foundational Skills, discuss the importance of rooming-in:
使用基礎技能，討論母嬰同室的重要性：

To learn how to recognize and respond to her baby’s feeding cues.
學習如何識別和回應寶寶的餵養信號。

To facilitate establishment of breastfeeding.
促進建立母乳餵養。

To facilitate mother and baby’s bonding/attachment.
促進母親和嬰兒的結合/依戀。

To enable frequent, unrestricted responsive feeding.
實現頻繁、無限制的回應式餵養。

To increase infant’s and mother’s well-being (less stress).
提高嬰兒和母親的幸福感（減輕壓力）。

To improve infection control (lower risk of spreading infectious diseases).
改善感染控制（降低傳播傳染病的風險）。

36. Explain 2 situations: 1 for the mother and 1 for the infant, when it is acceptable to separate mother and baby while in hospital.
36. 解釋 2 種情況：1 種是母親，1 種是嬰兒，在醫院期間可以將母親和嬰兒分開。

Question or case study
問題或案例研究

For justifiable medical reasons affecting the mother (e.g. Mother is unconscious or unable to hold her baby).
出於影響母親的正當醫療原因（例如母親失去知覺或無法抱嬰兒）。

For justifiable medical reasons affecting the baby (e.g. baby needs respiratory support or is unstable).
出於影響嬰兒的正當醫療原因（例如嬰兒需要呼吸支援或不穩定）。

45. Engage in a conversation with a mother separated from her preterm or sick infant regarding at least 2 reasons to be with her infant in the intensive care unit.
45. 與與早產兒或患病嬰兒分離的母親進行對話，瞭解至少 2 個與嬰兒一起在重症監護室的原因。

Observation
觀察

Using Foundational Skills, discuss the following:
使用基礎技能，討論以下內容：

She will help her baby heal and grow better.
她會説明她的寶寶癒合併更好地成長。

She will be able to breastfeed sooner and better.
她將能夠更快更好地進行母乳餵養。

She will be able to express breast milk more easily.
她將能夠更容易地擠出母乳。

She can feed her baby (using tube or other means).
她可以餵養她的寶寶（使用管子或其他方式）。

Her baby needs her touch, her warmth and her voice.
她的寶寶需要她的撫摸、她的溫暖和她的聲音。

When the mother is not able, the presence of significant others is also important.
當母親無法做到時，重要他人的存在也很重要。

Step 8. Support mothers to recognize and respond to their infants’ feeding cues.
第8步。支援母親識別嬰兒的餵養線索並做出反應。

37. Describe at least 2 early feeding cues and 1 late feeding cue.
37. 描述至少 2 個早期餵養線索和 1 個晚期餵養線索。

Question or case study
問題或案例研究

Early cues.
早期線索。

Baby is waking up slowly.
寶寶正在慢慢醒來。

Salivating or rooting.
流口水或生根。

Putting fingers or fist in or around his mouth.
將手指或拳頭放入他的嘴裏或周圍。

Vocalizing.
發聲。

Late cues
遲到的提示.

Crying.
哭。

Going back to sleep.
回去睡覺。

38. Describe at least 4 reasons why responsive feeding is important.
38. 至少描述4個原因，說明為什麼回應式餵養很重要。

Question or case study
問題或案例研究

Breastfeeding is facilitated following hormonal surge.
荷爾蒙激增後促進母乳餵養。

Faster development of milk supply (no delay in lactogenesis II).
加快乳汁供應的發展（不延遲泌乳II）。

Less breast engorgement.
減少乳房腫脹。

Initial weight loss and gain are within normal limits in early postnatal period.
在產後早期，最初的體重減輕和增加都在正常範圍內。

Mother learns to respond to her baby.
母親學會了對寶寶做出回應。

Less crying so less temptation to supplement.
少哭泣，少一些補充的誘惑。

Avoids triggering stress (elevated cortisol levels).
避免引發壓力（皮質醇水準升高）。

Baby learns to self-regulate intake.
寶寶學會自我調節攝入量。

Is essential to nurturing care.
對於培養護理至關重要。

39. Describe at least 2 aspects of responsive feeding (also called on-demand or baby-led feeding) independent of feeding method.
39. 描述與餵養方法無關的回應式餵養（也稱為按需餵養或嬰兒主導餵養）的至少 2 個方面。

Question or case study
問題或案例研究

Eliminate restrictions on the frequency or length of the infant’s feeds.
取消對嬰兒餵養頻率或長度的限制。

Respond promptly to infants’ cues for feeding, closeness and/or comfort.
及時回應嬰兒關於餵養、親近和/或舒適度的暗示。

Is essential to nurturing care.
對於培養護理至關重要。

46. Engage in a conversation with a mother of a preterm, late preterm or vulnerable infant (including multiple births) regarding the importance of observing at least 2 subtle signs and behavioural state shifts to determine when it is appropriate to breastfeed.
46. 與早產兒、晚期早產兒或易受傷害嬰兒（包括多胞胎）的母親進行對話，了解觀察至少 2 個微妙的跡象和行為狀態轉變以確定何時適合母乳餵養的重要性。

Observation
觀察

Using Foundational Skills, discuss the following:
使用基礎技能，討論以下內容：

Breastfeeding at the breast is guided by the infant’s competence and stability rather than a certain gestational/postnatal/postmenstrual age or weight.
母乳餵養是由嬰兒的能力和穩定性指導的，而不是根據一定的胎齡/產後/經后年齡或體重來指導的。

How to recognize discrete signs of transition from deep to active sleep and waking up.
如何識別從深度睡眠過渡到主動睡眠和醒來的離散跡象。

Mother is guided not to interrupt the deep sleep stage just for routine feeding.
指導母親不要僅僅因為常規餵養而中斷深度睡眠階段。

Mother encouraged to observe her infant’s signs of interest in rooting and sucking.
母親鼓勵她觀察嬰兒對生根和吸吮的興趣跡象。

Mother breastfeeds when her infant shows such signs.
當她的嬰兒出現這種跡象時，母親會進行母乳餵養。

58. Describe at least 4 elements to assess when a mother says that her infant is crying frequently.
58. 描述至少 4 個要素，當母親說她的嬰兒經常哭泣時進行評估。

Question or case study
問題或案例研究

Mother’s expectations of how a baby behaves.
母親對嬰兒行為的期望。

What strategies she has used to calm her baby.
她用了什麼策略來安撫她的寶寶。

Mother’s response to infant’s cues for feeding.
母親對嬰兒餵養線索的反應。

Baby’s needs for closeness and/or comfort.
嬰兒對親近和/或舒適的需求。

Signs of good positioning and effective latching.
良好定位和有效銜乳的跡象。

Suckling, swallowing, and milk transfer.
吸吮、吞咽和輸乳。

Infant’s feeding patterns.
嬰兒的餵養模式。

Infant’s sleep-wake patterns.
嬰兒的睡眠-覺醒模式。

Mother’s level of anxiety or tiredness.
母親的焦慮或疲倦程度。

Step 9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
第 9 步。就奶瓶、奶嘴和安撫奶嘴的使用和風險向母親提供諮詢。

53. Demonstrate to a mother how to safely cup-feed her infant when needed, showing at least 4 points.
53. 向母親演示如何在需要時安全地用杯子餵養嬰兒，至少要拿 4 分。

Observation
觀察

Use Foundational Skills to demonstrate the following:
使用「基礎技能」來演示以下內容：

Hygienic measures for preparation (hands and utensils).
準備工作的衛生措施（手和器具）。

How to express breast milk.
如何擠出母乳。

How to store expressed breast milk.
如何儲存擠出的母乳。

How to handle expressed breast milk.
如何處理擠出的母乳。

How to safely prepare formula.
如何安全地製備配方奶粉。

Ensure the baby is fully awake, alert and interested in feeding.
確保寶寶完全清醒、警覺並對餵養感興趣。

Hold the baby fairly upright for feeds.
在餵奶時將嬰兒完全直立地抱住。

Tip the cup so the milk just reaches the baby’s lips.
傾斜杯子，使牛奶剛好到達嬰兒的嘴唇。

Let the baby lap the milk at his own pace.
讓寶寶按照自己的節奏舔奶。

When the baby ends the feed in satiation, hold the baby upright and gently rub or pat his back to bring up any wind.
當嬰兒滿足地結束餵養時，將嬰兒直立抱起，輕輕摩擦或拍打他的背部，以引起任何風。

Look out for and respect satiation cues.
留意並尊重飽腹感的暗示。

54. Describe to a mother at least 4 steps to feed an infant a supplement in a safe manner.
54. 向母親描述至少 4 個步驟，以安全的方式餵養嬰兒補充劑。

Observation
觀察

Using Foundational Skills, explain the following:
使用基礎技能，解釋以下內容：

Hold the baby fairly upright for feeds.
在餵奶時將嬰兒完全直立地抱住。

Allow the baby to drink at his/her own pace.
讓寶寶按照他/她自己的節奏喝水。

Baby may need short breaks during the feed and may need to burp sometimes (paced feeding).
寶寶在餵奶過程中可能需要短暫的休息，有時可能需要打嗝（有節奏的餵養）。

When the baby ends the feed in satiation, hold the baby upright and gently rub or pat his back to bring up any wind.
當嬰兒滿足地結束餵養時，將嬰兒直立抱起，輕輕摩擦或拍打他的背部，以引起任何風。

Look out for and respect satiation cues.
留意並尊重飽腹感的暗示。

55. Describe at least 2 alternative feeding methods other than feeding bottles.
55. 描述除奶瓶以外的至少 2 種替代餵養方法。

Question or case study
問題或案例研究

Open cup or spoon.
打開杯子或勺子。

Dropper or syringe.
滴管或注射器。

Tube-feeding device with finger.
帶手指的管飼裝置。

Tube feeding device at the breast.
乳房上的管飼裝置。

56. Engage in a conversation with a mother who requests feeding bottles, teats, pacifiers and soothers without medical indication, including at least 3 points.
56. 與要求奶瓶、奶嘴、奶嘴和安撫奶嘴而無醫療指徵的母親進行對話，包括至少 3 分。

Observation
觀察

Use Foundational Skills to:
使用基礎技能：

Explore the reasons for a mother’s request for a feeding bottle, teat or pacifier.
了解母親要求提供奶瓶、奶嘴或安撫奶嘴的原因。

Address her concerns behind her request.
解決她請求背後的擔憂。

Educate on the risks of feeding bottles, teats or pacifier use, especially on suckling and nutritional status.
教育使用奶瓶、奶嘴或安撫奶嘴的風險，特別是關於吸吮和營養狀況的風險。

Suggest alternatives to calm a baby.
建議安撫嬰兒的替代方法。

List possible hygiene risks related to inadequate cleaning of feeding utensils.
列出與餵養用具清潔不充分相關的可能衛生風險。

Explain that suckling from a feeding bottle and teat may cause breastfeeding difficulty, especially if use starts before breastfeeding is established or bottle use is prolonged.
說明用奶瓶和奶嘴吸吮可能會導致母乳餵養困難，特別是如果在建立母乳餵養之前就開始使用或長時間使用奶瓶。

Suggest that pacifiers may replace suckling, which can lead to a reduction of maternal milk production.
建議安撫奶嘴可以代替吸乳，這可能導致產婦產奶量減少。

Alert the mother that a pacifier prevents the mother from observing the infant’s subtle feeding cues, which may delay feeding.
提醒母親注意安撫奶嘴會阻止母親觀察嬰兒微妙的餵養信號，這可能會延遲餵養。

Explain that the use of feeding bottles with teats in preterm infants interferes with learning to suckle at the breast.
說明在早產兒中使用帶奶嘴的奶瓶會干擾學習吸吮乳房。

59. Describe at least 4 elements of anticipatory guidance to give to a mother on calming or soothing techniques before or as alternatives to pacifiers.
59. 描述至少 4 個預期指導要素，以便在使用安撫奶嘴之前或作為安撫奶嘴的替代品向母親提供鎮靜或舒緩技巧。

Question or case study
問題或案例研究

Offer the breast again.
再次提供乳房。

Skin-to-skin with mother or support person.
與母親或支援者進行皮膚接觸。

Hold the infant.
抱著嬰兒。

Walk, move around.
走路，四處走動。

Rock.
岩石。

Sing.
唱。

Interact with the baby.
與寶寶互動。

Massage.
按摩。

Step 10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care.
第 10 步。協調出院，使父母及其嬰兒能夠及時獲得持續的支持和護理。

57. Engage in a conversation with a mother regarding at least 4 different ways to facilitate breastfeeding in order to prevent or resolve most common conditions of the lactating breasts (sore nipples, engorgement, mother who thinks she doesn’t have enough milk, infants who have difficulty sucking).
57. 與母親就至少 4 種促進母乳餵養的不同方法進行對話，以預防或解決哺乳期乳房最常見的情況（疼痛、腫脹、母親認為自己沒有足夠的乳汁、嬰兒吸吮困難）。

Observation
觀察

Use Foundational Skills to discuss:
使用基礎技能進行討論：

Frequent skin-to-skin.
頻繁的皮膚接觸。

24h rooming-in.
24小時房間。

Importance of skin-to-skin and rooming-in for both parents.
皮膚對皮膚接觸和母嬰同室對父母雙方的重要性。

Infant’s cues, signs of a good latch and milk transfer, infant swallowing, and how to remove a baby from the breast if in pain.
嬰兒的提示、良好銜乳和乳汁輸送的跡象、嬰兒吞咽，以及如果嬰兒感到疼痛，如何將嬰兒從乳房中取出。

Baby can remain at her breast for as long as he desires.
只要寶寶願意，他就可以留在她的乳房上。

Unrestricted frequency and responsive feeding.
無限制的頻率和回應式飼喂。

Avoidance of pacifiers/dummies and/or bottles during the first weeks.
在最初的幾周內避免使用安撫奶嘴/安撫奶嘴和/或奶瓶。

Typical feeding patterns: day and night for the first weeks and at least 8 times per 24h, expecting more often during the first week.
典型的餵養模式：第一周白天和黑夜，每 24 小時至少 8 次，第一周預期更頻繁。

Mother’s perception of adequate milk supply (also versus colostrum).
母親對充足乳汁供應的看法（也與初乳相比）。

How the mother can confirm reliable and adequate milk production by observing specific signs in the baby.
母親如何通過觀察嬰兒的特定體徵來確認可靠和充足的產奶量。

Breastfeeding takes practice, patience, and persistence.
母乳餵養需要練習、耐心和毅力。

60. Describe at least 2 locally available sources for timely infant feeding information and problem management.
60. 描述至少 2 個當地可用的來源，以便及時提供嬰兒餵養資訊和問題管理。

Question or case study
問題或案例研究

Follow-up visits by a healthcare provider.
醫療保健提供者的隨訪。

Primary healthcare centres.
初級衛生保健中心。

Community healthcare providers.
社區醫療保健提供者。

Home visitors.
家庭訪客。

Breastfeeding clinics.
母乳餵養診所。

Nurses, midwives, lactation consultants.
護士、助產士、哺乳顧問。

Peer counsellors, mother-to-mother support groups.
同伴輔導員，母親對母親的支援小組。

Code-compliant infant feeding phone/help lines (e.g. no phone lines from infant feeding products companies).
符合規範的嬰兒餵養電話/幫助熱線（例如，嬰兒餵養產品公司沒有電話線）。

** Add locally available resources
** 新增本地可用資源

61. Describe at least 2 ways the healthcare facility engages with community-based programmes to coordinate breastfeeding messages and offer continuity of care.
61. 描述衛生保健機構與社區規劃合作的至少兩種方式，以協調母乳餵養資訊並提供連續性護理。

Question or case study
問題或案例研究

Regular meetings.
定期會議。

Regular exchange of information.
定期交換資訊。

Discussion on population-based needs for resources in the community and at the healthcare facility.
討論基於人群的社區和醫療機構對資源的需求。

Sharing the same/similar material with parents.
與父母共用相同/相似的材料。

Forms for automatic referral at discharge.
出院時自動轉診的表格。

62. Develop individualized discharge feeding plans with a mother that includes at least 6 points.
62. 與母親一起制定個人化的出院餵養計劃，至少包括 6 分。

Observation
觀察

Using Foundational skills, assess a feed and the general health of mother and baby, then choose appropriate points that are relevant to the specific mother’s and baby’s needs to develop a plan, such as:
使用基礎技能，評估餵養和母親和嬰兒的總體健康情況，然後選擇與特定母親和嬰兒需求相關的適當點來制定計劃，例如：

Review mother’s understanding of her baby’s unique feeding cues,
回顧母親對寶寶獨特餵養線索的理解，

Review baby’s ability to achieve a comfortable latch, and
檢查寶寶獲得舒適銜乳的能力，以及

Review signs of milk transfer with infant swallowing.
檢查嬰兒吞咽時乳汁轉移的跡象。

Review signs of adequate of adequate intake (stools and urine).
檢查攝入量充足的跡象（糞便和尿液）。

Review mother’s understanding of her baby’s need to feed frequently at least 8 times in 24 hours or more.
回顧母親對寶寶在 24 小時內或更長時間內需要頻繁餵養的需求的理解，至少 8 次。

Review with mother the importance of eye-to-eye contact with baby while feeding.
與母親一起回顧在餵養時與嬰兒進行眼對眼交流的重要性。

Remind mother to let the baby finish nursing on the first breast, then offer the other breast until the baby seems satisfied by releasing the breast.
提醒媽媽讓寶寶完成第一個乳房的哺乳，然後提供另一個乳房，直到寶寶鬆開乳房似乎感到滿意。

Review mother’s position (how she holds baby) to assure comfortable, pain-free feeds.
檢查母親的姿勢（她如何抱嬰兒），以確保舒適、無痛的餵養。

Review mother’s understanding of ensuring / enhancing milk production and let-down.
審查母親對確保/提高產奶量和泌乳量的理解。

Review mother’s understanding of hand-expressing colostrum/breastmilk and why this is helpful.
回顧母親對手吸出初乳/母乳的理解，以及為什麼這有説明。

Reinforce mother’s awareness of risks of other fluids and importance of exclusive breastfeeding for 6 months.
加強母親對其他液體風險的認識以及6個月純母乳餵養的重要性。

Reinforce mother’s awareness of risks and uses of pacifiers and teats.
加強母親對安撫奶嘴和奶嘴的風險和使用的認識。

Reinforce that very few medications or illnesses are contraindicated during breastfeeding.
強調在母乳餵養期間，很少有藥物或疾病是禁忌的。

Provide mother with accurate sources of information and how to get help if needed.
為母親提供準確的資訊來源，並在需要時如何獲得説明。

Provide the mother with information for continued breastfeeding and general health support in the community.
向母親提供繼續母乳餵養和社區一般健康支持的資訊。

Remind mother that adequate food and drinks support her general health because special foods are not needed for breastfeeding.
提醒母親，充足的食物和飲料有助於她的整體健康，因為母乳餵養不需要特殊食物。

*as applicable* Appropriate guidance specific to the mother-infant dyad.
*如適用* 針對母嬰二人組的適當指導。

*as applicable* Reinforce mother’s understanding of safe sleeping (breastfeeding and co-sleeping) arrangements.
*如適用* 加強母親對安全睡眠（母乳餵養和同睡）安排的理解。

*as applicable* Observe mother’s ability to correctly use and care for her breast pump.
*如適用* 觀察母親正確使用和護理吸乳器的能力。

*as applicable* Observe mother’s ability to correctly prepare and use infant formula.
*如適用* 觀察母親正確準備和使用嬰兒配方奶粉的能力。

63. Describe to a mother at least 4 warning signs of infant undernourishment or dehydration for a mother to contact a health care professional after discharge.
63. 向母親描述至少 4 個嬰兒營養不良或脫水的警告信號，以便母親在出院后聯繫衛生保健專業人員。

Observation
觀察

Using Foundational Skills, explain the following signs:
使用基礎技能，解釋以下跡象：

Usually sleeping for more than 4 hours.
通常睡眠時間超過4小時。

Baby apathetic.
寶寶冷漠。

Irritable or weak cry.
煩躁或微弱的哭泣。

Always awake.
永遠保持清醒。

Never seeming satisfied.
似乎從不滿足。

Inability to suck.
無法吸吮。

More than 12 feeds per day.
每天超過12次進食。

Most feeds lasting more than 30 minutes.
大多數餵食持續時間超過 30 分鐘。

No signs of swallowing with at least every 3–4 sucks.
至少每吸 3-4 次沒有吞咽跡象。

Scant urine per day.
每天尿量稀少。

No stools per day.
每天不排便。

Fever.
發燒。

64. Describe at least 3 warning maternal signs for a mother to contact a health care professional after discharge.
64. 描述至少 3 個產婦警告信號，以便母親在出院后聯繫醫療保健專業人員。

Question or case study
問題或案例研究

Persistent painful latch.
持續性銜乳疼痛。

Breast lumps.
乳房腫塊。

Breast pain.
乳房疼痛。

Fever.
發燒。

Doubts about milk production.
對產奶量的懷疑。

Aversion to the child.
厭惡孩子。

Profound sadness.
深深的悲痛。

Any doubt about breastfeeding self-efficacy.
對母乳餵養自我效能感的任何疑問。