Element	0 points	1 point	2 points
Latch	No latch achieved	Repeated attempts; mother holds nipple in infant's mouth and must stimulate infant to suck	Infant grasps breast, tongue down, lips flanged (curled back), rhythmic sucking
Audible swallowing	None	A few with stimulation of the infant	< 24 hours of life: spontaneous and intermittent; > 24 hours of life: spontaneous and frequent
Type of nipple	Inverted	Flat	Everted (after stimulation)
Comfort of mother	Breasts are engorged, cracked, bleeding; large blisters or bruising; severe discomfort	Breasts are filling with milk, reddened/small blisters or bruising, mild/moderate discomfort	Breasts are soft and nontender
Help required	Full assistance (support person holds infant at the breast)	Minimal assistance (support person elevates head of bed/places support), support person teaches how to breastfeed on one side, then mother does the other side; support person holds the infant and then mother takes over	No assistance from support person; mother is able to position and hold infant herself