What criteria should I use to determine when to refer a breastfeeding mother to a lactation consultant?

Refer a breastfeeding mother to a lactation consultant when there are ongoing concerns about breastfeeding that cannot be resolved by initial assessment and support. These concerns include difficulties with positioning and attachment to the breast, ineffective feeding indicated by poor rhythmic sucking or audible swallowing, inadequate weight gain or weight loss in the baby, insufficient number of wet and dirty nappies, pain during breastfeeding, or complications such as mastitis or breast abscess. Additionally, if tongue-tie is suspected or if expressed milk feeding is needed as part of management, referral should be considered. Observing additional feeds beyond the initial assessments within the first 24 hours and first week after birth may help identify these issues. Referral is also appropriate when tailored face-to-face support and adjustments have not resolved the problems, or when specialist advice is needed to support the mother’s confidence and breastfeeding continuation NICE NG194.