Comparison of Bristol and LATCH Breastfeeding Assessment Tools

ABSTRACT Comparison of Bristol and LATCH Breastfeeding Assessment Tools, Department of Child Health and Diseases, Medical Specialization Thesis Breast milk is the primary source of nutrition for infant growth and development. Objective assessment tools are needed to evaluate breastfeeding success, identify mothers requiring support, and increase breastfeeding rates. The Bristol Breastfeeding Assessment Tool (BBAT) and the LATCH score are widely used for this purpose. This study was conducted prospectively and cross-sectionally between September 2024 and March 2025 at Alanya Alaaddin Keykubat University Faculty of Medicine, Alanya Training and Research Hospital, with the participation of 157 healthy mothers and their term infants. The BBAT and LATCH scores were administered to the participants within the first 24 hours postpartum and during the first-week outpatient visit after discharge. Infant feeding status was monitored by telephone on the 14th and 40th days. The mean age of the mothers was 29.02 ± 6.29 years (min: 18, max: 45), and 58.0% (n=91) had received breastfeeding education. The planned duration of breastfeeding was reported as 21.70 ± 5.37 months (min: 2, max: 48), and the planned duration of exclusive breastfeeding as 6.80 ± 3.56 months (min: 2, max: 24). Breastfeeding scores at 24 hours were 6.37 ± 1.92 for BBAT and 8.03 ± 1.79 for LATCH; at the first week, 7.48 ± 1.10 for BBAT and 9.10 ± 1.33 for LATCH. Both scales showed significantly higher scores at day 7 compared to day 1 (p<0.001). The exclusive breastfeeding rate was 83.4% (n=132) at 24 hours, 68.8% (n=108) at day 7, 71.9% (n=113) at day 14, and 68.8% (n=108) at day 40. Correlation analyses revealed a strong positive correlation between BBAT and LATCH scores at both 24 hours and the first week (r=0.783, r=0.719, p<0.001). Logistic regression analysis demonstrated that, within the first 24 hours, each one-year increase in maternal age reduced the likelihood of exclusive breastfeeding by 13.5% (OR: 0.865, p=0.010), whereas each one-point increase in LATCH score increased it 2.8-fold (OR: 2.783, p<0.001). At day 40 postpartum, the likelihood of exclusive breastfeeding was increased 4.6- fold by the absence of maternal health problems (OR: 4.606, p=0.007), 23-fold by living in a nuclear family (OR: 22.985, p=0.002), 1.6-fold by each one-point increase in the initial 24-hour LATCH score (OR: 1.619, p=0.001), and 1.8-fold by each one-point increase in the first-week BBAT score (OR: 1.782, p=0.018). Conversely, lack of breastfeeding education reduced the likelihood of exclusive breastfeeding at day 40 by 93.5% (OR: 0.065, p=0.004). In ROC analysis, the cut-off values for predicting exclusive breastfeeding at day 40 were determined as BBAT ≥6 and LATCH ≥7 within the first 24 hours, and BBAT ≥7 and LATCH ≥8 at the first week. These thresholds were found to be significant [AUC=0.695 (95% CI: 0.602–0.789; p<0.001), sensitivity: 88%, specificity: 47%]. Clinical outcomes showed that infants exclusively breastfed regained their birth weight in 6.44 ± 2.17 days, whereas those receiving formula supplementation did so in 7.98 ± 2.91 days (p<0.001). Furthermore, the rate of neonatal intensive care unit admission was significantly lower among exclusively breastfed infants (p=0.020). The BBAT and LATCH scores are reliable tools for the early assessment of breastfeeding success and the prediction of long-term breastfeeding continuation, and can be used interchangeably. Breastfeeding education, family structure, and early breastfeeding scores were identified as the strongest determinants of exclusive breastfeeding at day 40. The results of this study highlight the importance of objective assessment tools for early identification and support of at-risk mothers and infants. Keywords: Breast milk, breastfeeding, LATCH, Bristol Breastfeeding Assessment Tool.