breastfeeding
Enable an AI agent to recognise breastfeeding, record how it is proceeding for the feeding pair, and identify appropriate support or review without inferring milk intake or clinical safety from feeding behaviour alone.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
Researched by: Codex + Grok
Purpose and description
Enable an AI agent to recognise breastfeeding, record how it is proceeding for the feeding pair, and identify appropriate support or review without inferring milk intake or clinical safety from feeding behaviour alone.
Breastfeeding is the feeding of an infant or young child with human milk - by direct suckling at a lactating breast or by giving expressed milk - transferring energy, fluid, nutrients, and bioactive immune and developmental constituents from the lactating person to the child.
It can be Record a breastfeeding offer, attempt, or episode with explicit observation sources and unknowns.; Compare episodes to identify changes in attachment, comfort, interruptions, and reported transfer indicators.; Summarise breastfeeding alongside expression and other feeding routes without merging their meanings.; Identify missing observations and prepare focused questions for a qualified feeding professional.; Record consented support actions and compare the reported experience before and after them.; Track participant-chosen continuation, reduction, or stopping goals and link concerns to an applicable clinical review pathway..
Distinguishing features
Direct breastfeeding involves the child's mouth at the breast; receiving expressed human milk through a bottle or tube does not establish a direct breastfeeding episode.
Milk production or milk expression without a child feeding at the breast is lactation or expression rather than breastfeeding.
Skin-to-skin contact or proximity to the breast alone does not establish attachment, sucking, or milk transfer.
An attempted feed, attached sucking, and evidenced milk transfer are distinguishable states; the first two do not by themselves establish the third.
Feeding at the breast with a supplemental nursing device remains a breastfeeding interaction, while the source and route of supplemental milk require separate recording.
Scope
+ The lactating person and child participating in a feeding episode, their relationship, and their expressed preferences
+ Positioning, attachment, sucking, swallowing, and evidence or uncertainty about milk transfer
+ Episode timing, breast offered, interruptions, and patterns across feeds
+ Comfort, willingness, support needs, and participant-reported difficulties
+ The relationship between direct breastfeeding, milk expression, other feeding routes, and changes in feeding goals
- Lactation physiology and milk production independently of feeding activity
- Milk expression, storage, transport, and preparation as separate activities
- Bottle, cup, syringe, or tube feeding as separate feeding activities
- Diagnosis and treatment of breast conditions, oral conditions, or feeding disorders
- The child's overall nutritional status, growth assessment, and medical care
- Pregnancy, childbirth, and postpartum recovery beyond their recorded effects on breastfeeding
Characteristics
- Feeding pair
- References to the lactating person and child; relationship recorded when relevant Connects observations to the correct pair without assuming a biological-parent relationship.
- Episode participation
- Offered, attempted, attached, sucking, paused, ended, declined, unknown Distinguishes an offer or attempt from an ongoing feed.
- Milk-transfer evidence
- Not assessed, reported indicators, directly observed indicators, measurement available, inconclusive Prevents attachment or elapsed time from being treated as proof of intake.
- Episode timing
- Start and end timestamps; elapsed and observed active-feeding time in minutes, if known Supports pattern recognition while keeping elapsed time distinct from active feeding.
- Breast sequence
- Left, right, both with sequence, unspecified Allows side-specific experiences and changes within an episode to be recorded.
- Attachment and position
- Described position, attachment observations, assistance used, assessment source Makes a reported difficulty or successful adjustment interpretable.
- Participant comfort
- Comfortable, discomfort reported, pain reported, distress observed, not assessed; participant and timing identified Preserves each participant's experience rather than reducing success to feeding completion.
- Reported pain intensity
- Value on a named self-report scale, with location and timing; unknown when not reported Allows changes in the lactating person's experience to be compared without assigning a diagnosis.
- Feeding configuration
- Links to direct feeds, expressed-milk feeds, other milk feeds, complementary foods, and at-breast supplementation within a stated interval Places breastfeeding in context without conflating milk source with delivery route.
- Current breastfeeding goal
- Initiate, continue, increase, combine with other feeding, reduce, stop, undecided; attributed to the person expressing it Makes support responsive to the participant's goals rather than an assumed target.
Also called
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 18 findings · 29 questions.
Feeding pair and participation Identifies who is breastfeeding and whether a particular interaction is offered, attempted, underway, or ended.
Breastfeeding is a relationship-dependent activity whose occurrence cannot be inferred from lactation or proximity alone.
Pair and willingness
Records the participants, the lactating person's preferences, and the child's observed response.
Participants and preferences
The model must distinguish the feeding pair from caregivers or observers and attribute preferences to the person expressing them.
- Which lactating person and child are involved in this breastfeeding interaction? definition
- What willingness, refusal, or request to pause has been expressed by the lactating person, and what response has been observed in the child? boundary
Episode boundaries
Separates an offer or attempt from attachment, sucking, pauses, and completion.
Breastfeeding episode state
The model must preserve the observed stage of an interaction without automatically labelling every attempt a completed feed.
- Was the breast offered, was attachment attempted, and was attached sucking observed or reported? definition
- What marks the start, pauses, resumption, and end of this episode, and how were those boundaries recorded? measurement
Attachment and milk transfer Describes the feeding interaction at the breast and the evidence available about milk transfer.
A breastfeeding model must distinguish visible feeding behaviour from conclusions about intake.
Position and attachment
Records how the pair is positioned, how attachment is described, and what changes during the feed.
Attachment observation
The model must record concrete attachment observations and assistance used rather than relying only on an unexplained good-or-poor label.
- What position, breast, attachment behaviour, and repeated detachment were observed or reported? measurement
- Who described or assessed attachment, and was the assessment direct, remote, or recalled? provenance
Transfer evidence
Separates sucking and swallowing observations from measured intake and from unresolved uncertainty.
Milk-transfer confidence
The model must retain the basis and limits of any claim that milk was transferred during an episode.
- What sucking or swallowing observations, participant reports, or measurements support the recorded milk-transfer assessment? provenance
- If an intake estimate is supplied, what value, unit, method, assessor, and uncertainty accompany it? measurement
- What remains unknown about transfer despite the available observations? boundary
Feeding pattern and milk routes Places episodes within a defined time window and relates direct breastfeeding to other ways the child receives milk or food.
An isolated episode cannot describe a breastfeeding pattern, and human-milk feeding is not synonymous with direct breastfeeding.
Pattern across episodes
Records episode frequency, timing, breast sequence, and gaps in observation.
Observed feeding pattern
The model must state the observation window and record completeness before summarising frequency or change.
- Within what time window were breastfeeding episodes recorded, and which periods may be missing? boundary
- How many offers, attempts, and feeds were recorded, with what timing, duration, and breast sequence? measurement
Milk source and delivery
Keeps direct breastfeeding distinct from milk source, expression, supplementation, and other feeding routes.
Related feeding configuration
The model must link related feeding activities and identify supplemental delivery at the breast without assuming all milk came from that breast.
- What other milk or food was provided during the same interval, and through which linked feeding activities? boundary
- Was a supplemental nursing device used at the breast, and what is known about the supplemental milk's source and amount? measurement
Comfort, difficulty, and review Records participant experience, feeding difficulties, and the basis for seeking additional assessment.
Breastfeeding state includes comfort and unresolved concerns as well as whether an episode occurred.
Experience during feeding
Captures the lactating person's reported sensations and the child's observed behaviour with episode-specific timing.
Comfort and distress
The model must distinguish self-reported pain from observed behaviour and preserve when each occurred.
- What discomfort or pain did the lactating person report, at which location and stage of feeding? measurement
- What child behaviour prompted concern, who observed it, and when did it occur relative to attachment or sucking? provenance
Concerns and clinical links
Connects unresolved feeding concerns to relevant assessments without embedding unverified diagnostic rules.
Assessment and review status
The model must distinguish an unassessed concern, a professional assessment, and a documented review plan.
- Which concerns about feeding, intake, or participant wellbeing remain unassessed, and which have a linked professional assessment? boundary
- What applicable professional guidance or individual care plan governs the next action, and who is responsible for review? action
Support and feeding transitions Records practical support, participant-chosen goals, and changes in breastfeeding over time.
An agent needs to relate proposed support to the person's circumstances and intentions rather than assume that increasing breastfeeding is always the goal.
Practical feeding support
Captures conditions that affect feeding opportunities and support actions accepted by the participant.
Support action and response
The model must connect a practical difficulty to an agreed support action and the subsequently reported or observed response.
- What positioning assistance, accessibility need, privacy constraint, separation, or other circumstance affected this breastfeeding interaction? boundary
- What support was requested or accepted, and what changed in comfort, attachment, or ability to feed afterward? action
Goals and transitions
Tracks intentions to initiate, maintain, combine, reduce, or stop breastfeeding and any associated support plan.
Participant-directed feeding plan
The model must keep desired changes separate from observed changes and attribute plans to their decision-makers.
- What does the lactating person currently want to change or maintain about breastfeeding, and when was that preference expressed? provenance
- What agreed next step and review point support that goal, and which related feeding or clinical plans must be linked? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Kinds and varieties
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Exclusive breastfeeding (human milk only; oral rehydration, drops and vitamins allowed)
- Predominant breastfeeding (human milk plus water or water-based drinks)
- Partial or mixed feeding (human milk plus infant formula or other milks)
- Complementary feeding with continued breastfeeding (human milk plus solid or semi-solid foods, typically from about six months)
- Direct at-breast feeding
- Expressed-milk feeding, including exclusive pumping
- Induced lactation or relactation (milk production without, or after interruption of, a recent pregnancy)
- Wet nursing (a person other than the child's parent suckles the child)
- Which of these kinds and varieties hold for the sense of breastfeeding this model covers, and on what evidence? provenance
Identifiers and schemes
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Wikidata - Q174876 - Item for breastfeeding as a practice.
- MeSH - D001942 - Heading Breast Feeding.
- SNOMED CT - 69840006 - Breastfeeding (regime/therapy); related findings include 169741004 Breast fed.
- ICD-10-CM - Z39.1 - Encounter for care and examination of lactating mother; infant feeding difficulty at the breast is separately coded (e.g. P92.5).
- Which of these identifiers and schemes hold for the sense of breastfeeding this model covers, and on what evidence? provenance
Standards and regulation
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- International Code of Marketing of Breast-milk Substitutes (World Health Organization, 1981) and subsequent World Health Assembly resolutions
- Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding (WHO and UNICEF)
- Global Strategy for Infant and Young Child Feeding (WHO and UNICEF, 2003)
- Maternity Protection Convention, 2000 (No. 183) - paid nursing breaks (International Labour Organization)
- Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding (WHO/UNICEF, 1990)
- PUMP for Nursing Mothers Act (United States, 2022), extending Fair Labor Standards Act break-and-space duties for expressing milk
- Equality Act 2010 protections against discrimination for breastfeeding (United Kingdom)
- Council Directive 92/85/EEC on pregnant and breastfeeding workers (European Union)
- Which of these standards and regulation hold for the sense of breastfeeding this model covers, and on what evidence? provenance
Real-world use
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Initiation in the delivery room with skin-to-skin contact and a first feed in the hour after birth
- On-demand feeding at home through infancy, including night feeds that often supply a large share of early intake
- Expression at work into bottles or bags after return from parental leave, using a dedicated pump room or equivalent space
- Pasteurised donor human milk in neonatal intensive care when the parent's own milk is insufficient, especially for preterm infants
- Public feeding in civic and commercial spaces, with legal protection in many but not all jurisdictions
- Clinical and peer support via IBCLC consultants, baby-friendly maternity units, WIC, and volunteer groups such as La Leche League
- Which of these real-world use hold for the sense of breastfeeding this model covers, and on what evidence? provenance
Typical measurements
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Recommended exclusive-breastfeeding duration - 6 (WHO recommendation; observed population medians are often much shorter) - months
- Recommended continued breastfeeding with complementary foods - 12-24 or beyond - months of age
- Feed frequency in the early weeks (exclusive, on demand) - 8-12 - feeds per 24 h
- Established daily milk yield - 600-1000 (central values often ~750-800) - mL/day
- Typical session duration after latch is established - 10-40 - minutes
- Time from birth to first breastfeed (early-initiation indicator) - 0-60 (target: within 1 hour) - minutes
- LATCH score (latch, audible swallowing, type of nipple, comfort, hold) - 0-10 - points
- Per-feed transfer after the first month - 60-150 - mL
- Which of these typical measurements hold for the sense of breastfeeding this model covers, and on what evidence? provenance
Failure modes and hazards
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Poor latch or low transfer leading to excessive weight loss, hypernatraemic dehydration, exaggerated jaundice, or failure to thrive
- Nipple trauma, vasospasm, and pain that drive early cessation
- Engorgement, blocked ducts, lactational mastitis, and breast abscess
- True low supply (insufficient glandular tissue, retained placenta, uncorrected hypothyroidism) versus common perceived low supply
- Classic galactosemia in the infant - an absolute contraindication to human-milk feeding
- Vertical transmission risk for HIV, HTLV-1, and untreated infectious tuberculosis; CMV risk in very preterm infants fed raw milk
- Transfer of some medicines, chemotherapy, and environmental toxicants via milk
- Workplace, social, and marketing pressures that shorten duration even when physiology is intact
- Which of these failure modes and hazards hold for the sense of breastfeeding this model covers, and on what evidence? provenance
Regional variation
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Prelacteal feeds (water, honey, formula, ritual foods) remain common in parts of South Asia, the Middle East, and North Africa, delaying exclusive breastfeeding
- Colostrum is discarded as unclean in some communities in parts of sub-Saharan Africa and Central Asia
- Nordic and some other high-leave European settings show high exclusive rates; the United States, United Kingdom, and several East Asian settings show high initiation but rapid drop-off
- WHO recommends breastfeeding with maternal antiretroviral therapy where unsafe formula is the greater risk; several high-income authorities advise against breastfeeding when formula is acceptable, feasible, affordable, sustainable and safe
- Islamic fiqh treats milk kinship (rada) as creating marriage-barred kinship when a child is wet-nursed
- Longer statutory leave in much of Europe favours at-breast feeding; United States practice leans on workplace pumping after a short leave
- Some English-language LGBTQ+ clinical services use 'chestfeeding' for the same physiological act
- Which of these regional variation hold for the sense of breastfeeding this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Reported by the breadth pass; each item needs checking against its source before it becomes normative.
- Infant formula feeding - The milk is an industrially manufactured substitute, not human milk; composition and infection-risk profile differ even when the delivery device is a bottle.
- Exclusive pumping / bottle feeding of the parent's own expressed milk - The infant is not attached to the breast; the milk origin is still the parent. Direct breastfeeding additionally depends on latch and infant sucking dynamics.
- Donor human-milk feeding - Milk comes from a screened donor or milk bank, usually pasteurised, and is not suckled from the child's parent.
- Wet nursing - The lactating person is not the child's parent; the act is still suckling at a human breast.
- Complementary feeding - Energy also comes from solid or semi-solid foods; it is an age-stage addition, not an alternative name for milk feeding.
- Lactation - Lactation is milk production (physiology); breastfeeding is the feeding practice that may use that milk.
- Bottle feeding - A delivery method (artificial teat) independent of whether the contents are human milk or formula.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of breastfeeding this model covers, and on what evidence? provenance
Sources
- Infant and young child feeding (fact sheet) - WHO definitions of exclusive, predominant and continued breastfeeding; six-month exclusive and two-year continued recommendations; early initiation within one hour of birth.
- International Code of Marketing of Breast-milk Substitutes - The principal international instrument restricting promotion of formula and other breast-milk substitutes.
- Global Strategy for Infant and Young Child Feeding - Joint WHO/UNICEF policy frame for exclusive breastfeeding to six months, continued breastfeeding to two years or beyond, and complementary feeding.
- Policy Statement: Breastfeeding and the Use of Human Milk - American Academy of Pediatrics clinical policy on duration, contraindications (including classic galactosemia), and support practices in the United States.
What the second pass must settle
- Does the registry intend breastfeeding to mean direct feeding at the breast only, or the broader receipt of human milk, and which neighbouring registered models own lactation, expression, and other feeding routes?
- How should comfort sucking and attempts with no evidenced milk transfer be classified so that they remain visible without being counted as confirmed intake?
- Which validated observation methods and measurement conventions should support attachment and milk-transfer assessments, and what limits apply in different feeding contexts?
- Which authoritative, locally applicable guidance should govern concern escalation, especially for premature children, medically complex feeding pairs, or individual care plans?
- Does an existing Vercy world model already cover this activity, and which parts should be linked rather than duplicated?