Table 4.

Summary of the detailed instrument from studies on preterm infants’ cues during breastfeeding

Author/year/country/language	Instruments for observing the preterm infants’ cues
	Instrument/developer	The instruments’ general description	Validity and reliability of the instrument
Lin et al. (2013)	-The Preterm Infants Cues Coding System (PFCCS) -The original version was developed by Lin (2005)	-The coding system consisted of (1) a video of preterm infant cues; (2) a coding guide; (3) a checklist -Video of preterm infant cues during a breastfeeding session -The coding guide covers four categories of infants’ cues with 24 label behaviors for breastfeeding and description -Need training coder for PFCCS observer	-Inter-rater reliability showed 84-98% (good agreement) -Intra-rater reliability showed 83-97.5% (good agreement)
Giannì et al. (2017)	The modified instrument from Infant Driven Scale (IDS) (Newland et al., 2013)	-The instrument assessed the infant’s feeding readiness and sucking quality -Consist of four items observation: (1) postmenstrual age/PMA (score ranging from 1 to 6); (2) volume of milk during feeding (score from 1 to 3 at bottle feeding); (3) oral feeding readiness (score ranging from 1 to 5); (4) sucking quality (ranging from 1 to 5 at bottle feeding; 1 to 4 at the breast) -The best infant feeding readiness cues indicated with the highest score in each item	Not reported
Nyqvist et al. (1996)	-The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) -Need certification for NIDCAP observer -A model developed by Als (1995)	-NIDCAP is a tool for assessing breastfeeding and advice -Assessment of the preterm infants’ behavioral cues based on four systems: (1) autonomic (heart rate, respiration, skin color, startles, twitches, gastrointestinal signs); (2) motor (muscle tone, posture, active movement); (3) state (level of wakefulness, clarity of state patterns of state transition); (4) attention and interaction system -The result of the assessment can be identified as cues for approach and cues of avoidance	Reliability was checked before the study, but the test’s result was not reported
Nyqvist et al. (1999)	-The Preterm Infant Breastfeeding Behavior Scale (PIBBS) -Raters can be nurses or mothers -Raters need training	The guideline for observing preterm infant cues during breastfeeding focuses on six infant cues that are: rooting, areolar grasp, latch-on, sucking, longest sucking burst, swallowing	Kappa values between mothers and nurses range from 0.68 to 0.94 or 80–97% agreement which indicated good agreement between raters