Implementation of a Novel Tool to Collect Milk Feeding Data on Infants in Primary Care Clinics.


We aimed to capture milk feeding type in real time in a racially and socioeconomically diverse population. An electronic tool to assess milk feeding type at every medical visit for children aged 0 to 2 years was designed and incorporated into nursing workflows. The Milk Box tool was successfully added to the electronic clinical workspace of a large health system. There were eight clinics, with diverse characteristics, which incorporated the use of the Milk Box tool over 12 months. Time to 50% uptake of Milk Box varied from 3 to 5 months. Time to >80% uptake varied from 6 to 8 months. Our results show that Milk Box can be quickly incorporated into a clinical workflow when the team is given appropriate training and support. The tool also allows a primary care practice to study local breast milk consumption trends and to provide both individualized and system-level lactation support.





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Publication Info

Maradiaga Panayotti, Gabriela M, Dean S Miner, Emily A Hannon, Melissa C Kay, Sophie K Shaikh, Karen R Jooste, Elizabeth Erickson, Teresa Kovarik, et al. (2022). Implementation of a Novel Tool to Collect Milk Feeding Data on Infants in Primary Care Clinics. Clinical pediatrics. p. 99228221101002. 10.1177/00099228221101002 Retrieved from

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Maradiaga Panayotti

Gabriela Muriel Maradiaga Panayotti

Adjunct Associate Professor in the Department of Pediatrics

Melissa Kay

Assistant Professor of Pediatrics

Melissa Kay is a public health nutritionist conducting research in support of early life obesity prevention. Her educational background includes public health, food policy and applied nutrition, epidemiology, and nutrition interventions. She is currently faculty in the Department of Pediatrics and is using digital technologies to augment clinical care between primary care visits as well as visits with the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Using interactive text messaging, Dr. Kay supports caregivers in adopting healthy feeding behaviors for themselves and their families.  


Sophie Kay Shaikh

Assistant Professor of Pediatrics

Karen Roussel Jooste

Assistant Professor of Pediatrics

Karen Jooste, MD, MPH is a palliative care physician and pediatrician at Duke University. She works on the Pediatric Quality of Life team at Duke Children’s Hospital and Health Center, and with adults in both palliative care and hospice care. She completed her residency in Pediatrics at the Children’s Hospital of New York at the Columbia University Irving Medical Center, her Master of Public Health at the Mailman School of Medicine, Columbia University and her Hospice and Palliative Medicine Fellowship at Duke. She trained as an Integrative Health Coach at Duke Integrative Medicine in 2012. Her passion as both a clinician and an educator, is the intersection between communication, racial and gender equity, ethics and medical humanities (narrative medicine). 

Dr. Jooste teaches narrative medicine to interprofessional students (Medicine, Nursing, PT and PA students) through the Trent Center at Duke and co-leads annual workshops at Duke Integrative Medicine in Leading Others in Writing for Health.  She is a Faculty leader and educator in the Clinical Skills Foundation Course at the Duke School of Medicine.  She is trained as a VitalTalk trainer and facilitator in Advanced Communication Skills and teaches as part of the PEACCE Corps Education Team (Promoting Equity and Alignment of Care via Communication Education).  Dr Jooste is the Vice Chief of Diversity, Equity and Inclusion of the Division of Palliative Care. She facilitates workshops at Duke called Conversations with Colleagues to promote and strengthen diversity, inclusion , antiracism and belonging.  

One of her favorite roles is as a coach for the Duke Residency Professional Development Coaching Program.  She also serves as an Ethics Consultant at Duke University Hospital and as a member of the Professional Accountability (PACT) team, promoting professionalism.



Charles Thomas Wood

Assistant Professor of Pediatrics

My research is focused on the identification of factors in early childhood that increase risk for excessive weight gain and obesity. I am specifically interested in understanding the development of feeding styles and behaviors, appetite, and the interaction between infant and caregiver, with the goal of developing primary care interventions to prevent obesity. I am engaged in evidence synthesis and teach evidence-based medicine to students, residents, and fellows.

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