Background: It was challenging for mothers and nurses to facilitate breastfeeding for preterm infants. The preterm infants experienced problem in coordination sucking, swallow, and breathing. Availability of an instrument to observe preterm infants’ behavior during breastfeeding was needed including in Indonesia. Indonesia was identified as top five countries in the world with high number of preterm infants. Therefore, this study was intended to translate and cross-culture adaptation of the Preterm Infant Breastfeeding Behavior Scale (PIBBS) to Indonesia culture. Methods: A translation instrument using forward and backward method involved six experts were used as the study design. A pilot testing involving a convenience sampling of three Indonesian late preterm infants aged 34-<37 weeks’ gestation also was used by researchers. Ten consecutive breastfeeding events were observed by the principal investigator and the trained mothers. A self-designed demographic sheet and PIBBS were used as the instrument. Inter-rater reliability tests with the percentage of agreement and Intraclass Correlation Coefficient were used as the statistical analysis. Results:The study showed that the percentage of agreement between two raters for observing the preterm infant’s rooting behavior, areolar grasp, latch-on, sucking, longest sucking, and swallowing were 80-100%. Intraclass Correlation Coefficient for observing the preterm infant’s rooting behavior, areolar grasp, latch-on, sucking, longest sucking, and swallowing were >0.90, 1.00, 1.00, 1.00, 1.00, >0.90, 1.00 respectively. Conclusion: The study revealed PIBBS-Indonesian final version. The PIBBS-Indonesian version had excellent reliability. Therefore, the PIBBS-Indonesia version is appropriate and can be used to observe the preterm infants’ breastfeeding behavior in Indonesia.

Keywords:breastfeeding behavior, preterm infants, observation instrument, Indonesia.