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Breast Pump Program Application

Medela Swing Maxi Breast Pump 

Supporting families on their feeding journey

To establish and maintain an adequate breastmilk supply mothers usually need to hire a hospital style breast pump. However, this is not possible for all families. The LLTF Breast Pump program provides eligible families with a Medela Swing Maxi double electric breast pump to support parents while they are caring for a premature or sick baby in the neonatal intensive care unit (NICU). It is advised that the mother continues to access the hospital style breast pumps when she is with her baby in NICU/SCN and uses the Medela Swing Maxi if the parent is away from their baby. In this program a nominated hospital social worker/lactation consultant evaluates the family’s need by considering several factors, including financial difficulties, gestational age of baby at time of birth, length of stay in the NICU and barriers in establishing milk supply. The social worker/hospital staff member will then complete an LLTF application form after gaining the mother’s consent on behalf of the parent/carer, which is found below.[/vc_column_text]

Nomination criteria

Below are our qualification guidelines for nomination:

  • The family must currently have a baby in NICU/SCN
  • The family is unable to afford to hire or purchase an appropriate electric pump.
  • The family is wanting to establish and provide breastfeeding/breast milk for their baby
  • Baby was born at 32 weeks or earlier or has a major health complication requiring a long stay in hospital of 4 weeks or more
  • The baby is from a disadvantaged, Indigenous, Torres Strait Island background or rural or regional location.

How do I nominate a family for support?

*LLTF will supply each participating hospital with 8 Medela Swing maxi Breast pumps every two months. The hospital agrees to store the pumps safely until approval of application is received.

Step 1 – The Social Worker / Lactation Consultant complete the family nomination form below.

Step 2 – LLTF staff contact the nominated health professional via phone/email to confirm approval of application.

Step 3 – If approved, the nominated hospital staff member will present the Breast Pump and supporting letter to the family on behalf of LLTF (please allow 2 days for approval).

LLTF Breast Pump Program Application Form

Please nominate a family currently staying in your NICU/SCN by completing the form below. All sections must be completed for your application to be processed and reviewed.
We endeavour to review applications and respond within 5 working days. 
If you have any queries relating to the LLTF Family Assistance Program, please contact:

Amy Baker
Special Projects Coordinator
Life's Little Treasures Foundation
Phone: 0402 558 200
Email:  [email protected]
Application Criteria


Details of Health Professional Making Application








Baby Details

Parent/Carer Information - Parent 1
We may need to contact the recipient parents as part of the LLTF Breast Pump program, so enter as many details of the parents as you can in the sections below.

Please DO NOT enter your own contact details if the parent details are not known, simply leave them blank.








Parent/Carer Information - Parent 2
We may need to contact the recipient parents as part of the LLTF Breast Pump program, so enter as many details of the parents as you can in the sections below.

Please DO NOT enter your own contact details if the parent details are not known, simply leave them blank.








The information detailed in this nomination form will only be used to assist LLTF in the delivery of LLTF specific information and the LLTF Breast Pump Program. Personal information is never passed onto a third party. For full details on our privacy policy please go to our privacy statement on our website.
LLTF Form Bottom

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