Breastfeeding Experiences of Mothers of Children with Down Syndrome

Breastfeeding Experiences of Mothers of Children with Down Syndrome: A Qualitative Study

Purpose: It is known that despite the benefits of breast milk and breastfeeding, children with Down syndrome (DS) are breastfed less than other children are. More information is needed to reveal the problems experienced regarding breastfeeding in this group of children and take precautions. The purpose of this study was to learn about the breastfeeding experiences of mothers of children with DS. Methods: The study was carried out by conducting in-depth interviews with 17 women who met the inclusion criteria in Turkey between September 1 and December 1, 2023. Content analysis was used to analyze the data. Results: As a result of the content analysis, five themes emerged. These themes were changing of body and emotions, why doesn't my baby suck?, I have to breastfeed my baby, I am not alone, and experiences should be shared. Conclusions: It was determined that mothers of children with DS experienced problems/difficulties due to individual, baby-related, and environmental factors. The positive effects of breastfeeding children with DS can be made prevalent in society by supporting these mothers.

Receiving a Prenatal or Postnatal Diagnosis of (Dis)Ability: The Role and Importance of the Nurse

ABSTRACT

The phenomenon of carrying and birthing an infant with a (dis)ability is complex and emotionally driven for parents. Infants with (dis)abilities are at risk for long-term health and developmental challenges, which may cause fear and stress in families. Parents report dissatisfaction with their experience of learning of their infant's (dis)ability diagnosis. After unexpected news is given to expecting or new parents prenatally or postnatally, it is the nurse who is often left with parents during an extremely emotional and vulnerable time. Although nurses play a pivotal role in supporting parents through this vulnerable time, their specific role is not well defined. This narrative synthesis reviews the role of the nurse during complex family situations and applies findings to their role in supporting families through receiving the diagnosis of a (dis)ability for their infant either prenatally or postnatally. Nurses can assist parents through this process of adaptation by using a compassionate and empathetic approach in their care, facilitating opportunities for parent-infant bonding, speaking with person-first language, clarifying complex information, and assisting with allocation of various internal and external resources. Future research dedicated to the creation of best practice clinical guidelines on communicating with families during the diagnosis of (dis)ability would assist nurses and other health care professionals in meeting the multifaceted and sensitive needs of parents and families, ultimately contributing to improved health outcomes for the parents, family, and infant.

Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards

There is a paucity of literature exploring the challenges of breastfeeding sick children in hospital. Previous research has focused on single conditions and hospitals which limits understanding of the challenges in this population. Although evidence suggests that current lactation training in paediatrics is often inadequate, it is unclear where the specific training gaps are. This qualitative interview study of UK mothers aimed to explore the challenges of breastfeeding sick infants and children on a paediatric ward or paediatric intensive care unit. From 504 eligible respondents, a sample of 30 mothers of children aged 2-36 months with various conditions and demographic backgrounds was purposively chosen, and a reflexive thematic analysis undertaken. The study identified previously unreported impacts such as complex fluid needs, iatrogenic withdrawal, neurological irritability and changes to breastfeeding behaviour. Mothers described breastfeeding as emotionally and immunologically meaningful. There were many complex psychological challenges such as guilt, disempowerment, and trauma. Wider struggles such as staff resistance to bedsharing, inaccurate breastfeeding information, lack of food and inadequate breast pump provision made breastfeeding more challenging. There are numerous challenges related to breastfeeding and responsively parenting sick children in paediatrics, and these also impacted maternal mental health. Staff skill and knowledge gaps were widespread, and the clinical environment was not always conducive to supporting breastfeeding. This study highlights strengths in clinical care and provides insight into what measures are perceived as supportive by mothers. It also highlights areas for improvement, which may inform more nuanced paediatric breastfeeding standards and training.

Mothers of children with down syndrome: A qualitative study of experiences of breastfeeding and breastfeeding support

BACKGROUND

Children with down syndrome (DS) are breastfed to a lesser extent than infants in general, despite research showing that it is possible for these children to breastfeed successfully.

AIM

The aim was to describe how mothers of children with DS experienced breastfeeding and breastfeeding support from healthcare professionals.

METHOD

A qualitative study with an inductive approach. Individual interviews were performed with seven mothers from southern Sweden. The interviews were analysed using qualitative content analysis.

RESULT

The mothers felt that the support varied, as some healthcare professionals were supportive, while others had preconceptions regarding breastfeeding and DS. They also experienced that the guidelines could be an obstacle in the encounter with healthcare professionals thereby affecting the possibility to establish breastfeeding. Information and support were important to the mothers, and when insufficient, they turned to the internet for help.

CONCLUSIONS

Mothers felt that healthcare professionals were bound to ward routines and guidelines, which could be contrary to their own and the family's wishes. They were also sensitive to the attitudes of healthcare professionals, which can affect their own state of mind. Healthcare professionals' preconceptions regarding breastfeeding and DS have not changed, despite research showing that infants with DS can breastfeed successfully. Increased awareness of the possibility to breastfeed an infant with DS is needed to provide better support to mothers.

Using art to raise awareness of breastfed children with medical complexity

Background

Current infant feeding support is often targeted at establishing breastfeeding in healthy term infants, or supporting lactation for preterm infants in the neonatal setting. Breastfeeding presents different challenges for children beyond the neonatal period who have a medical complexity. The tendency to focus on breastfeeding as a preventative public health intervention overlooks the fact that mothers and children with medical complexity often require additional and targeted support to continue to breastfeed. Despite this identified need, there is very little research, policy or clinically specific teaching within paediatrics that is nuanced enough to support this vulnerable population.

Raising awareness of breastfed children with medical complexity in paediatrics

While research, policy and embedded Baby Friendly Health Initiative (BFHI) standards in both the maternity and neonatal directorates exists, paediatrics is a separate discipline and contrastingly, has very little lactation support infrastructure. To this end, a doctoral study was commenced aiming to identify the differences for this vulnerable and largely overlooked group. One of the related outputs of the ongoing research is the use of creative methods to raise awareness. This commentary highlights a project with an artist to develop a series of portraits alongside a book and health professional education to increase awareness of these children’s needs.

Conclusions

The breastfeeding needs and challenges of children in the paediatric setting are unique and require additional awareness, creativity and skills to support optimal infant and young child breastfeeding. Using art can connect professionals to the lived experiences of families trying to persevere through medical complexity.

Can I breastfeed my baby with Down syndrome? A scoping review

AIM

To summarise existing evidence about barriers and enablers to breastfeeding babies with Down syndrome (DS) in peer-reviewed literature.

METHODS

Ovid Medline, CINAHL, Scopus and Ovid Emcare were searched. Inclusion and exclusion criteria were used to screen yielded articles and those meeting the criteria were included for data extraction. Two authors extracted data including outcomes, design, definition of DS, barriers and enablers to breastfeeding babies with DS.

RESULTS

Sixteen studies met the inclusion and exclusion criteria. Barriers and enablers were categorised into maternal, child and health professional factors.

CONCLUSIONS

This review identified a significant literature gap related to breastfeeding babies with DS and more definitive research under current standards is needed. Mothers reported the need for high-quality health professional breastfeeding support and evidence-based effective breastfeeding techniques. A collaborated and concerted approach from both mothers and health professionals is important to optimise breastfeeding for babies with DS.

Randomized Clinical Trial of a Prenatal Breastfeeding and Mental Health Mixed Management Intervention

BACKGROUND

The continuity of maternal depressive symptoms throughout the perinatal period and breastfeeding problems have adverse influences on breastfeeding.

RESEARCH AIM

To compare the feeding patterns and breastfeeding experiences, maternal health and mental health, and breastfeeding self-efficacy between women with depressive symptoms who participated in a prenatal individualized mixed management intervention and those who received usual care.

METHODS

Chinese primigravida (N = 182) with an Edinburgh Postnatal Depression Scale score ≥ 9 in late pregnancy (≥ 28 weeks and < 35 weeks) were randomly assigned to the intervention group (n = 84) or the control group (n = 84). Intervention group participants received four sessions of individualized mixed management combining psycho-education and breastfeeding education. Breastfeeding self-efficacy, feeding patterns, maternal depression, and health status were evaluated in both groups.

RESULTS

Significant differences were noted between the groups in breastfeeding self-efficacy at 42 days postpartum (p < .05) and feeding patterns at 3 months and 6 months postpartum (p < .05). Repeated measures analysis of variance showed significant differences in the EPDS scores between groups at three postpartum time points (p < .05). The intervention group had significantly lower postpartum depression as diagnosed by the MINI (p < .05).

CONCLUSIONS

A prenatal individualized mixed management intervention holds promise as an effective prevention and health promotion program addressing breastfeeding outcomes and maternal mental health.This RCT was registered (ChiCTR-IOR-17013761) with Chinese Clinical Trial Registry, http://www.chictr.org.cn/enIndex.aspx on 12/7/2017.

The challenges of medically complex breastfed children and their families: A systematic review

Exclusive breastfeeding for the first 6 months and then alongside solid food for the first 2 years and beyond is the gold standard in young child nutrition. There is an abundance of literature relating to the preventative nature of breastmilk and breastfeeding against many infectious diseases and chronic conditions. However, despite medically complex infants and children being a group that could benefit most from continued breastfeeding, breastfeeding duration and exclusivity are lower among more complex paediatric populations. The reasons for this are not well known, and there is a paucity of data relating to supporting infants who have acute or chronic illness, disability or congenital anomaly to breastfeed. This systematic review aimed to understand the challenges of breast/chestfeeding the medically complex child and to establish the gaps in healthcare provision that act as barriers to optimal infant and young child feeding. The search was limited to studies published in English, focused on breastfed sick infants in hospital, with no date limits as there is no previous systematic review. Of 786 papers retrieved, 11 studies were included for review, and seven themes identified. Themes included practical and psychological challenges of continuing to breastfeed in a hospital setting, complications of the condition making breastfeeding difficult, lack of specialist breastfeeding support from hospital staff and a lack of availability of specialist equipment to support complex breastfeeding. The findings affirm the lack of consistent high-quality care for lactation support in paediatric settings and reinforce the need for further focused research in this area.

Care Coordination Needs of Families of Children with Down Syndrome: A Scoping Review to Inform Development of mHealth Applications for Families

Care coordination is a critical component of health management aimed at linking care providers and health-information-involved care management. Our intent in this scoping review was to identify care coordination needs of families of children with Down syndrome (DS) and the strategies they used to meet those needs, with the goal of contributing to the evidence base for developing interventions by using an mHealth application (mHealth apps) for these families. Using established guidelines for scoping reviews, we searched five databases, yielding 2149 articles. Following abstract and full-text review, we identified 38 articles meeting our inclusion criteria. Studies incorporated varied in regard to research designs, samples, measures, and analytic approaches, with only one testing an intervention by using mHealth apps. Across studies, data came from 4882 families. Common aspects of families' care coordination needs included communication and information needs and utilization of healthcare resources. Additional themes were identified related to individual, family, and healthcare contextual factors. Authors also reported families' recommendations for desirable characteristics of an mHealth apps that addressed the design of a personal health record, meeting age-specific information needs, and ensuring access to up-to-date information. These results will further the development of mHealth apps that are tailored to the needs of families with a child with DS.

What are the implications of Zika Virus for infant feeding? A synthesis of qualitative evidence concerning Congenital Zika Syndrome (CZS) and comparable conditions

If a mother contracts the Zika Virus before or during pregnancy, then there is a risk of the child developing Congenital Zika Syndrome (CZS). An infant can then experience problems feeding due to the specific physical and developmental consequences of Congenital Zika Syndrome (CZS), such as microcephaly, dysphagia and an increased likelihood of choking. This qualitative evidence synthesis accesses direct and indirect evidence to inform WHO infant feeding guidelines. We conducted a qualitative evidence synthesis of the values and preferences of relevant stakeholders (e.g. pregnant women, mothers, family members and health practitioners) concerning infant (0-2 years) feeding in the presence of: 1) CZS (the'direct evidence'); 2) severe disability and nonprogressive, chronic encephalopathies ('indirect evidence'), which present with similar problems. Authors' findings were extracted, synthesised using thematic synthesis techniques, and confidence in the findings were assessed using GRADE-CERQual. Six CZS-specific studies (all from Brazil) were included in the direct evidence, with a further eight indirect studies reporting feeding difficulties in infants with severe disability and nonprogressive, chronic encephalopathies. Included studies highlighted: breast-feeding represented the preference for all mothers in the studies in both reviews, and the inability to do so affected bonding between parents and child, and generated fear and anxiety relating to feeding choices, especially around the risks of choking and swallowing; the perception that health professionals were often unable to offer appropriate advice; the potential value of training; and a strong desire to achieve individual maternal autonomy in infant feeding decisions. Confidence in most findings ranged from low to moderate. The evidence base has limitations, but consistently reported that parents of children with feeding difficulties due to Congenital Zika Syndrome, or similar, need information, advice and counselling, and substantial emotional support. Parents perceive that these needs are often neither recognised nor satisfied; optimal feeding and support strategies for this population have not yet been identified.

Exclusive Breastfeeding for Twin Babies and Its Influencing Factors: A Study in East Java, Indonesia

This study aimed to identify the factors that influence the success of exclusive breastfeeding in twins. This cross-sectional study was conducted on 184 mothers who had twins aged 6-23 months in Malang Raya, East Java, Indonesia and used the consecutive sampling technique. The data was collected through distributing questionnaires containing questions related to knowledge about exclusive breastfeeding, breastfeeding self-efficacy, and the support of family and certified health workers. Multinomial regression statistical test results show that the most influential factor for the success of exclusive breastfeeding with twins was breastfeeding self-efficacy (OR 0.111; 95% CI 0.033-0.387). A high level of breastfeeding self-efficacy can increase a mother's confidence to be able to provide exclusive breastfeeding for twins. This study suggests that nurses can provide breastfeeding counselling to improve breastfeeding self-efficacy.