UK mothers' experiences of bottle refusal by their breastfed baby

Why have a bottle when you can have draught? Exploring bottle refusal by breastfed babies

Bottle refusal by breastfed babies is a scenario that has received surprisingly little attention in the literature, given the number of mothers who appear to be experiencing it globally and the subsequent negative impact it can have. In line with this, we undertook a study to explore mothers' views on why their breastfed baby refuses to bottle feed. A parallel, two-stage, exploratory qualitative design was employed using 30 semi-structured interviews and 597 online forum posts. Data were analysed using a thematic analysis, and a biopsychosocial model was applied resulting in four overarching themes being identified: 'Breastfeeding is the answer to everything….' 'Bottle feeding: an alien concept… 'Babies are individuals' and 'Find the right bottle and don't delay'. The psychological benefits of breastfeeding, not inherent in bottle feeding, appeared to underpin some mothers' views on their baby's refusal. Other mothers explained refusal as being down to a baby's biological expectation to be fed by the breast; therefore, bottle feeding was not a normal concept to them. A baby's individual personality and temperament were also suggested as contributing to the scenario and refusal was linked to babies disliking a certain brand of bottle and being introduced to it 'too late'. This study's findings point to a complex, multifactorial picture underpinning bottle refusal by breastfed babies, which transcends physical, psychological and biological concepts, and is influenced by socio-cultural norms surrounding infant feeding. Recognition of these contributing factors is needed to aid those supporting mothers experiencing the scenario and, importantly, to underpin mothers' decision-making around managing it.

What Does It Mean to Be Breastfed? A Concept Analysis in the Context of Healthcare Research, Clinical Practice, and the Parent Perspective

Over the past 3 decades, there have been attempts to define breastfeeding for scientific research. However, a lack of clarity remains, with concurrent ambiguity in clinical practice and insufficient inclusion of the parent perspective. Furthermore, previous concept analyses of "breastfeeding" may not fully represent what it means for an infant to be breastfed. Therefore, this concept analysis sought to define "breastfed" in the context of Western healthcare research, clinical practice, and the parent perspective. Informed by Rodgers' evolutionary method, a literature search resulted in 16 representative articles, with related terms, attributes, antecedents, and consequences identified. Analysis of the literature resulted in a theoretical definition of breastfed as a valuable process, experience, or characteristic that involves human milk consumption by an infant through a variety of delivery methods. To be breastfed relies on the existence of lactation, whether from a parent or another source, and depends upon the intentional decision of a birthing person, caregiver, or provider. It is recommended that healthcare providers and institutions adopt this inclusive definition, committing to a linguistic and conceptual distinction between a breastfed infant and direct breastfeeding. Increased clarity may improve comparability between studies, reporting to government agencies, provider communication, and supportive, family-centered care.

The differential role of practical and emotional support in infant feeding experience in the UK

Social support is a known determinant of breastfeeding behaviour and is generally considered beneficial. However, social support encompasses a myriad of different supportive acts, providing scope for diverse infant feeding outcomes. Given the vulnerability of postpartum mental health, this paper aims to explore both how support prolongs breastfeeding and which forms of support promote the positive experience of all infant feeding. Using survey data collected online from 515 UK mothers with infants aged 0-108 weeks, Cox regression models assessed the relationship between receiving different types of support, support need and breastfeeding duration. Quasi-binomial logistic regression models assessed the relationship between receiving support, infant feeding mode and maternal experience of infant feeding. Rates of negative infant feeding experience indicate the widespread need for support: e.g. 38% of currently, 47% of no longer and 31% of never breastfeeding women found infant feeding stressful. Overall, practical support via infant feeding broadly predicted shorter breastfeeding durations and poorer feeding experience; results in relation to other forms of support were more complex. Our findings indicate different forms of support have different associations with infant feeding experience. They also highlight the wide range of individuals beyond the nuclear family on which postpartum mothers in the UK rely. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Nipple shield use does not impact sucking dynamics in breastfeeding infants of mothers with nipple pain

Nipple shields (shield) may reduce pain during breastfeeding, but the impact on infant sucking dynamics is not known. We examined the effects of shield use on sucking dynamics, milk removal and nipple pain in two groups of breastfeeding dyads: pain group (PG): shield used for nipple pain; comparison group (CG): no breastfeeding difficulties. Twenty PG (6 ± 4 weeks postnatal) and 28 CG dyads (8 ± 6 weeks postnatal) attended 2 monitored breastfeeding sessions with shield use randomised. Within-subject outcomes were compared. PG: shield use did not affect intra-oral vacuum (peak p = 0.17, baseline p = 0.59), sucking frequency (p = 0.20) or milk transfer (40 mL vs 48 mL, p = 0.80; percentage of available milk removed (PAMR) 55% vs 57%, p = 0.88), and reduced McGill pain scores (p = 0.012). CG: shield use increased non-nutritive sucking (10% more, p = 0.049), and reduced nutritive sucking (18% less, p = 0.017) and milk transfer (63 mL vs 31 mL p < 0.001, PAMR 65% vs 36% p < 0.001). For both groups, feeding duration increased by 2 min (p < 0.0001) and non-nutritive portions of the feed increased with shield use.Conclusion: Nipple shield use improved maternal comfort and did not impact milk removal or sucking strength in PG, but significantly reduced milk transfer and nutritive sucking in CG. What is Known: • Mothers report that nipple shields reduce nipple pain and enable continued breastfeeding. • Concerns that nipple shield use may reduce milk transfer and alter infant sucking patterns are based on limited published evidence. What is New: • Nipple shield use is associated with a 25% reduction in pain scores in breastfeeding mothers with chronic nipple pain. • Milk transfer is not reduced in dyads that regularly use a shield for chronic nipple pain. • Intra-oral vacuums are not impacted by nipple shield use in mothers experiencing pain.

UK mothers' experiences of bottle refusal by their breastfed baby

Little is known about bottle refusal by breastfed babies; however, an informal review of global online forums and social media suggested large numbers of mothers experiencing the scenario. This study aimed to explore UK mothers' experiences of bottle refusal by their breastfed baby in order to provide understanding of the scenario and enhance support for mothers experiencing it. A 22‐point online questionnaire was developed and completed by 841 UK mothers. Findings suggest that mothers introduced a bottle to their breastfed baby due to physical, psychological and socio‐cultural factors. Advice and support for mothers experiencing bottle refusal was not always helpful, and 27% of mothers reported bottle refusal as having a negative impact on their breastfeeding experience. When compared with eventual bottle acceptance, bottle refusal was significantly associated with previous experience of bottle refusal (p < .001), how frequently mothers intended to feed their baby by bottle and babies being younger at the first attempt to introduce a bottle (p < .001). This study provides a unique insight into the complexities of bottle refusal by breastfed babies and the impact it can have upon mothers' breastfeeding experiences. It generates knowledge and understanding that can help to inform practice and policies. In addition, a ‘normalising’ of the scenario could enable mothers, and those supporting them, to view and manage it more positively.