Supporting breastfeeding when clinical nutrition interventions are required in the paediatric healthcare setting: a...

Breastfeeding is often compromised when clinical nutrition interventions are implemented for complex paediatric patients, in a healthcare environment where breastfeeding supports are currently under-resourced. This systematic review aimed to investigate how breastfeeding can be supported when it is disrupted for clinical nutrition interventions in the paediatric healthcare setting. The experience of mothers who breastfeed their child requiring nutrition support and/or therapeutic dietary measures is also explored.

A search was conducted across five databases; Ovid-Medline, Ovid-Embase, CINAHL Complete, Scopus and Cochrane Library. Eligible papers included breastfeeding dyads where the infant/child required a nutrition intervention in the global paediatric healthcare setting, limited to those published in the English language and year 2000 onwards. Manuscripts that focused on preterm infants, maternity or neonatal care settings, healthcare professionals, or a maternal clinical condition impacting breastfeeding were excluded. Results were synthesised into key measures to support breastfeeding and overarching themes illustrating a mother's experience breastfeeding her child with complex nutritional needs.

From 13,177 manuscripts screened, a total of 36 manuscripts were included. Clinical conditions in the manuscripts identified included congenital heart disease, congenital anomalies, inborn errors of metabolism, acute and chronic respiratory conditions, trisomy 21, faltering growth and hyperbilirubinaemia. Measures to support breastfeeding (n = 19 primary research studies and n = 5 case studies) encompassed environmental modifications and improvements to hospital procedures; access to lactation support professionals and education; and clinical practices that facilitated breastfeeding. Key themes across papers exploring maternal experience (n = 12 manuscripts) were difficulties breastfeeding a child with complex nutritional needs; a desire to breastfeed that informed maternal identity and emotions; and a supportive healthcare team that promoted breastfeeding.

This review highlights environmental and practical strategies that can optimise breastfeeding for paediatric patients receiving clinical nutrition interventions and support maternal feeding intentions. Many strategies to support breastfeeding are geared towards supporting lactation physiology to increase maternal milk supply. More research is needed to explore what psychological and emotional supports mothers need from the healthcare team when encountering breastfeeding difficulties and unmet expectations feeding a nutritionally complex child.