Mothers' perceptions and decision-making regarding tandem breastfeeding in Türkiye: a child health-focused...

Tandem breastfeeding, defined as breastfeeding two non-twin children during the same period, remains an underexplored practice in maternal and child health. Although it may be perceived as a way of maintaining breastfeeding continuity and emotional closeness with the older child, mothers may also encounter physical, emotional, practical, social and professional challenges. This study aimed to explore mothers' perceptions of tandem breastfeeding in Türkiye and to examine how these perceptions are shaped by emotional, socio-cultural, practical and healthcare-related factors.

A qualitative study design based on reflexive thematic analysis was used. Semi-structured, in-depth interviews were conducted with 21 mothers who had at least one child aged 0-2 years and were familiar with the concept of tandem breastfeeding. Mothers were recruited using purposive and snowball sampling. Current or previous direct tandem breastfeeding experience was not systematically recorded as a mother characteristic. Interviews were audio-recorded, transcribed verbatim and analysed inductively using MAXQDA 24. The study was reported in accordance with the COREQ checklist.

Four main themes were identified: the perceived meaning of tandem breastfeeding, the perceived burden of tandem breastfeeding, social perceptions, and limited professional support. Mothers associated tandem breastfeeding with maintaining the mother-child bond, preventing abrupt weaning of the older child, and supporting a sense of fairness between siblings. They also perceived it as potentially involving physical fatigue, sleep deprivation, emotional ambivalence, increased care demands, and uncertainty regarding practical feasibility. Social norms, family attitudes, misconceptions, and limited access to evidence-based professional guidance influenced mothers' decision-making. Because direct tandem breastfeeding experience was not systematically recorded, the findings represent a combination of perceptions, beliefs, observed examples, anticipated concerns, and decision-making considerations rather than the confirmed lived experiences of a clearly defined group of tandem breastfeeding mothers.

Tandem breastfeeding was perceived as a complex maternal and child health practice shaped by emotional, practical, socio-cultural, and healthcare-related factors. The findings provide insight into how mothers understand and evaluate tandem breastfeeding and how they approach decisions about whether to initiate or continue the practice. However, because mothers with confirmed direct tandem breastfeeding experience could not be distinguished from those expressing perceptions, expectations, or observed experiences, the findings should not be interpreted as evidence of the lived experience, feasibility, safety, or clinical outcomes of tandem breastfeeding. Further research involving clearly identified mothers with direct tandem breastfeeding experience is needed.