There were conceptual limitations to the reviewed studies: (1) lack of understanding of maternal perception of infant behavior and (2) perceived insufficient milk as a remaining primary reason for breastfeeding discontinuation. There were methodological limitations: (1) lack of theory-based interventions and (2) lack of intervention fidelity. Future studies involving breastfeeding should focus on the causes of the problems driven by theory-based interventions integrated with intervention fidelity.

No abstract

Perceived insufficient milk (PIM) is the primary reason for breastfeeding discontinuation globally. This study evaluated the short-term impact of mother-infant interactions through home interventions designed to overcome PIM as a result of the infant's behavior, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. A single group, three-occasion prepost design was used. Mother-infant interactions were measured by the Nursing Child Assessment Feeding Scale (NCAFS) at 6, 13, and 27 days postpartum. There were significantly increased mother-infant interactions during intervention. Specifically, significant growth over the intervention occurred for mother's sensitivity to cues, cognitive growth fostering, infant's clarity of cues, and responsiveness to caregiver. The NCAFS total score was also significantly improved. Although modifications are required, the three home intervention sessions showed promise in improving mother-infant interactions during breastfeeding. Further investigation using a randomized experimental design is warranted.

Objective-The purpose of this review was to examine outcome measures used in interventions focusing on enhancement of breastfeeding initiation, duration, and exclusivity. Methods-A literature search guided by search terms on outcome measures of breastfeeding interventions was conducted using PubMed, CINAHL Plus, & PsycINFO databases on publications between 2006 and 2017.Results-Nine studies were included in this review, using PRISMA guidelines. Rates of breastfeeding initiation, duration, and exclusivity were measured during specific points in time. Data collection methods involve interviews, self-report, observations, and/or feeding logs. Although breastfeeding types (exclusive breastfeeding, predominant breastfeeding, and complementary breastfeeding) were measured, methods of infant feeding (breastfeeding and bottle feeding) were rarely assessed, ignoring significant mediators or moderators of breastfeeding.Conclusions-There were methodological limitations to the reviewed studies: (1) a 24-hour recall bias, (2) misclassification of breastfeeding categories, (3) lack of consistency in breastfeeding definitions, and (4) few reports of the reason for breastfeeding discontinuation. Future studies should focus on the modifiable cause of the problem: outcome measures attributed to the targets of the intervention, followed by breastfeeding initiation, duration, and/or exclusivity.