Healthcare professionals’ perspectives on infant feeding support in paediatric inpatients: single-centre qualitative study

Abstract

ObjectiveTo provide information on baseline knowledge, skills and attitudes (KSA) of paediatric staff to formulate a plan for improving infant feeding support in hospitals.DesignSemistructured interviews assessed baseline infant feeding KSA and experiences in 14 paediatric health professionals of various grades (medical students, healthcare assistants, ward nurses and specialist nurses). Audio recordings were transcribed verbatim and underwent thematic analysis. An online questionnaire gathered descriptive statistics about participants.SettingA single large hospital trust, North East England.ResultsSeven major themes were identified in KSA: culture and trends, roles and working practice, training and resources, the health professional, understanding the parent, effective communication and the challenges of feeding the ill child.Staff discussed various organisational and personal barriers to acquiring infant feeding support training and experience, and to delivering feeding support. Staff were keen to support families with feeding but often felt constrained by a belief that this required specialist knowledge and skills. Although staff believed they actively promoted breastfeeding-friendly messages, it was evident that marketing communications and personal experiences inadvertently influenced their approach to families.ConclusionsThe development of clear, evidence-based infant feeding education and training for paediatric staff delivered by experienced mentors is warranted. Training should cover background theory, delivering practical support, communication skills and creating a baby-friendly hospital environment. UNICEF Baby Friendly Standards would be suitable to inform content. Training is likely to be received positively by staff and benefit women and babies in this setting.

The lactation skill gaps of multidisciplinary paediatric healthcare professionals in the United Kingdom

“…This was reflected in many of the comments left in the free text boxes, with several professionals stating that they did not feel the need for training as they had their own personal experience. This has previously been highlighted by several other studies exploring training and attitudes of general practitioners, 24,25 obstetricians and gynaecologists, 26 medical students 27 and paediatricians 8,28 . However, many of these studies have also found that knowledge is lacking, clinicians do not feel confident and practice may not be evidence‐based 9 .…”

“…The low rates of provision of breastfeeding training to undergraduate healthcare professional students are unsurprising given the absence of oral infant feeding on any clinical competency but are nevertheless concerning and are likely to be contributing to the widespread lack of confidence among practitioners 8,37–39 …”

“…When asked why, the responses included the training not being easy to access, pitched at an inappropriate level, not fit for purpose or hard to prioritise amidst other competing clinical needs. A small study in a large children's hospital found that current training focused on healthy infants, rather than supporting breastfeeding in complex cases 8 . Another study found that there is a lack of practical skills−based training provided to healthcare professionals 39 .…”

“…Without designated specialist paediatric lactation support, the task of supporting breastfeeding is therefore likely to fall to clinical staff on the ward. However, several studies have found that breastfeeding training for physicians and nurses is inadequate, 4–6 lacks clarity regarding the optimal educational approach, 7 and many healthcare professionals default to their own experiences of breastfeeding 8–10 . Moreover, training for staff such as those working in dietetics and speech and language therapy, who often support medically complex feeding, is patchy and may be formula industry‐funded 11–16 …”

What are the needs and challenges of breastfed medically complex infants and children in the paediatric setting?

“…This was also reflected in many of the comments left in the free text boxes, with several professionals stating that they didn't feel the need for training as they had their own personal experience. This has previously been highlighted by several other studies exploring training and attitudes of general practitioners (Finneran and Murphy, 2004;Brodribb et al, 2008), obstetricians and gynaecologists (Gonzalez et al, 2014) medical students (Moukarzel et al, 2018) and paediatricians (Pound et al, 2014;Baker et al, 2021). However, many of these studies have also found that knowledge is lacking, clinicians do not feel confident, and practice may not be evidence-based (Boss et al, 2021).…”