Background: Breastfeeding twins implies that the mother breastfeeds children of the same age and the children can be breastfed either together or separately. There are many benefits with breastfeeding twins, including the fostering of attachment. Breastfeeding is often represented as a natural and easy process, however, many mothers find the experience to be challenging. Aim: This study aimed to describe how mothers experience breastfeeding twins. Method: The study was conducted through a meta synthesis where qualitative research was included. Searches for articles were made through the electronic databases PubMed and CINAHL. A total of ten scientific studies with qualitative design were included. Results: The results are based on four main themes; 1) Experiences of physically influential factors. The mothers experienced difficulties breastfeeding twins simultaneously and found it time-consuming. 2) Experiences of psychologically influential factors. The mothers felt insecure and were afraid that there wouldn’t be enough breastmilk for both twins. 3) Experiences of support from the surroundings. The support from the mothers’ partner and her surroundings was shown to be important and improved the conditions for breastfeeding the twins. Finally, 4) Experiences of the community's influence. The mothers experienced some benefits during hospitalisation with the twins but mostly disadvantages, which complicated the breastfeeding. Conclusion: Mothers’ experiences of breastfeeding twins were found to be both negative and positive as seen from a physical and psychological perspective. The results indicate the importance of support from the healthcare staff when breastfeeding, which further promotes the attachment between the mother and her children. The nurse has a significant role in encouraging the mother's self-efficacy, independence and motivation to breastfeed her twins for as long as the mother and the children wishes. / Bakgrund: Tvillingamning innebär att mamman ammar syskon i samma ålder och barnen kan ammas var för sig eller samtidigt. Det finns många fördelar med att amma tvillingar, bland annat främjar det anknytningen. Amning framställs ofta som en naturlig och enkel process, men för många mammor upplevs tvillingamningen som svår och mer utmanande än de kunnat föreställa sig. Syfte: Syftet med arbetet var att beskriva hur mammor upplever det att tvillingamma. Metod: Syftet besvarades genom en metasyntes där forskning med kvalitativ ansats inkluderades. Artikelsökningarna genomfördes i databaserna PubMed och CINAHL och resulterade i tio vetenskapliga kvalitativa studier. Resultat: Resultatet sammanfattades genom fyra huvudsakliga teman; 1) Upplevelser av fysiskt påverkande faktorer. Mammorna upplevde att det var svårt att amma två barn samtidigt och att amningen var tidskrävande. 2) Upplevelser av psykiskt påverkande faktorer. Mammorna kände osäkerhet och rädsla över att bröstmjölken inte skulle räcka till båda tvillingarna. 3) Upplevelser av stöd från omgivningen. Stöd från partner och andra personer i omgivningen var viktigt och ökade förutsättningarna för att amma tvillingarna. Slutligen 4) Upplevelser av samhällets påverkan. Mammorna upplevde vissa fördelar men mestadels nackdelar med att vistas på sjukhus med sina tvillingar, vilket försvårade amningen. Slutsats: Mammor upplevde amningen både som något positivt och negativt sett från ett fysisk samt psykiskt perspektiv. Resultatet visade även på betydelsen av stödet mammor erhöll från sjukvårdspersonal kring sin amning, vilket kan gynna anknytningen/bindningen mellan tvillingarna och mamman. Sjuksköterskan har en viktig roll i att främja mammornas självkänsla, självständighet och motivation till att amma sina tvillingar så länge som mamman och barnet önskar.

Thesis advisor: Britt F. Pados / Background. Ankyloglossia, commonly known as tongue-tie, reduces tongue mobility through restriction of the lingual frenulum. A recent professional consensus notes that tongue-tie is one possible reason for breastfeeding challenges. Prevalence reporting of tongue-tie has been variable, and an understanding of which infants benefit most from treatment is unknown.Screening and treatment guidelines have not been developed, mainly due to low-level evidence in published research. Despite this, there has been a substantial increase in tongue-tie treatment via frenotomy in the last 15 years. Purpose. The purpose of this program of research was to improve our understanding of tongue- tie and its impact on infant feeding. Eight specific aims were developed to achieve this purpose: 1) identify the prevalence rate of anyloglossia in infants age birth through 12 months; 2) review and evaluate the diagnostic criteria used to diagnose ankyloglossia; 3) identify and summarize original research addressing the impact of ankyloglossia on infant feeding, comparing symptoms of problematic feeding before and after frenotomy; 4) review the quality of the feeding-related outcome measures and psychometric properties of the assessment tools used; 5) describe changes in problematic feeding symptoms, as measured by the NeoEAT, pre- and post-frenotomy; 6) explore the contribution of infant age to the magnitude of change in problematic feeding pre- and post-frenotomy; 7) describe changes in maternal symptoms pre- and post-frenotomy; and 8) evaluate the relationships between maternal symptoms and symptoms of problematic feedingpre- and post-frenotomy. Methods. First, we performed a systematic review and meta-analysis of the literature on tongue- tie to determine the prevalence of the anomaly in the infant population and critiqued the methods used to achieve tongue-tie diagnosis. Second, we identified and summarized original research addressing the impact of tongue-tie on infant feeding, comparing symptoms of problematic feeding before and after frenotomy. In this same study, we evaluated the psychometric properties of the assessment tools used in the published research. Next, we assessed maternal and infant symptoms of problematic feeding pre- and post-frenotomy. In this same study, we utilized a comprehensive evaluation of infant feeding symptoms using a validated measure. Results. Cumulatively, this dissertation research has identified symptoms in both mothers and their infants in the setting of tongue-tie. Each of the eight specific aims proposed for this dissertation were addressed. Specifically, through the meta-analysis and systematic review, we determined 1) prevalence of tongue-tie is higher than previously thought, affecting 8% of the infant population, 2) current screening tools for tongue-tie require psychometric evaluation, 3) LATCH scores and maternal self-efficacy improve following frenotomy but little is known about the effect of frenotomy on infant feeding, and 4) infant feeding has not been evaluated comprehensively or with a validated measure for babies with tongue-tie. The research study conducted in Chapter IV found that 5) infants with severe tongue-tie experienced significant improvements in problematic feeding symptoms following tongue-tie correction as measured by the NeoEAT, 6) regardless of infant age, improvements in symptoms of problematic feeding were seen post-frenotomy in babies with severe tongue-tie, 7) maternal symptoms previously thought to occur in the setting of tongue-tie improved following frenotomy (e.g., painful or difficult latch), and 8) symptoms that have not been assessed in earlier research also improved after tongue-tie correction (e.g., chewing on nipple, incomplete breast drainage, and over supply of breastmilk). Conclusions. The program of research in this dissertation has made meaningful contributions to the literature on tongue-tie. Through the production of the first meta-analysis of prevalence data, a thorough evaluation of the available research, and the determination of maternal and infant symptoms associated with tongue-tie, we have crafted recommendations for future research and recommendations for improvements in the clinical management of infants with this oral anomaly. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

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Background: The present study examined the effects of breastfeeding and its duration on the development of childhood obesity from 24 months through grade 6. Methods: U.S. longitudinal data collected from 1234 children were analyzed using logistic regression models and generalized estimating equation (GEE). Child height and weight were measured six times at ages of 24 months, 36 months, 54 months, grade 1, grade 3, and grade 6. Results: During the early 1990s, prevalence of breastfeeding was low in the United States, 60% and 48% at 1 and 6 months, respectively. Nonsmoking, white, married mothers with both parents in the household, and with income above the poverty line, were more likely to breastfeed at 1 month of age of their babies. Obesity rate of the children increased with age from 24 months to grade 6. Logistic regression showed that breastfeeding at month 1 was associated with 53% (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.30-0.73) and 47% (OR: 0.53, 95% CI: 0.36-0.78) decreased risks for childhood obesity at grades 1 and 6, respectively. GEE analysis showed that breastfeeding at 1 month reduced risk for childhood obesity by 36% (95% CI: 0.47-0.88) from ages 24 months through grade 6. Regarding breastfeeding duration, more than 6 months (vs. never) was associated with a decreased risk for childhood obesity by 42% (OR: 0.58, 95% CI: 0.36-0.94). Conclusions: Breastfeeding at 1 month and more than 6 months reduced the risk of childhood obesity. Rate of breastfeeding was low in the United States in the 1990s, which may have had long-term implications on children.

This talk will: 1. Define existing breastfeeding best practices 2. Review breastfeeding initiatives and metrics 3. Discuss geographical considerations and cultural competency 4. Examine case studies of at-risk breastfeeding families

Breastfeeding has been shown to protect both the mother and infant, and health care professionals consider it to be the best choice for feeding an infant. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food, referrals to other social service programs, and nutrition and breastfeeding education for enrolled families. However, community support for the breastfeeding woman once she leaves the hospital is limited, especially in Philadelphia, PA. The purpose of this mixed-methods study was to explore the impact of prenatal breastfeeding education and understand the role that members of the community play in the infant feeding decision-making process. A purposive, convenience sample of 36 postpartum breastfeeding women enrolled for WIC benefits completed a survey and an in-depth interview about infant feeding choices and their support system at their return WIC appointment. The quantitative survey data were analyzed using Spearman's rank correlation coefficient and multiple regressions while the qualitative data were analyzed using Moustakas' modification of two methods, referred to as MVKMAP. The analysis of data showed that the postpartum breastfeeding education given at the WIC office had the most influence on participants' decision to breastfeed followed by prenatal education. Some participants reported receiving overwhelming breastfeeding support from the WIC peer counselor, which indicates that members of the WIC community play a role in the infant feeding decision making process. The study findings help to contribute to social change by identifying the need for breastfeeding support by medical providers, hospitals, and WIC offices at the prenatal period not only at the postpartum appointment.

Breastfeeding reduces morbidity and mortality among mothers and children, yet African-American women breastfeed at lower rates than women of other racial and ethnic groups do. Higher rates of overweight, obesity, and low socioeconomic status may be contributing factors in this population; however, limited research exists regarding the roles of maternal overweight and obesity on breastfeeding outcomes. The purpose of this study was to examine whether social support and self-efficacy positively influence breastfeeding outcomes among overweight and obese African American women. Self-efficacy and social support theories provided the theoretical framework for the study. Research questions examined whether (a) maternal overweight and obesity, social support, and self-efficacy were associated with breastfeeding initiation and duration among African-American women; and (b) self-efficacy mediated this association. The study design was a quantitative retrospective analysis of a subset of secondary data from the 2009-2011 Pregnancy Risk Assessment Monitoring System (n = 10,926). SPSS 21.0-® was used for analyses. Obesity was significantly associated with breastfeeding durations of 9-16 weeks and 17 or more weeks. Self-efficacy was significantly associated with breastfeeding initiation only. Social support was negatively associated with breastfeeding durations of 9-16 weeks among obese women. Positive social change implications include increased knowledge of the associations between overweight, obesity, social support, self-efficacy, and breastfeeding outcomes among African-American women. This knowledge could be used to inform the development of interventions to improve breastfeeding and weight related health outcomes.

Breastmilk feeding at birth demonstrates short- and long-term medical and neurodevelopmental advantages. Infants who are exclusively breastfed demonstrate less nausea, vomiting, and diarrhea, and they experience less upper respiratory and ear infections than do infants who are not breastfed. One strategy that supports breastfeeding initiation is providing skin-to-skin contact (STS) with mothers and newborns immediately upon birth. The purpose of this project was to evaluate the impact of a second session of STS on the postpartum unit on exclusive breastfeeding rates at discharge. A retrospective comparison design using Swanson's caring model was used to guide the evaluation study that examined and compared the rate of exclusive breastfeeding before and after the new model of care was implemented. The historical controls rate included all delivered women in a 3-month period who expressed a desire to exclusively breastfeed and who had one session of STS. In this group, the exclusive breastfeeding rates were 46% at discharge. After the practice change, the 75 women who expressed a desire to exclusively breastfeed and who had the second session of STS demonstrated exclusive breastfeeding rates of 72% at discharge. The increased rate of exclusive breastfeeding and the promotion of newborn health represent a major contribution to positive social change through the introduction of a second session of STS. The extension of the STS practice from only the immediate postdelivery setting to the postpartum setting provides a contribution to nursing practice that can be shared in any birth or similar practice setting.

PURPOSE: A retrospective chart review was conducted to determine if nutritional source of feeding and/or infant age at diagnosis of cystic fibrosis had any effect on nutritional status and subsequent growth accretion. Additionally, an attempt was made to identify predictors for poor growth in patients with undiagnosed cystic fibrosis. METHODS: Data was collected from medical and clinic charts at Primary Children's Medical Center (PCMC), Salt Lake City, Utah, for subjects born between January 1, 1995 and December 31, 200 I, who were diagnosed with cystic fibrosis before 1 year of age. Thirty-one subjects met inclusion parameters. These subjects were divided into two groups: an "early" diagnosis group (N= 13) included those who were diagnosed before 9 weeks of age, and a "late" diagnosis group (N= 18) included those who were diagnosed after 9 weeks of age. "Breastfed at diagnosis" (N=7) and "not breastfed at diagnosis" (N= 17) groups were established as well, with nutritional source of feeding remaining unknown for 7 of the 31 subjects. RESULTS: Paired t-tests indicated that children who were primarily breastfed at time of diagnosis did not grow significantly more than children who were formula-fed at time of diagnosis, although regression analysis indicated that nutritional source of feeding at time of diagnosis was a significant predictor of growth later in life. This contradiction could have come about due to the small sample size. Age at diagnosis had a significant effect on growth, at diagnosis, at age 2 years, and age 6 years. Children who were diagnosed early grew taller and weighed more than the children who were diagnosed after 9 weeks of age, both at the 2-year mark and at the 6- year mark. Additionally, low blood albumin levels at diagnosis were predictive of more growth at age 2 years and 6 years. Other identified predictors of growth included gender, age at diagnosis, and whether the child had a family history of cystic fibrosis. This research highlights the crucial need for early detection and correction of malnutrition in infants and children with cystic fibrosis. It should be viewed as a pilot study, with more research needed in this area.