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  • 1.
    Blixt, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Partners' experiences of breastfeeding: a qualitative evaluation of a breastfeeding support intervention in Sweden2024In: International Breastfeeding Journal, E-ISSN 1746-4358, Vol. 19, article id 6Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization states that women and their families need breastfeeding support from the healthcare system. However, knowledge about the most effective way to involve the partner in breastfeeding is lacking. A qualitative evaluation can provide insight and knowledge about the partner's experiences towards a breastfeeding support intervention and thus contribute to how forthcoming breastfeeding support policies are designed. The aim of this study was to explore partners' experiences regarding breastfeeding while participating in The Breastfeeding Study.

    Methods: An exploratory, longitudinal and qualitative design was used. This study was part of The Breastfeeding Study, which took place in Sweden. The intervention was performed in line with the Ten Steps to Successful Breastfeeding. Partners in the in the intervention group (IG) were part of a structured breastfeeding support programme. An individual breastfeeding plan was established in cooperation with the parents-to-be during pregnancy, and the plan was followed up at the child healthcare centre. A purposive sample was recruited from March to December 2021. Interviews and diary entries from IG (n = 8) and control group (CG) (n = 8) during pregnancy and 2 months after birth were analysed by content analysis, in accordance with the COREQ guidelines.

    Results: Partners' experiences can be summarised under the main category of 'Striving to be part of the family and important that the family's everyday life was well-functioning'. IG partners experienced that both parents were involved and cooperated in the breastfeeding process and that guidance from healthcare professionals (HCPs) helped them to feel secure. CG partners experienced feeling excluded and not receiving support from HCPs.

    Conclusion: Both parents need to be targeted in breastfeeding support policies to meet the support needs. Midwives at antenatal care and child healthcare nurses at the child healthcare centre have important roles to play in providing structured breastfeeding support and a breastfeeding plan. Both IG and CG partners strived to become a part of the infant's life and to make family life work. Midwives should involve both parents in a reflective dialogue on how the partner can be involved, apart from just feeding the infant.

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  • 2.
    Blixt, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Rosenblad, Andreas Karlsson
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Breastfeeding training improved healthcare professional's self-efficacy to provide evidence-based breastfeeding support: A pre-post intervention study2023In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 125, article id 103794Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe healthcare professional's (HCP's) perceived self-efficacy in their ability to provide breastfeeding support before and after a breastfeeding training program.

    DESIGN: Pre-post intervention study.

    SETTING: Antenatal care and child healthcare (CHC) centres in Sweden during 2020.

    PARTICIPANTS: An intervention group consisting of 39 HCPs (midwives 51.3%, child healthcare nurses 46.2%) completing a questionnaire at baseline and after intervention, and a control group of 34 HCPs (midwives 61.8%, child healthcare nurses 38.2%) completing a questionnaire at baseline.

    INTERVENTION: A breastfeeding training program in line with the Ten Steps to Successful Breastfeeding and WHO recommendations about breastfeeding.

    MEASUREMENTS AND FINDINGS: The 11-item Breastfeeding Support Confidence Scale (BSCS) measures HCP's self-efficacy regarding providing breastfeeding support in line with Ten Steps to Successful Breastfeeding and WHO recommendations. The intervention group experienced a significantly increased self-efficacy from pre-intervention to post-intervention for 8 of the 11 BSCS items, with the overall BSCS index score increasing from 36.87 to 39.56 points (p = 0.001). The index score in the intervention group at follow-up was significantly higher than the corresponding score in the control group at baseline (p = 0.025). The intervention group had significantly higher scores at follow-up than the control group at baseline on the questions: "I'm sure that I can help mothers continue to breastfeed even if the infant doesn't follow the growth curve" (p = 0.026) and "I'm sure that I can help mothers continue to breastfeed when the breastfeeding is painful" (p = 0.048).

    KEY CONCLUSIONS: The breastfeeding training program improved HCP' self-efficacy to provide evidence-based support to breastfeeding mothers.

    IMPLICATIONS FOR PRACTICE: This training program is well suited to implement in clinical practice and follows the Ten Steps to Successful Breastfeeding.

    TRIAL REGISTRATION: ACTRN12623000648628.

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  • 3.
    Blomqvist, Ylva Thernström
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Parents need support to find ways to optimise their own sleep without seeing their preterm infant's sleeping patterns as a problem2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 2, p. 223-228Article in journal (Refereed)
    Abstract [en]

    AIM: This study described how parents perceived their own sleep, and their infants', during neonatal intensive care unit (NICU) admission and after discharge. It also explored the infants' sleeping location at home.

    METHODS: The study was conducted in the NICUs of two Swedish university hospitals. The parents of 86 infants - 86 mothers and 84 fathers - answered questionnaires during their infants' hospital stay, at discharge and at the infants' corrected ages of two, six and 12 months. The parents' own sleep was explored with the Insomnia Severity Index.

    RESULTS: Mothers reported more severe insomnia than fathers during their infants' hospitalisation, and these higher insomnia severity scores were associated with more severe infant sleep problems at discharge (p = 0.027) and at two months (p = 0.006) and 12 months (p = 0.002) of corrected age. During the study period, 4%-10% of the parents reported severe or very severe infant sleeping problems. The bed-sharing rate was 75% after discharge and about 60% at the corrected age of 12 months.

    CONCLUSION: Maternal insomnia during an infant's hospital stay was associated with later perceptions of sleep problems in their children. Parents need support to find solutions for optimal sleep without seeing their child's sleeping patterns as a problem.

  • 4.
    Cato, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics. Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.
    Instrument development and an intervention to increase parents' self-efficacy regarding their infant's sleep2024In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 39, article id 100944Article in journal (Refereed)
    Abstract [en]

    Objective

    Many Swedish parents experience that their infant has sleeping problems. Parents’ self-efficacy regarding their infants’ sleep may play an important role in how they perceive these problems. This pilot study aimed to develop an instrument measuring parents’ self-efficacy regarding their infant’s sleep and to examine if parents’ self-efficacy was affected by an intervention focusing on parental education.

    Method

    Mothers and fathers, at a maternity unit in Sweden, were drawn into either an intervention (n = 46) or a control (n = 42) group. The intervention group received a home visit from a nurse who provided information about infant sleep; the importance of attachment; and advice regarding sleep, breastfeeding and bed sharing, including guidelines for safe bed sharing. Three months later, the participants answered questions on background data, breastfeeding, sleep and self-efficacy.

    Results

    The 11-item two-factor Uppsala Parental Self-Efficacy about Infant Sleep Instrument (UPPSEISI) was constructed to measure parents’ perceived self-efficacy. In adjusted analyses, being in the intervention group was associated with a higher self-efficacy (P = 0.035), as were being a mother (P = 0.003) and being satisfied with one’s own sleep (P = 0.007), while parents’ own sleeping problems were associated with a lower self-efficacy (P = 0.015).

    Conclusion

    Importantly, parental education may increase parents’ self-efficacy regarding their infant’s sleep.

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  • 5. Dykes, Charlotta
    et al.
    Hellman, Carola
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Bramhagen, Ann-Cathrine
    Parents experience a sense of guilt when their newborn is diagnosed small for gestational age, SGA. A grounded theory study in Sweden2022In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 62, p. e8-e15Article in journal (Refereed)
    Abstract [en]

    Background: To become a parent of a child who is born small for gestational age can lead to challenges in addition to the newly acquired parenting role. There is currently a lack of knowledge regarding parents' experiences of having a child born small for gestational age.

    Purpose: The purpose of this study was to describe the experience of becoming a parent of a child small for gestational age

    Design and method: A qualitative inductive approach was chosen with grounded theory as a method, a strategic selection was used and individual interviews with open questions were performed.

    Results: The results showed that the parents expressed guilt over the child's size and focused on the ability to nourish their child to keep their unexpectedly small child alive. An experienced concern about the child's food intake could be seen throughout the entire interview material and the need for information was great. A common experience of the parents was that constant feeding of the child dominates their lives.

    Conclusion: The conclusion is that the unexpectedly small size of the child awakens the parent's instinct to provide life-sustaining care and the parents need increased support and more information around the child's condition. This requires well-trained professionals, because parents to children born SGA often harbour feelings of unpreparedness and guilt.

    Practice implications: Increased understanding and knowledge about the parents' experience of having a child born SGA, healthcare services can optimize the potential for better attachment between parent and child as well as offer appropriate support.

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  • 6.
    Funkquist, Eva-Lotta
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Carlsson, Marianne
    Department of Public Health and Caring Sciences.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Consulting on feeding and sleeping problems in child health care: what is at the bottom of advice to parents?2005In: Journal of Child Health Care, Vol. 9, no 2, p. 137-152Article in journal (Refereed)
  • 7.
    Funkquist, Eva-Lotta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tuvemo, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Jonsson, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Serenius, Fredrik
    Department of Clinical Sciences, Umeå University, Sweden.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Preterm appropriate for gestational age infants: size at birth explains subsequent growth2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 12, p. 1828-1833Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to evaluate growth and breastfeeding up to 18 months corrected age (CA) among preterm appropriate for gestational age (AGA) infants whose mothers initiated breastfeeding during the infants' hospital stay. Methods: One hundred and twenty-seven preterm AGA infants with a median birth weight of 2320 (769-3250) g and gestational age 34.29 (25.00-35.86) weeks were evaluated up to a CA of 18 months. A retrospective, descriptive and comparative design was used. Data were obtained by chart review of hospital medical records and a questionnaire completed by the mothers. Results: The changes in standard deviation scores (SDS) during the infants' hospital stay were -0.9 for weight, -0.3 for length and -0.5 for head circumference (HC). Infants with higher SDS at birth showed more negative changes from birth to discharge. Median increments in SDS from discharge to a CA of 2 months were as high as, or higher than, the loss from birth to discharge. Conclusion: Preterm AGA infants with higher SDS for weight, length and HC at birth are at higher risk of inadequate growth during their hospital stay.

  • 8.
    Funkquist, Eva-Lotta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tuvemo, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Jonsson, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Serenius, Fredrik
    Department of Clinical Sciences, Umeå University, Sweden.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Influence of test weighing before/after nursing on breastfeeding in preterm infants2010In: Advances in Neonatal Care, ISSN 1536-0903, E-ISSN 1536-0911, Vol. 10, no 1, p. 33-39Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Swedish hospitals apply various regimens for preterm infants' nutrition in connection with their mothers' establishment of breastfeeding. Milk intake is assessed either by test weighing before and after breastfeeding or by observing the infant's suckling behavior (ie, clinical indices). These differing policies may lead to differences in infants' feeding progress. The purpose of this study was to compare effects on breastfeeding and weight gain of preterm infants, depending on whether the volume of breast milk intake when suckled in the hospital was estimated by "clinical indices" or determined by test weighing. SUBJECTS: Sixty-four infants treated at a unit applying test weighing were compared with 59 infants treated at a unit assessing milk intake by "clinical indices." DESIGN AND METHODS: A retrospective, descriptive, and comparative design was used to explore the consequences of different nutrition regimens. Data were obtained from a review of hospital medical records. PRINCIPAL RESULTS: The infants treated at the hospital where test weighing was practiced attained exclusive breastfeeding at an earlier postmenstrual age (PMA) and were also discharged at an earlier PMA. However, the 2 study units were alike regarding the proportion of infants attaining exclusive breastfeeding, the postnatal age when this occurred, and the weight pattern in hospital. CONCLUSION: To establish breastfeeding in preterm infants, test weighing before and after breastfeeding and gradual reduction of supplementation are both applicable regimens. Mothers can be encouraged to choose either of them, although test weighing may help infants attain exclusive breastfeeding at an earlier PMA.

  • 9.
    Gerhardsson, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Prospective questionnaire study showed that higher self-efficacy predicted longer exclusive breastfeeding by the mothers of late preterm infants.2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 5, p. 799-805Article in journal (Refereed)
    Abstract [en]

    AIM: An important variable that influences breastfeeding outcomes is how confident a woman feels about her ability to breastfeed successfully at an early stage. We investigated breastfeeding self-efficacy in the mothers of late preterm infants.

    METHODS: This was a prospective, comparative study that focused on mothers who had delivered babies at 34 + 0 to 36 + 6 weeks and were recruited in 2012-2015 from a neonatal intensive care unit and a postnatal ward at a Swedish university hospital. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was used to psychometrically assess the mothers at 40 weeks of postmenstrual age (n = 148) and at three months of corrected age (n = 114).

    RESULTS: The BSES-SF scores were higher in the 87% of mothers that exclusively breastfed when their babies reached 40 weeks (57.1 out of 70) than those who did not (41.4, p < 0.001), indicating better self-efficacy. The figures remained higher in the 68% of exclusive breastfeeding mothers at three months of corrected age (60.9 versus 51.7).

    CONCLUSION: Self-efficacy was an important predictor of the length of breastfeeding in mothers of late preterm infants, and the BSES-SF can be used to detect low self-efficacy that could lead to early breastfeeding cessation.

  • 10.
    Gerhardsson, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Mothers' Adaptation to a Late Preterm Infant When Breastfeeding.2020In: Journal of Perinatal & Neonatal Nursing, ISSN 0893-2190, E-ISSN 1550-5073, Vol. 34, no 1, p. 88-95Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to psychometrically test the Adaptation to the Late Preterm Infant when Breastfeeding Scale (ALPIBS) and also to test how a mother's self-efficacy predicts adaptation to a late preterm infant when breastfeeding. This study had a longitudinal and prospective design, and data collection was consecutive. Mothers (n = 105) with infants born between 340/7 and 366/7 weeks were recruited from a neonatal intensive care unit or a maternity unit. The ALPIBS was developed using exploratory factor analysis, and the association between breastfeeding self-efficacy and ALPIBS score was examined using linear regression analysis. The Breastfeeding Self-Efficacy Scale-Short Form instrument was used to measure self-efficacy in breastfeeding. A higher degree of self-efficacy was significantly associated with a higher degree of adaptation to the late preterm infant's breastfeeding behavior (P < .001). We identified 4 separate underlying factors measured by 11 items in the ALPIBS: (A) breastfeeding is a stressful event; (B) the infant should breastfeed as often as he or she wants; (C) a mother has to breastfeed to be a good mother; and (D) it is important to ensure control over the infant's feeding behavior. There is a link between self-efficacy and ALPIBS score, and self-efficacy is a modifiable factor that influences breastfeeding.

  • 11.
    Gerhardsson, Emma
    et al.
    Pediatric Specialist Outpatient Department, University Hospital, Uppsala, Sweden.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    The Swedish Version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and Validity Assessment2014In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 30, no 3, p. 340-345Article in journal (Refereed)
    Abstract [en]

    Background:

    Among Swedish mothers, breastfeeding duration has been declining in recent years. An instrument for early identification of women at risk for shorter breastfeeding duration may be useful in reversing this trend.

    Objectives:

    The aims of this study were to translate and psychometrically test the Swedish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), examine the relationship between breastfeeding self-efficacy and demographic variables, and evaluate associations with breastfeeding continuation plans in Swedish mothers.

    Methods:

    The BSES-SF was translated into Swedish using forward and back translation. The sample consisted of 120 mothers who, during the first week postpartum, came for a routine follow-up visit at the postnatal unit in a university hospital. The mothers were compared based on demographic data and their future breastfeeding plans.

    Results:

    The Cronbach's alpha coefficient for internal consistency for the BSES-SF was 0.91 and the majority of correlation coefficients exceeded 0.3. A 1-factor solution was found that explained 46% of the total variance. There was no difference in confidence in breastfeeding between mothers with early hospital discharge and mothers who received postnatal care at the hospital. Primiparas who stayed longer at the hospital were less confident in breastfeeding than primiparas who had a shorter hospital stay. Breastfeeding mothers who planned to partially breastfeed in the near future had lower BSES-SF scores, compared to those who planned to continue exclusive breastfeeding.

    Conclusion:

    The Swedish version of the BSES-SF has good reliability, validity, and agreement with mothers' plans regarding breastfeeding continuation and exclusivity.

  • 12.
    Gerhardsson, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Oras, Paola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Healthcare Sciences and e-Health.
    Thernström Blomqvist, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Health care professionals report positive experience with a breastfeeding training program based on the Baby-Friendly Hospital Initiative for Neonatal Intensive Care2023In: Journal of Perinatal & Neonatal Nursing, ISSN 0893-2190, E-ISSN 1550-5073, Vol. 29, no 1, p. 75-80Article in journal (Refereed)
    Abstract [en]

    Support from health care professionals (HCPs) with good knowledge and positive attitudes toward breastfeeding has been associated with better breastfeeding outcomes in the mothers of preterm infants. The aim of the study was to describe HCPs' experiences of a breastfeeding training program. A total of 48 specialist registered nurses, registered nurses, assistant nurses and physicians working at a neonatal intensive care unit attended a breastfeeding training program and answered a questionnaire including Likert scales and open-ended questions. The participants reported that their interest in breastfeeding had increased as a median (range) of 10 (8–10) on a 10-point scale and rated to what extent they had received new tools for breastfeeding support as a median of 10 (8–10) after training. There were no differences in the median between different professions' ratings. Qualitative content analysis of the open-ended questions resulted in two categories: Discussions of the case scenarios in the group and Knowledge regarding breastfeeding. The results showed that discussions based on breastfeeding scenarios were perceived as valuable; the health care professionals reported receiving new knowledge and useful practical skills. This program was shown to increase health care professionals’ interest in breastfeeding and is useful for different health care professions.

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  • 13.
    Gerhardsson, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Oras, Paola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Thernström Blomqvist, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Developing the Preterm Breastfeeding Attitudes Instrument: a tool for describing attitudes to breastfeeding among health care professionals in neonatal intensive car2021In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 94, article id 102919Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to develop an instrument that measures health care professionals' (HCPs) attitudes to breastfeeding and skin-to-skin contact in relation to the Baby-Friendly Hospital Initiative for neonatal intensive care.

    Design: The study was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding for both full-term and preterm infants. The study had a pre-test/post-test design using online questionnaires distributed by email before and after a training programme.

    Setting and participants: A total of 70 specialist registered nurses, registered nurses, assistant nurses and physicians working at a Swedish neonatal intensive care unit answered 55 breastfeeding attitudes questions online before the training. The Preterm Breastfeeding Attitudes Instrument (PreBAI) consists of twelve of these 55 items/questions, selected using exploratory factor analysis.

    Measurements and findings: Higher scores indicated more positive attitudes and the median total PreBAI score was 42 points (out of 48), on both the preand the post-test questionnaires, showing no significant difference. In the pre-test questionnaire, the majority of HCPs (84%) stated that they needed further breastfeeding training. They also stated that they perceived breastfeeding as very important, scoring a median of 10 (range 5-10) points on a 10-point scale. Three separate underlying dimensions were identified in the questionnaire, indicating different attitudes: Facilitating (five items), Regulating (four items), and Breastfeedingand skin-to-skin contact-friendly (three items). A positive correlation was found between how many years the HCPs had worked in neonatal care, and their PreBAI score (r(s) = 0.383, p = 0.001). Those who had previously received extra breastfeeding education scored higher on the instrument.

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  • 14.
    Grandahl, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Stern, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Sophiahemmet Univ, Dept Hlth Promoting Sci, Box 5605, SE-11486 Stockholm, Sweden..
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Longer shared parental leave is associated with longer duration of breastfeeding: a cross-sectional study among Swedish mothers and their partners2020In: BMC Pediatrics, E-ISSN 1471-2431, Vol. 20, article id 159Article in journal (Refereed)
    Abstract [en]

    Background: Breastfeeding is associated with health benefits for both the mother and infant and is therefore important to support; moreover, parental leave is a beneficial factor for breastfeeding. The Swedish parental leave is generous, allowing each parent to take 90days; additionally, a further 300days can be taken by either parent. Generally, mothers take 70% of the parental leave days, mainly during the first year. However, breastfeeding duration has declined in the last decade, and it is not known how shared parental leave is associated with the duration of breastfeeding.

    Aim: To investigate how parental leave is associated with the duration of exclusive and partial breastfeeding of the infant during the first 12months after birth. An additional aim was to describe infants' and parents' characteristics and mode of birth in association with the duration of exclusive and partial breastfeeding.

    Methods: This cross-sectional study was part of the Swedish Pregnancy Planning Study, conducted in Sweden in 2012-2015. The parents were recruited at 153 antenatal clinics in nine counties. In total, 813 couples completed a follow-up questionnaire 1 year after birth. Linear regression models were used to analyse the association between parental leave and the duration of breastfeeding.

    Results: Infants were exclusively breastfed for, on average, 2.5months (range 0-12months) and partially breastfed, on average, 7months (range 0-12months). Most of the parental leave was taken by the mother (mean=10.9months) during the infant's first 12months, while the partner took 3months, on average. The parental leave (used and planned) during the infant's first 24months were, on average, 21months. In the multivariate linear regression analysis, mothers' and partners' high level of education (p<0.001, p=0.044, respectively), mothers' higher age (p=0.049), non-instrumental vaginal birth (p=0.004) and longer parental leave for the first 24months (p<0.001) were associated with longer duration of partial breastfeeding.

    Conclusion: The duration of partial breastfeeding was associated with higher parental educational level, higher age, non-instrumental vaginal birth and longer parental leave.

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  • 15.
    Hedberg Nyqvist, Kerstin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Early skin-to-skin contact between healthy late preterm infants and their parents: an observational cohort study2017In: PeerJ, E-ISSN 2167-8359, Vol. 5, article id e3949Article in journal (Refereed)
    Abstract [en]

    Background

    Skin-to-skin contact (SSC) is an important factor to consider in the care of late preterm infants (born between 34 0/7 and 36 6/7 completed weeks of gestation). The literature suggests that SSC between preterm infants and their mothers facilitates breastfeeding. However, more studies are needed to explore potential dose-response effects between SSC and breastfeeding as well as studies that explicitly investigate SSC by fathers among late preterm infants. The aim was to investigate the duration of healthy late preterm infants’ SSC with the mother and father, respectively, during the first 48 h after birth and the associations with breastfeeding (exclusive/partial at discharged), clinical and demographic variables.

    Methods

    This was an observational cohort study in which parents to healthy late preterm infants, born between 34 5/7 and 36 6/7 completed weeks of gestation, recorded duration of SSC provided by mother and father, respectively. Demographic and clinical variables were retrieved from the medical records and were used as predictors. Multiple linear regression analysis was used to assess the association between the predictors and the outcome, SSC (hours), separately for mothers and fathers.

    Results

    The mean (standard deviation [SD]) time per day spent with SSC with mothers (n = 64) and fathers (n = 64), was 14.7 (5.6) and 4.4 (3.3) hours during the first day (24 h) after birth and 9.2 (7.1) and 3.1 (3.3) hours during the second day (24 h), respectively. Regarding SSC with mothers, no variable was significantly associated with SSC during the first day, while the mean (95% confidence interval [CI]) time of SSC during the second day was 6.9 (1.4–12.4) hours shorter for each additional kg of birthweight (p = 0.014). Concerning SSC with fathers, the mean (95% CI) time of SSC during the first day was 2.1 (0.4–3.7) hours longer for infants born at night (p = 0.015), 1.7 (0.1–3.2) hours longer for boys (p = 0.033), 3.2 (1.2–5.2) hours longer for infants born by caesarean section (p = 0.003), and 1.6 (0.1–3.1) hours longer for infants exclusively breastfed at discharge (p = 0.040). During the second day, the mean (95% CI) time of SSC with fathers was 3.0 (0.6–5.4) hours shorter for each additional kg of birthweight (p = 0.014), 2.0 (0.5–3.6) hours longer for infants born during night-time (p = 0.011), 2.9 (1.4–4.4) hours longer if the mother was primipara (p < 0.001), and 1.9 (0.3–3.5) hours shorter if supplementary artificial milk feeds were given. None of the other predictors, i.e., mother’s age, gestational age, or induction of labor were significantly associated with infants’ SSC with mothers or fathers during any of the first two days after birth.

    Conclusion

    Future studies are warranted that investigate duration of SSC between late preterm infants and their parents separately and the associations with breastfeeding and other variables of clinical importance.

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  • 16.
    Karlsson Rosenblad, Andreas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Solna, Sweden.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Self-efficacy in breastfeeding predicts how mothers perceive their preterm infant's state-regulation2022In: International Breastfeeding Journal, E-ISSN 1746-4358, Vol. 17, no 1, article id 44Article in journal (Refereed)
    Abstract [en]

    Background

    Mothers of preterm infants often perceive the infant as having problems with crying, sleeping and feeding, sometimes summarised as ‘state-regulation’. Breastfeeding rates are lower among preterm infants, and the mother’s self-efficacy in breastfeeding is central to understanding which mothers are going to breastfeed their infants. We have previously shown that mothers with higher self-efficacy have an easier time adapting to the infant and in this study we hypothesised that the degree of self-efficacy also is associated with how difficult the mother believes it is to take care of the infant. The aim of this study was to investigate whether the late preterm infant’s mother’s self-efficacy in breastfeeding was associated with how the mother experienced her infant’s state-regulation at three months of corrected age.

    Methods

    The study had a prospective and longitudinal design with a consecutive data collection through questionnaires. Inclusion criteria were mothers (n = 105) with a singleton infant born between 34 + 0 and 36 + 6 weeks of gestation. At term age, the mothers completed the Breastfeeding Self-efficacy Scale-Short Form and at the three months corrected age follow-up, mothers completed the Infant state-regulation index: questions related to whether the infant had difficulties with colic, persistent crying, comforting, falling asleep, sleep problems, breastfeeding, eating or poor weight gain.

    Results

    The analyses showed that being an older mother, perceiving breastfeeding support, and having a higher breastfeeding self-efficacy were all significantly associated with identifying the infant as having better state-regulation.

    Conclusions

    There was an association between mothers’ self-efficacy in breastfeeding and her perceptions of how good state-regulation the infant had. This is an important finding, as self-efficacy is a manageable factor that could positively affect how the mother perceives taking care of her infant. Clinical implication: Improved self-efficacy is known to be an important factor in increased breastfeeding prevalence and healthcare professionals should also target mother’s self-efficacy in breastfeeding to improve mother-infant relationship.

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  • 17.
    Lindström Nilsson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatric oncology research with a special focus on side effects.
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatric oncology research with a special focus on side effects.
    Enskär, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatric oncology research with a special focus on side effects.
    Edner, Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Children's interaction with a dog when having Animal Assisted Activity in paediatric hospital care2023In: Complementary Therapies in Clinical Practice, ISSN 1744-3881, E-ISSN 1873-6947, Vol. 53, article id 101807Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to investigate the interaction process between child and dog and how it possibly affects children's wellbeing during Animal Assisted Activity.

    Children have reported negative feelings such as fear and anxiety when being cared for in hospital and various kinds of complementary treatment can alleviate this. Different complementary treatments, including interaction with a dog, can create positive emotions and the treatment has been reported to have both physiological and psychological beneficial effects. However, there is a lack of studies describing children's interaction with a dog.

    This is an observational study, analysed from field notes with qualitative content analysis using a deductive approach. Children (n = 49) aged 3–18 years of age at a paediatric hospital voluntarily participated in the study.

    The results are reported on a six-level scale that describes the child-dog interaction: 1. Passive interaction, 2. One-way non-spoken communication, 3. Facilitating the interaction, 4. Interaction by activity encouragement, 5. Interaction initiated by the child, and 6. Interaction through deepened interplay. All children attained level five. Eighty-nine per cent attained level six and these children interacted fully, having a two-way deepened interplay with the dog. Further, when the interaction proceeded to a deepened interplay this affected the children positively both physically and emotionally.

    Structured Animal Assisted Activity with a dog that includes an introduction, an active part and a relaxing part is a suitable model to offer children in paediatric hospital care since the children attained a child-initiated interaction or interaction through deepened interplay.

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  • 18.
    Lindström Nilsson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Pediatric Surgery.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Edner, Ann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Pediatric Surgery.
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Children report positive experiences of animal-assisted therapy in paediatric hospital care2020In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 109, no 5, p. 1049-1056Article in journal (Refereed)
    Abstract [en]

    Aim

    To evaluate children's experiences of and responses to animal-assisted therapy using a therapy dog as complementary treatment in paediatric hospital care.

    Methods

    The study was performed using mixed methods, by means of qualitative and quantitative data. Fifty children in a paediatric surgery ward, at a tertiary hospital in Sweden, were included between February 2016 to May 2017. Children answered questions about feelings of well-being and experiences of the hospital stay before and after animal-assisted therapy, and experiences of their interaction with a therapy dog.

    Results

    The children's well-being increased from moderately good before to very good after animal-assisted therapy, and the children assessed the hospital stay as better after than before. The vast majority of the children (93%) assessed the interaction with the dog as very good. The children described mixed experiences before and mainly positive aspects of joy, satisfaction and pain relief after animal-assisted therapy.

    Conclusion

    The children's responses before interaction, of both a positive and negative nature, show a focus shift after the interaction with a therapy dog to mainly positive nature regarding self-reported feeling of well-being and experiences of the hospital stay. Using a therapy dog in paediatric hospital care is suitable complementary treatment.

  • 19.
    Mattsson, Elisabet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Wickström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Healthy late preterm infants and supplementary artificial milk feeds: Effects on breast feeding and associated clinical parameters2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 4, p. 426-431Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to compare the influence of supplementary artificial milk feeds on breast feeding and certain clinical parameters among healthy late preterm infants given regular supplementary artificial milk feeds versus being exclusively breast fed from birth.

    DESIGN: a comparative study using quantitative methods. Data were collected via a parental diary and medical records.

    METHODS: parents of 77 late preterm infants (34 5/7-36 6/7 weeks), whose mothers intended to breast feed, completed a diary during the infants׳ hospital stay.

    FINDINGS: infants who received regular supplementary artificial milk feeds experienced a longer delay before initiation of breast feeding, were breast fed less frequently and had longer hospital stays than infants exclusively breast fed from birth. Exclusively breast-fed infants had a greater weight loss than infants with regular artificial milk supplementation. A majority of the mothers (65%) with an infant prescribed artificial milk never expressed their milk and among the mothers who used a breast-pump, milk expression commenced late (10-84 hours after birth). At discharge, all infants were breast fed to some extent, 43% were exclusively breast fed.

    KEY CONCLUSIONS: clinical practice and routines influence the initiation of breast feeding among late preterm infants and may act as barriers to the mothers׳ establishment of exclusive breast feeding.

  • 20.
    Oras, Paola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Ljungberg, Tomas
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    A breastfeeding support program changed breastfeeding patterns but did not affect the mothers' self-efficacy in breastfeeding at two months2020In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 151, article id 105242Article in journal (Refereed)
    Abstract [en]

    Background: Even though the biological norm in humans is frequent on demand breastfeeding,sparse feeding intervals have become the cultural norm in most Western countries due to a history of on schedule breastfeeding. This discrepancy between the biological basis and the culturally driven practice continues to interfere with women’s ability to breastfeed.

    Aim: Our aim was to describe breastfeeding patterns in 2-month-old infants before and after the implementation of a breastfeeding support program. A secondary aim was to investigate the relationship between breastfeeding patterns and the mother’s self-efficacy in breastfeeding.

    Methods: The study had a baseline/intervention design and was part of a larger project aiming to revive the Ten Steps to Successful Breastfeeding program. The larger project included breastfeeding training for health care professionals and provision of breastfeeding information to parents, including information about on demand breastfeeding. Data were gathered viabreastfeeding diaries (n=79 mothers from each group) and the Breastfeeding Self-efficacy Scale–Short Form (n=83 in the baseline group and n=79 in the intervention group).

    Results: On demand breastfeeding patterns were more common in the intervention group (97.5%) than in the baseline group (74.7%) (p<0.001), and breastfeeding sessions were more frequent in the intervention group (a median of 14 times per 24 hours versus 11 times in the baseline group; p=0.026). Self-efficacy in breastfeeding did not differ between the groups, but was higher in mothers with exclusive breastfeeding.

    Conclusions: Knowledge about infants’ breastfeeding behavior can strengthen on demand breastfeeding. Exclusive breastfeeding is associated with higher self-efficacy.

  • 21.
    Oras, Paola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Thernström Blomqvist, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Gradin, Maria
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks2015In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 31, no 3, p. 377-385Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support.

    OBJECTIVE:

    This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age.

    METHODS:

    As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions.

    RESULTS:

    In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8).

    CONCLUSION:

    Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.

  • 22.
    Oras, Paola
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Thernström Blomqvist, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Gradin, Maria
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 7, p. 783-789Article in journal (Refereed)
    Abstract [en]

    AIM:

    This study investigated the effects of skin-to-skin contact on breastfeeding attainment, duration and infant growth in preterm infants, as this has not been sufficiently explored.

    METHODS:

    A prospective longitudinal study on Kangaroo mother care was carried out, comprising 104 infants with a gestational age of 28+0 to 33+6 and followed up to one year of corrected age. Parents and staff recorded the duration of skin-to skin contact during the stay in the neonatal intensive care unit (NICU). Medical data were collected through patient records and follow-up questionnaires were filled in by parents.

    RESULTS:

    The 53 infants who attained full breastfeeding in the NICU did so at a median (range) of 35+0 (32+1 to 37+5) weeks of postmenstrual age and skin-to-skin contact was the only factor that influenced earlier attainment in the regression analysis (R(2) 0.215 p<0.001). The daily duration of skin-to-skin contact during the stay in the NICU did not affect the duration of breastfeeding or infant growth after discharge. Furthermore, infant growth was not affected by the feeding strategy of exclusive, partial breastfeeding or no breastfeeding.

    CONCLUSION:

    A longer daily duration of skin-to-skin contact in the NICU was associated with earlier attainment of exclusive breastfeeding.

  • 23.
    Stern, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Sophiahemmet Univ, Dept Hlth Promoting Sci, S-11428 Stockholm, Sweden..
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Perinatal, Neonatal and Pediatric Cardiology Research.
    Grandahl, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    The association between early introduction of tiny tastings of solid foods and duration of breastfeeding2023In: International Breastfeeding Journal, E-ISSN 1746-4358, Vol. 18, article id 4Article in journal (Refereed)
    Abstract [en]

    Background: Conflicting advice and non-evidence-based recommendations have a negative effect on breastfeeding. Since 2011, the National Food Agency in Sweden has informed parents that they can introduce tiny tastings (1 mL of solid food, i.e. other sources of nutrition than breastmilk/formula) to infants from four months of age. It is unknown how national recommendations, which differ from the Word Health Organisation's recommendation, affect breastfeeding. We hypothesised that introduction of tiny tastings of solid foods would shorten the duration of continued breastfeeding.

    Methods: This retrospective study utilises data from the longitudinal 'Swedish Pregnancy Planning Study', in which mothers were recruited at antenatal clinics on a national level. The participants completed three questionnaires up to one year after birth (n = 1,251). Linear regression models were used to analyse the association between the introduction of solid foods and the duration of breastfeeding.

    Results: As hypothesised, introduction of tiny tastings shortened the duration of continued breastfeeding. Half of all infants (48%) were fed with tiny tastings already in the fourth month. The correlation analysis showed that the earlier the infants started with tiny tastings, the earlier they ate larger amounts of solid food. In a multivariate linear regression analysis, five factors were identified as having a negative effect on the duration of breastfeeding: low infant age upon introduction of tiny tastings, low maternal age, low level of maternal education, high maternal BMI and twin birth.

    Conclusions: Early introduction of tiny tastings of solid foods shortened the duration of breastfeeding. It is difficult to influence most conditions that affect breastfeeding, for example, the mother's educational level, BMI, age and if she has given birth to twins. In contrast, national guidelines can always be updated. Recommendations from the Swedish authorities should adhere to the WHO's recommendation, which states exclusive breastfeeding for six months and continued breastfeeding for at least two years or longer.

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