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Needle-related procedures are painful for infants, highlighting the need to enhance the use and understanding of non-pharmacological strategies to alleviate pain and anxiety during such procedures. This study aims to explore how needle-related routine care procedures, such as vaccinations and blood samples, are designed and described by parents and healthcare professionals to minimize pain and anxiety in newborns and infants aged 3 and 5 months, in the framework of Kolcaba's Comfort Theory. Using a convergent mixed-method approach, which combines qualitative and quantitative data collection and analysis, the results are presented according to the three pillars of Comfort Theory: relief, ease, and transcendence. In total, 16 healthcare professionals, 40 parents, and 27 infants aged 0-5 months were included in the study. The findings describe how needle-related procedures were carried out and perceived by healthcare professionals and parents. Several key aspects were identified as important for alleviating pain, including support for parents, pain relief, preparation for parents, support and comfort for the infant, ensuring safety for the infant and experiences of well-being. The study suggests several practices to decrease pain and anxiety for infants undergoing needle-related procedures in routine care. These include supporting and preparing parents with information about the procedure and possible pain relief methods for the infant, fostering a calm environment, and ensuring the safety of the infant throughout the process.Trial registration ISRCTN 12280133. Registration date: 24/04/2023.

BACKGROUND: Step three of the Ten Steps to Successful Breastfeeding encourages midwives in antenatal care to discuss the importance and management of breastfeeding with expectant and new parents. However, there is a gap in the literature regarding mothers' experiences of individual antenatal breastfeeding education. This study aims to explain and understand the meaning of the research phenomenon: support from midwives and partners during a structured breastfeeding support programme in antenatal care. The lived experiences of this phenomenon are interpreted from the perspectives of expectant mothers (during pregnancy) and new mothers (two months postpartum).

METHODS: The analysis employed a lifeworld hermeneutic approach, based on diaries and interviews with 20 mothers conducted during pregnancy and two months after birth. Participants received structured breastfeeding support based on the Ten Steps to Successful Breastfeeding. A purposive sample was recruited in 2021 in Sweden.

RESULTS: The research phenomenon, support from midwives and partners during a structured breastfeeding support programme in antenatal care, is understood through the following themes: Feeling safe through responsive, individualised dialogue; Grounding confidence through tailored and accessible breastfeeding knowledge; Breastfeeding as an existential anchor for emotional closeness and maternal identity; Co‑creating space for breastfeeding, with partner support as negotiated meaning; Weighing breastfeeding as a lived balance of perceived gains and everyday constraints; Trust as a foundation for perseverance and acceptance; and Feeling left behind when dialogue and continuity are missing. The main interpretation can be understood as being prepared to make independent decisions about breastfeeding.

CONCLUSIONS: Being prepared to make independent decisions about breastfeeding extends beyond receiving information and is shaped through responsive, meaningful encounters. Individual dialogue grounded in each mother's lived experiences, needs, and circumstances fostered a sense of safety, reflection, and growing confidence throughout pregnancy and early motherhood. Mothers valued support that recognised their perspectives and strengthened their ownership of breastfeeding decisions, while negotiated partner involvement deepened shared understanding without compromising maternal autonomy. The findings highlight that continuity‑based, individual antenatal breastfeeding education can complement group sessions, enhance maternal satisfaction, and enable midwives to provide more equitable and accessible care for all families.

TRIAL REGISTRATION: ACTRN12623000648628. Date registered 15th June 2023. Retrospectively registered.

The WHO guidelines on safe formula feeding emphasize the importance of proper handling with professional guidance. However, many infants worldwide are given unsafe formula, with parents struggling with handling procedures. Despite the prevalence of formula feeding, research on formula handling in Swedish settings is limited. This study explores and describes parents' practices and experiences in handling infant formula, their experiences of information on safe handling and their potential needs. Individual semi-structured interviews were conducted with 15 mothers who had experienced formula feeding their infants. Data were transcribed verbatim and analyzed using qualitative content analysis. One overarching theme was identified: "Navigating alone without a compass, with a desire for a safe journey", along with four categories: (1) Varying degrees of safe handling, (2) Challenging but doable, (3) The centrality of guidance and support, and (4) Aspects that also matter. Mothers used varying degrees of safe methods for preparation, storage and cleaning. Although they perceived the methods as feasible, they encountered numerous challenges. Moreover, they received insufficient professional information, relying mainly on informal sources. While guidance and support were requested, they also desired inclusion, as the lack of information and support caused feelings of shame and guilt. Positive emotions surrounding formula availability, shared feeding responsibilities and increased parental freedom influenced its use and handling, as did cost-related constraints. This study suggests that guidance on safe formula feeding is not a priority in the healthcare continuum. To promote optimal health in infants, the results highlight the need to review the quality, implementation, understanding, and adherence to national and local formula feeding guidelines.

Aim: To design and test the feasibility of a complex intervention to increase breastfeeding rates and improve clinical practice.

Methods: The six-step intervention mapping process was employed: [i] needs assessment, [ii] definition of performance objectives, [iii] selection of methods and applications, [iv] program design, [v] planning for implementation and [vi] planning for evaluation. The Ten Steps to Successful Breastfeeding served as the foundational framework. During step [i], three pilot studies were conducted. One study involved primiparous mothers: one group received standard care and the other additional breastfeeding information. Two studies examined infant sleep; the first was a focus group with healthcare professionals, analysed through qualitative content analysis and the second randomised families to standard care or sleep education.

Results: The pilot studies [i] showed increased exclusive breastfeeding rates, effective use of sleep-related materials by healthcare professionals and greater parental attunement. Performance objectives [ii] focused on attitudes, skills and norms for professionals and practices and expectations for organisations. Theories [iii] included attachment theory and self-efficacy. Program design [iv] featured parental information and professional training. Implementation [v] and evaluation [vi] used the Ten Steps as indicators.

Conclusion: Intervention Mapping supported the development of a feasible, theory-based breastfeeding support program with contextual relevance.

OBJECTIVE: This study aimed to assess healthcare professionals' attitudes towards breastfeeding, in line with the WHO guidelines, before and after a breastfeeding intervention in Sweden.

METHODS: A quasi-experimental, prospective, longitudinal before-and-after design with a control group was used. Data were collected between 2020 and 2021. The sample included 26 midwives and child healthcare nurses in the intervention group, and 18 in the control group, all working in antenatal and child healthcare centres. The intervention group received breastfeeding training based on the WHO recommendations. The 15-item Healthcare Professionals' Attitudes instrument was used to measure attitudes.

RESULTS: The intervention improved attitudes on nine of the 15 questions immediately post-training, with effects maintained at one-year. The largest change was for the item: 'It is appropriate for infants to wait until they are six months old before tasting samples' (p = 0.000). At follow-up, five items differed significantly between groups: 'Infants can have commercial milk formula in the evening if they breastfeed frequently at night' (p = 0.002), 'It is inappropriate for a mother to breastfeed a one-year-old in a restaurant' (p = 0.017), 'It is appropriate for infants to breastfeed every three hours' (p = 0.020), 'When a mother has bleeding nipples, it is appropriate to inform her that formula is acceptable' (p = 0.023), and 'It is important for infants to have uninterrupted sleep at night' (p = 0.047).

CONCLUSION: The breastfeeding training programme improved healthcare professionals' attitudes towards breastfeeding, with positive effects sustained one year following the intervention.

Objective

This study aimed to elucidate healthcare professionals' (HCPs) evaluations of a breastfeeding training program that incorporated diverse professions along the care continuum.

Methods

The breastfeeding training program was conducted over a full day during 2018-2019. To enable as many HCPs as possible to participate, the program was offered om twelve different dates. Approximately 25 HCPs took part on each occasion. Both qualitative and quantitative data was gathered on each occasion. The cohort comprised 238 HCPs, including midwives, registered nurses, specialist registered nurses, assistant nurses, physicians, and psychologists, all actively engaged in clinical practice at delivery/maternity wards or child healthcare centers. HCPs completed questionnaires featuring both closed and open-ended queries at the commencement and conclusion of the training program. Additionally, participants collaborated in small groups to propose improvements within the care continuum.

Results

Following the training program, HCPs reported a perceived increase in their interest in breastfeeding and noted the acquisition of novel tools for breastfeeding support. Noteworthy aspects of the training program, as identified by participants, included group discussions, the structure of the training session, inspiration for breastfeeding support, newfound knowledge regarding breastfeeding, and the utility of provided parental materials.

Conclusion

The breastfeeding training program was beneficial across various HCP roles. The training program served to augment participants' interest in breastfeeding and equipped them with resources to bolster ongoing breastfeeding support efforts. Facilitating HCP attendance at such training sessions and fostering commitment to breastfeeding promotion emerge as crucial imperatives.

Trial registration

Detailed information about the program and its implementation is available in the trial registered in the ISRCTN Registry: https://doi.org/10.1186/ISRCTN91972905.

Background

Hospitalization for children often involves stress induced by fear and pain. Complementary therapies, such as Animal Assisted Activities (AAA) with dogs, can alleviate the hospital experience.

Purpose

The first aim of this study was to initiate the development of an instrument that measures healthcare professionals’ attitudes toward complementary therapy, specifically dogs in AAA. The second aim was to elucidate the emerging effects of introducing dogs to children in healthcare settings, as reported by healthcare professionals.

Materials and methods

A questionnaire covering demographics, rating attitudes, and allergy and hygiene risks, followed by open-ended questions, was completed by 61 healthcare professionals (HCPs). Quantitative data were analysed statistically, while qualitative data underwent content analysis.

Results

The Attitude Instrument of Complementary Therapy (AICT) included 7 items and was evaluated using exploratory factor analysis. Healthcare professionals had a median score of 25 (range 18–28), high scores indicating a more positive attitude. However, 36 % of the HCPs perceived a risk of allergies, and this group had a significantly lower median score, 22 versus 26. Open-ended answers were analysed into four categories: “Dogs could positively affect children in hospital”, “Dogs may pose a risk of allergies in children”, “Dogs might be frightening for children” and “Dogs can affect healthcare professionals’ working situation”.

Conclusion

The AICT can serve as a valuable tool for investigating HCPs’ attitudes to dogs in AAA as complementary therapies. Professionals view dogs as beneficial for hospitalized children, but attitudes toward dogs working in paediatric care can be influenced by concerns about risks such as allergies.

Aim: Skin-to-skin contact postpartum has many well-documented benefits, but there is a lack of evidence on effective strategies to enhance the practices and on the duration of skin-to-skin contact beyond the first hour postpartum. This study aimed to determine if an educational breastfeeding programme for healthcare professionals and parents could increase skin-to-skin contact duration in newborns.

Methods: A quasi-experimental design with baseline and intervention measurements was used in two clinics. Newborns between 37+0 and 42+0 weeks gestation were included. The intervention involved targeted training for healthcare professionals and an educational package on breastfeeding and skin-to-skin contact for parents.

Results: 211 parents recorded a diary and skin-to-skin contact duration with the mother on day one increased from 12.9 h in the baseline group to 14.6 h in the intervention group (p=0.009). The proportion of newborns receiving nearly continuous skin-to-skin contact (>20 h) increased from 33% to 58% (p=0.001). Newborns who had more skin-to-skin contact on day one were held more frequently by parents at 2months.

Conclusions: The intervention increased skin-to-skin contact duration and the proportion of newborns receiving nearly continuous skin-to-skin contact during the first 24 h. Enhancing skin-to-skin contact is essential and the programme could positively impact family health.

Aim

Skin-to-skin contact postpartum has many well-documented benefits, but there is a lack of evidence on effective strategies to enhance the practices and on the duration of skin-to-skin contact beyond the first hour postpartum. This study aimed to determine if an educational breastfeeding programme for healthcare professionals and parents could increase skin-to-skin contact duration in newborns.

Methods

A quasi-experimental design with baseline and intervention measurements was used in two clinics. Newborns between 37 + 0 and 42 + 0 weeks gestation were included. The intervention involved targeted training for healthcare professionals and an educational package on breastfeeding and skin-to-skin contact for parents.

Results

211 parents recorded a diary and skin-to-skin contact duration with the mother on day one increased from 12.9 h in the baseline group to 14.6 h in the intervention group (p = 0.009). The proportion of newborns receiving nearly continuous skin-to-skin contact (> 20 h) increased from 33% to 58% (p = 0.001). Newborns who had more skin-to-skin contact on day one were held more frequently by parents at 2 months.

Conclusions

The intervention increased skin-to-skin contact duration and the proportion of newborns receiving nearly continuous skin-to-skin contact during the first 24 h. Enhancing skin-to-skin contact is essential and the programme could positively impact family health.

Aim

To design and test the feasibility of a complex intervention to increase breastfeeding rates and improve clinical practice.

Methods

The six-step intervention mapping process was employed: [i] needs assessment, [ii] definition of performance objectives, [iii] selection of methods and applications, [iv] program design, [v] planning for implementation and [vi] planning for evaluation. The Ten Steps to Successful Breastfeeding served as the foundational framework. During step [i], three pilot studies were conducted. One study involved primiparous mothers: one group received standard care and the other additional breastfeeding information. Two studies examined infant sleep; the first was a focus group with healthcare professionals, analysed through qualitative content analysis and the second randomised families to standard care or sleep education.

Results

The pilot studies [i] showed increased exclusive breastfeeding rates, effective use of sleep-related materials by healthcare professionals and greater parental attunement. Performance objectives [ii] focused on attitudes, skills and norms for professionals and practices and expectations for organisations. Theories [iii] included attachment theory and self-efficacy. Program design [iv] featured parental information and professional training. Implementation [v] and evaluation [vi] used the Ten Steps as indicators.

Conclusion

Intervention Mapping supported the development of a feasible, theory-based breastfeeding support program with contextual relevance.