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“It’s like you’re feeding your child twice” Barriers and facilitators to human milk feeding children with cystic fibrosis
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  • Adrianne Colborg,
  • Brandon M. Smith,
  • Deanna Green,
  • Samya Z Nasr,
  • Gregory Sawicki,
  • Michael Schechter,
  • Kristin Riekert,
  • Kimberly M. Dickinson
Adrianne Colborg
Baylor College of Medicine Department of Pediatrics
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Brandon M. Smith
Johns Hopkins Children's Center
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Deanna Green
Johns Hopkins All Children's Foundation
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Samya Z Nasr
University of Michigan Department of Pediatrics
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Gregory Sawicki
Boston Children's Hospital Division of Pulmonary Medicine
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Michael Schechter
Children's Hospital of Richmond at Virginia Commonwealth University
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Kristin Riekert
Johns Hopkins University Department of Medicine
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Kimberly M. Dickinson
Emory University Department of Pediatrics

Corresponding Author:[email protected]

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Abstract

Background: Cystic Fibrosis Foundation guidelines recommend human milk (HM) as the ideal source of nutrition for children with CF (cwCF). Despite known pulmonary and nutritional benefits, fewer cwCF ever receive HM compared to the general population. Early nutrition choices are preference-sensitive, yet little is known about the factors that impede or sustain HM feeding among parents of cwCF. Objectives: Explore perceptions and experiences of mothers of cwCF who initiated HM feeding. Methods: Mothers of cwCF aged ≤10 years completed audio-taped, semi-structured interviews describing their experiences with HM feeding. Interviews were transcribed and two researchers independently coded the transcripts and conducted content and thematic analysis using an inductive approach. Results: Participants included 28 mothers who initiated HM feeding. Major themes included 1) the impact of a CF diagnosis on HM feeding plans 2) CF-specific challenges to HM feeding 3) mixed perceptions of the CF team’s support for HM feeding and of the role of formula in CF nutritional care and 4) the benefit of lactation consultants as part of the CF care team. Conclusion: Many parents prioritize HM for their cwCF given the well-established health benefits. However, CF-specific barriers to HM feeding are common and nutritional challenges necessitating fortification add additional barriers to sustained HM feeding efforts. While HM may improve long-term pulmonary outcomes, our findings demonstrate the need for personalized support for mothers desiring to HM feed to facilitate shared decision-making around options to optimize early nutritional status among cwCF.