Breastfeeding strategies following nurslings’ hospitalization: a scoping reviewObjective: to map strategies aimed at promoting and maintaining breastfeeding following nurslings’ hospitalization.
Method: a scoping review guided by the recommendations of the Joanna Briggs Institute Reviewer’s Manual. The search was carried out in seven databases and in repositories of theses and dissertations. The selection of studies was conducted on a web application by two independent blind reviewers. The data were analyzed descriptively.
Results: in total, 1,325 publications were obtained, of which 29 were included in the study. The following were identified as health strategies associated with breastfeeding: education and guidance, support and follow-up, clinical and technical interventions, complementary therapies, technology and innovation, environment and physical conditions, nutrition and hydration, protocol and guidelines.
Conclusion: the evidence reinforces that multifaceted strategies are essential post-discharge in order to strengthen self-management and sustain breastfeeding beyond the hospital setting. Primary Health Care can play an important role in care continuity.
Descriptors:
Breastfeeding; Patient Discharge; Nursing Care; Health Strategies; Primary Health Care; Lactation
Highlights:
(1) With evidence-based techniques, breastfeeding can be re-established. (2) Family and professional support is essential for maintaining breastfeeding. (3) Education and social support increase the duration and exclusivity of breastfeeding. (4) Technologies increase access to breastfeeding information and support. (5) Complementary interventions help to optimize milk production.
Objetivo: mapear estratégias voltadas à promoção e à manutenção do aleitamento materno após a internação hospitalar do lactente.
Método: revisão de escopo guiada pelas recomendações do Joanna Briggs Institute Reviewer’s Manual. A busca foi realizada em sete bases de dados e em repositórios de teses e dissertações. A seleção dos estudos foi conduzida em um aplicativo da web por dois revisores independentes e às cegas. A análise dos dados foi realizada de forma descritiva.
Resultados: obtiveram-se 1.325 publicações, das quais 29 foram incluídas no estudo. Foram identificadas como estratégias em saúde associadas à amamentação: educação e orientação, suporte e acompanhamento, intervenções clínicas e técnicas, terapias complementares, tecnologia e inovação, ambiente e condições físicas, nutrição e hidratação, protocolo e diretrizes.
Conclusão: as evidências reforçam que estratégias multifacetadas são essenciais no pós-alta para fortalecer a autogestão e sustentar a amamentação além do ambiente hospitalar. A Atenção Primária à Saúde pode desempenhar papel importante na continuidade do cuidado.
Descritores:
Aleitamento Materno; Alta do Paciente; Cuidados de Enfermagem; Estratégias de Saúde; Atenção Primária à Saúde; Lactação
Destaques:
(1) Com técnicas baseadas em evidências, é possível restabelecer a amamentação. (2) O suporte familiar e profissional é essencial para a manutenção do aleitamento. (3) Educação e apoio social aumentam a duração e a exclusividade da amamentação. (4) Tecnologias ampliam o acesso a informações e suporte à amamentação. (5) Intervenções complementares ajudam a otimizar a produção de leite.
Objetivo: mapear estrategias dirigidas a promover y continuar con la lactancia materna después de la hospitalización del lactante.
Método: revisión de alcance que sigue las recomendaciones del Joanna Briggs Institute Reviewer’s Manual. La búsqueda se realizó en siete bases de datos y en repositorios de tesis y disertaciones. La selección de estudios fue realizada mediante una aplicación web por dos revisores independientes y a ciegas. El análisis de datos se realizó de forma descriptiva.
Resultados: se obtuvieron 1.325 publicaciones, de las cuales 29 fueron incluidas en el estudio. Se identificaron las siguientes estrategias de salud asociadas a la lactancia materna: educación y orientación, apoyo y seguimiento, intervenciones clínicas y técnicas, terapias complementarias, tecnología e innovación, ambiente y condiciones físicas, nutrición e hidratación, protocolo y guías.
Conclusión: la evidencia ratifica que las estrategias multifacéticas son esenciales después del alta para fortalecer la autogestión y continuar con la lactancia materna fuera del entorno hospitalario. La Atención Primaria de Salud puede desempeñar un papel importante en la continuidad de la atención.
Descriptores:
Lactancia Materna; Alta del Paciente; Atención de Enfermería; Estrategias de Salud; Atención Primaria de Salud; Lactancia
Destacados:
(1) Con técnicas basadas en evidencia se puede restablecer la lactancia materna. (2) El apoyo familiar y profesional es fundamental para continuar con la lactancia materna. (3) La educación y el apoyo social aumentan la duración y la exclusividad de la lactancia materna. (4) Las tecnologías amplían el acceso a la información y el apoyo a la lactancia materna. (5) Las intervenciones complementarias ayudan a optimizar la producción de leche.
Introduction
Newborns and nurslings are more vulnerable to illness due to their immune immaturity. Exclusive breastfeeding (EBF) is essential for strengthening immunity and preventing illness, but separation from the mother during hospitalization, associated with prematurity, can lead to early weaning, thus affecting child development and increasing the risk from hospitalizations(1).
The mother’s presence during hospitalization is crucial, and practices such as skin-to-skin contact, rooming-in and educational support for breastfeeding (BF) are recommended, as evidenced by a systematic review(2). In addition, sucking stimulation is essential, with the support of trained professionals and appropriate protocols(3). In this context, the Academy of Breastefeeding Medicine (ABM) develops guidelines for successful breastfeeding, such as clinical protocol no. 35, which supports breastfeeding during hospitalization(4).
Therefore, the use of innovative approaches and health tools can strengthen women’s learning, promoting breastfeeding and encouraging preventive behaviors(5). The technologies involved, which include management, educational and care interventions, are essential for health promotion, prevention and care(6). In maternal and child care, educational materials help provide guidance on breastfeeding, thus stimulating family autonomy and supporting maternal self-efficacy(7).
A clinical trial with 112 pregnant women showed that the use of a serial album in the intervention group significantly increased breastfeeding rates, with the likelihood of success being twofold as compared to that in the control group (p<0.001)(8). In turn, the study on the development and application of the leaflet “Every woman can breastfeed!” showed that this educational technology promoted maternal empowerment and the sharing of knowledge with puerperal women and their companions, thus strengthening self-efficacy for breastfeeding(9).
Nurses play an essential role in promoting and supporting breastfeeding, with technical guidance and emotional support, especially in Primary Health Care (PHC), which coordinates care in the Health Care Network(10). With a focus on child health, its approach prioritizes bonds, maternal experiences and the use of soft technologies(11), empowering women, families and communities in the home environment. Such integrated care can reduce hospital admissions and strengthen public policies(6), thus consolidating PHC as a key point for encouraging breastfeeding.
In view of the above, the objective of this study is to map out strategies aimed at promoting and maintaining breastfeeding after a nursling has been admitted to hospital. This review is based on the possibility of gathering information to support the construction of future soft-hard technologies aimed at protecting and providing basic support for breastfeeding in the home environment.
Method
Study design
This scoping review was carried out following the methodology of the Joanna Briggs Institute (JBI)(12), concomitantly with the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) checklist(13). The protocol was registered on the Open Science Framework (OSF) platform, which can be accessed via the following link: https://doi.org/10.17605/OSF.IO/XJ374
In order to carry out the review, the following stages were considered: Phase 1 - Eligibility criteria; Phase 2 - Sources of information and literature search; Phase 3 - Selection of sources of evidence; Phase 4 - Data extraction; and Phase 5: Data analysis and presentation.
Phase 1 - Eligibility criteria
The acronym PCC (population, concept and context) was used to formulate the study objective: P (population) = nurslings; C (concept) = breastfeeding; C (context) = post-hospitalization. The study’s guiding question was: what scientific production is there on strategies to promote and maintain breastfeeding following nurslings’ hospitalization?
Complete studies aligned with the topic were considered, covering various methodological designs, both published and unpublished (gray literature), with no language restrictions. As for the period of publication, the interval from 2012 to 2024 was established, with 2012 being the year of approval of the global target related to child nutrition, stipulated by WHO/PAHO, through the World Health Assembly, with a view to promoting a 50% increase in the EBF rate by 2025(14). This was considered a political milestone with a major impact on the issue.
Phase 2 - Information sources and literature search
In order to identify the relevant studies, we consulted the periodical databases of the Nursing Database (BDENF), Latin American and Caribbean Health Sciences Literature (LILACS), accessed via the Virtual Health Library (VHL) platform, as well as the National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Cumulative Index Nursing Allied Health Literature (CINAHL), Cochrane Library and Scopus.
In addition, a survey was carried out in additional sources, such as Google Scholar, the CAPES Theses and Dissertations Catalog and the Brazilian Digital Library of Theses and Dissertations (BDTD). A manual search was also carried out on the list of references of the selected studies.
In order to obtain a comprehensive overview of the current state of knowledge, a four-stage search strategy was developed, following the guidelines of the JBI manual for scoping reviews(12). Firstly, an initial search was conducted in the BDENF and PubMed databases, using DeCS-MeSH terms and index terms, to examine the titles and abstracts of the articles found and identify terms to be added to the search strategy. The research tactic was then adapted for the other databases, considering their individual particularities.
Subsequently, there was a search of gray literature sources, complementing the findings of the productions indexed in the databases, in order to encourage the incorporation of information related to technical management in BF. In addition, a manual search was carried out on the list of references of the selected studies to ensure that the information was up to date.
The search process incorporated controlled terms and keywords pertinent to the components of the PCC strategy, combined with the Boolean operators AND and OR. The search approach, covering all the keywords and indexing terms identified, was duly adapted for each source of information consulted, as shown in Figure 1 below:
Phase 3 - Selecting sources of evidence
The studies obtained from the search of the aforementioned databases were transferred to the EndNote reference manager in order to automatically eliminate duplicate studies. They were then exported to the Rayyan software, where the stages for study exclusion were performed, beginning with an analysis of the titles and abstracts, followed by a complete reading. These steps were carried out independently by two reviewers, without any divergence regarding the exclusion of articles, which eliminated the need to consult a third reviewer.
Phase 4 - Data extraction
The data extraction phase was carried out with the purpose of organizing, analyzing and interpreting the information present in the selected studies, according to the established objective. For this procedure, a data extraction form was structured, covering information such as identification of the journal/source, author, year, country of origin of the study, objectives, population and sample, methodological design, main study outcomes and the authors’ conclusion.
Phase 5: Data analysis and presentation
Data analysis involved drawing up a synthesis of the findings, in line with the objectives of the review, and discussing the implications of the results. Based on the information extracted, a descriptive analysis was carried out and the results were organized in a table with the main characteristics of the studies included.
The studies were classified into five levels of evidence: Level 1 covers systematic reviews and reliable randomized clinical trials; Level 2, cohort studies and “outcomes” research; Level 3, case-control studies; Level 4, case series and observational studies without controls; and Level 5, expert opinions without critical evaluation(15). This classification organizes the quality of the evidence, guiding decisions based on the most reliable data.
Ethical aspects
As this was a scoping review, it was not necessary to request approval from the Research Ethics Committee. We also declare that there is no conflict of interest.
Results
A total of 1,325 studies (articles, documents, theses and dissertations) were identified, of which 398 were excluded due to duplication, using the EndNote program. After analyzing the titles and abstracts, 123 studies were selected for full reading, of which 29 formed the final sample. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) was used to describe the searches and select the studies, as illustrated in Figure 2 below
Note: Adapted according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA-ScR)(13).
Flowchart of the selection process for the studies included in the review. Campina Grande, PB, Brazil, 2024
As for the continents, the studies were mostly distributed in South America (41.38%), followed by North America (31.03%), Asia (13.79%), Europe (6.9%), Oceania (3.45%) and Central America (3.45%).
The characterization of the studies identified is shown below, considering aspects such as authorship, year and place of publication, as well as design and level of evidence, as shown in Figure 3.
Regarding the methodological design, review studies predominated (34.48%), including scoping, integrative and systematic studies, followed by protocols and guidelines (27.59%), cross-sectional studies (13.79%) and qualitative cross-sectional studies (6.9%). Finally, there was only one article for a cohort study (3.45%), randomized clinical trial (3.45%), non-experimental correlational study (3.45%), thesis (3.45%) and book chapter (3.45%). As for the period of publication, the majority were published between 2018 and 2024 (68.97%), followed by the period between 2012 and 2017 (31.03%).
The table below summarizes the main characteristics of the studies included in the scoping review, highlighting key aspects such as objectives, main outcomes, conclusions and the strategies obtained. The detailed presentation of the studies makes it possible to assess the relevance and quality of the approaches investigated, facilitating critical analysis and directing interpretations, as shown in Figure 4:
For analysis purposes, the included studies were organized into four thematic categories: educational and social approaches to promoting breastfeeding (31.0%), family, community and professional support for breastfeeding (34.5%), techniques for resuming breastfeeding (24.1%) and complementary interventions to optimize milk production (34.5%). Considering the multifactorial nature of the interventions, the same study could be classified in more than one category.
Below are the main strategies identified in the included studies, distributed according to the four thematic categories described above. These strategies include evidence-based actions aimed at continuous breastfeeding support, as illustrated in Figure 5:
Promoting breastfeeding faces interconnected challenges that require effective strategies. Misinformation can be tackled with educational actions, while nipple confusion, associated with the use of pacifiers and bottles, requires guidance on safe alternatives. Stress and sleep deprivation, in turn, require support networks and encouragement for self-care. Hypogalactia, which may be related to these factors, can be addressed with frequent breast stimulation, skin-to-skin contact and appropriate devices, combined with technical and emotional support.
Discussion
Based on the systematized results, it can be seen that the strategies aimed at promoting, supporting and resuming BF involve different approaches, grouped into four thematic categories for analysis purposes. Each of these categories is discussed below, in the light of the available evidence and the settings in which the interventions were applied.
Techniques for resuming breastfeeding
Several studies have shown the effectiveness of relactation and translactation practices in re-establishing breastfeeding, especially in cases of early weaning and in premature newborns. With the right support, relactation has been shown to be effective, helping to produce breast milk, especially in low-birth weight infants(16). In this context, one study showed that 78.6% of infants resumed breastfeeding after implementing these techniques(17). In addition, some protocols, such as ABM Clinical Protocol #12, guide the transition of premature babies from the NICU to home, promoting breastfeeding(18), while ABM Clinical Protocol #9 addresses supplementation with human milk or formula and the use of assistive devices(19).
Furthermore, a study revealed that the early onset of milk expression, the increased frequency of extraction sessions and skin-to-skin contact are decisive factors in optimizing milk production in mothers of very low-birth-weight babies, also highlighting the importance of access to adequate pumps and the training of health professionals to support mothers(20). In this context, breast compressions are recommended to improve milk transfer. Switching breasts during feeding (switch nursing) has also been identified as an effective technique for stimulating multiple milk letdowns, ensuring better nutrition for the baby and a more positive experience for the mother(21).
Family, community and professional support for breastfeeding
Continued support from professionals and family members is essential for maintaining breastfeeding, especially after discharge from hospital(22). Studies carried out in the United States show that educational and social interventions can increase the duration and exclusivity of breastfeeding(23) by overcoming barriers such as the perception of insufficient milk(24). In Brazil, prenatal education has been shown to be effective in improving health indicators related to breastfeeding(25).
Ministerial documents emphasize the importance of multi-professional support and family and community participation for successful breastfeeding up to the age of two(26). This support should continue after hospital discharge, with community follow-up and regular consultations(27). ABM Clinical Protocol #2 reinforces family-centered follow-up(28), and care models with training and community support have shown good results in the Unified Health System (SUS), helping to prevent early weaning(29).
Complementary interventions to optimize milk production
A review of clinical studies in Malaysia evaluated the use of galactagogue plants, such as fenugreek and milk thistle, which showed positive effects on breast milk production(30) and are natural and effective alternatives for mothers with lactation difficulties(31). In addition, non-pharmacological practices, such as acupuncture and music therapy, have also shown potential to increase milk production and improve mothers’ emotional well-being, despite variable results(32). The combination of these interventions, along with techniques such as breast massage, acupressure and the use of galactagogues, can promote lactation and reduce maternal stress(33).
Acupuncture has shown potential to increase breast milk production by stimulating hormones such as oxytocin and prolactin. A systematic review indicated that many mothers who underwent acupuncture sessions reported a significant increase in the amount of milk. In addition, this technique helps to reduce stress and pain by promoting relaxation, which facilitates breastfeeding. Although widely used in Asia, rigorous research to standardize protocols and evaluate its effectiveness still lacks, but evidence suggests that it can be useful for mothers with lactation difficulties(34).
Music therapy has shown positive effects in promoting BF, especially when mothers listen to relaxing music while expressing milk, with 30-minute sessions repeated at least 10 times, which can increase milk production and reduce stress(35). It also helps to reduce anxiety and improves mothers’ mental health, which are important factors for successful breastfeeding. Although the evidence on its effects on babies’ sleep and on reducing cortisol in milk is limited, the practice is well accepted, risk-free and affordable for mothers(36).
Educational and social approaches to promoting breastfeeding
Educational interventions and ongoing social support increase the duration and exclusivity of breastfeeding by addressing modifiable causes such as stress and lack of knowledge about milk production(25). Group activities, information materials and on-call support from health teams are essential for successful breastfeeding(29) as well as frequent contact with mothers and their support networks(23).
The use of digital technologies has been highlighted as an essential resource in breastfeeding support, especially among vulnerable populations, offering access to information and real-time guidance for mothers with limited access to onsite(22). These tools expand breastfeeding support by providing quality data and personalized help(32). Online support groups, direct channels with experts and monitoring platforms have shown effectiveness in resolving challenges, prolonging breastfeeding and creating a favorable environment(37).
In addition, nursing training must be improved to strengthen support for BF, emphasizing the continuous training of professionals. This involves the use of digital resources and the integration of innovative technologies that help address cultural and social challenges related to breastfeeding(29).
The limitations in this study were the small number of studies carried out specifically in Primary Health Care. Strategies with potential for application at this care level were included, considering the role of PHC in care continuity. In addition, some articles were excluded because they were not available in full. To minimize bias, the search was expanded to several databases, including protocols and related documents. The classification of the level of evidence was not used as a criterion for accepting or rejecting strategies, as it was not part of the methodological scope. Further research is, therefore, recommended to explore the determinants identified and their applicability to real outcomes.
Conclusion
The scoping review identified different strategies for maintaining and resuming BF after hospitalization, highlighting educational actions, multi-professional and family support, evidence-based interventions, complementary therapies and the use of technologies to increase access to information and support. It also highlights the importance of favorable settings and guidelines to guide professional practice in the home context.
Further research into the effectiveness of these interventions is recommended, with a focus on the use of technologies in post-discharge follow-up, the standardization of techniques and the evaluation of impacts on BF continuity. These results can support public policies and improve maternal and child care in Primary Health Care.
Lastly, there is a need for interdisciplinary actions that increase access to and resolution of post-discharge care, integrating these measures into daily care and strengthening breastfeeding promotion and support.
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*
The publication of this article in the thematic series “Scope of Nursing Practice in Primary Health Care” is part of Activity 2.2 of Reference Term 2 of the PAHO/WHO Collaborating Centre for Nursing Research Development, Brazil.
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How to cite this article
Rocha SAR, Buck ECS, Costa CBA, Andrade SSC. Breastfeeding strategies following nurslings’ hospitalization: a scoping review. Rev. Latino-Am. Enfermagem. 2025;33:e4674 [cited]. Available from: . https://doi.org/10.1590/1518-8345.7800.4674
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Data Availability Statement
All data generated or analysed during this study are included in this published article.
Edited by
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Associate Editor:
Maria Lúcia Zanetti
Data availability
All data generated or analysed during this study are included in this published article.
Publication Dates
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Publication in this collection
10 Nov 2025 -
Date of issue
2025
History
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Received
12 Dec 2024 -
Accepted
03 May 2025
