INTRODUCTION:

Exclusive Breastfeeding up to six months of life is considered the ideal practice for growth, development and protection of the newborn. Breast milk is the ideal food for the infant, as it is rich in fats, minerals, vitamins, enzymes and immunoglobulins¹. The absence of exclusive breastfeeding or early weaning with the introduction of other types of food before the age of six months has harmful consequences for the infant's health, such as early exposure to infectious agents, contact with foreign proteins and damages to the digestion process^2,3.

Globally, only 38 percent of infants aged 0 to 6 months are exclusively breastfed. Recent analyses show that suboptimal breastfeeding practices, including non-exclusive breastfeeding, contribute to 11.6 percent of mortality in children under 5 years of age. This was equal to about 804,000 child deaths in 2011 (WHO/UNICEF). In 2012, the World Health Assembly (WHA) unanimously endorsed a set of six global nutrition targets, including an increase in exclusive breastfeeding (EBF) rates, be achieved by 2025 to improve maternal, infant and young child nutrition across the world⁴.

In India, according to the National Family Health Survey-3 (NFHS-3, 2005-2006), EBF rate at 6 months was 46.4%⁵. Several studies focusing on the constraints to EBF concluded that; breastfeeding problems, delivery by caesarean section, perceived or real breast milk insufficiency, inadequate weight gain of the infant, return to official work by the mother, and cultural practices are the factors influencing mothers' decision for continuation of breastfeeding^6,7,8,9,10.

MATERIALS AND METHODS:

A descriptive-analytical study was undertaken to assess the breastfeeding problems and factors leading to early weaning during the exclusive breastfeeding period among mothers in a tertiary care center in Ernakulam district, Kerala from February to March 2019. The setting of the study was Pediatric wards and OPD of selected Tertiary Care Hospital, Ernakulam District, Kerala. After getting IRB approval and informed consent from the subjects, 75 mothers of infants attending pediatric ward and OPDs of tertiary care centers were interviewed using a structured interview schedule to assess the breastfeeding problems and factors that led to early weaning. The sampling technique was convenience sampling technique. Sample selection criteria includes all mothers of infants attending the pediatric OPD or selected wards who can understand Malayalam or English.

RESULTS:

The prevalence of exclusive breastfeeding among the study subjects was 61.3 %. Nearly 43 % of the mothers reported breastfeeding problems. 38.7 % of the mothers started early weaning during exclusive breastfeeding.

Out of 75 mothers, nearly 42.67% had severe or moderate intrinsic breastfeeding problems and only 2.67% had moderate extrinsic breastfeeding problems. The common problems reported were perceived insufficient milk (50%), not having enough milk (37%), child sleeping at the breast (50 %).

The factors leading to early weaning reported by mothers who started early weaning were family members' advice (48. 27 %), health professionals' advice (27.58 %), and working mothers' (20.68 %).

The study shows none of the selected sociodemographic characteristics of mother and birth characteristics of baby were significantly associated with the breastfeeding problems but there is significant association between breastfeeding problems and status of early weaning.

DISCUSSION:

As per Objective 1: To estimate the proportion of the breastfeeding problems of mothers during exclusive breastfeeding period.

The results of the present study findings indicated the common breastfeeding problems were perceived insufficient milk (50%) ,not having enough milk(37%), child sleeping at the breast(50%), child want to be breastfed all the time(26.7%), child is crying too often(12%), milk has stopped(8%), inverted or flat nipple(4%),cracked or sore nipple(16%), baby agitated and crying (13.3%) , latching not correct(1.3%),drugs contradicted to breastfeeding(10.7%), hospitalization (6.7%), baby’s infection (9.33%), regurgitation of milk (10.7%), preterm baby(17.3%), baby’s NICU admission (38.7%) and other problems like hematemesis and galactosemia(4%). Out of 75 mothers interviewed, 20% of them reported having breastfeeding problems.

There are studies which showed similar findings of the present study.

A systematic review done by Karaçam Z, Sağlık M in Turkey in 2018. They reviewed 27 articles and seven theses. A total of 6736 parents and 592 babies were included in these studies. They reported that the most frequent problems were mother’s milk deficiency/worry about milk deficiency/thinking her baby is not satisfied/baby’s inadequate weight gain (15.7%), lack of knowledge and experience about breastfeeding/need for education and support (17.8%). Again, these studies showed that women stated the problems about have flat/depressed/small nipple (7.7%), pain/sensitivity (3.9%), swelling/fullness/engorgement (10.8%), redness (28.8%), crack/wound/bleeding (26.1%) and mastitis (5.6%).

However, a study by Feenstra MM et al in Denmark in 2018 reported contradictory findings to the present study. They found that most prominent breastfeeding problems were infant’s inability to latch on (40%) and mothers having sore, wounded and cracked nipples (38%).

As per Objective 2: To identify the causes of early weaning among mothers of infants.

The results of the present study findings indicated that the rate of exclusive breastfeeding was 61.3%. Also, the common factors of early weaning were inadequate milk(24%), Family member’s advice (18.67%), Health professional’s advice(10.67%), Child feels happy after complementary feed (9.33%) and working mother (8%). The factors such as pregnancy of the mother, breast refusal by the baby, mother’s illness were not associated with early weaning.

A similar finding was reported by Josmitha Maria D’Souza and Umarani where they conducted a descriptive survey in 2014 in kotekar area, Mangalore, Karnataka to assess the factors leading to early weaning of infants. The sample size was 100 mothers of infants. The findings suggest that factors like working mother, lack of knowledge, young mothers and inadequate breast milk secretion, mother’s attitude, role of significant others, medical conditions of the infant, medical conditions of the mother and mythical factors were the causes for early weaning.

A study conducted by Sreeja M in 2016 in Palakkad reported that advice from family members and insufficient breast milk were the major reasons for non-adherence of exclusive breastfeeding. Majority of participants had good awareness regarding duration of exclusive breastfeeding (82%). But only 24 percent of the participants practiced exclusive breastfeeding up to 5-6 months. Only 27 percent of women who were aware about exclusive breastfeeding practiced exclusive breastfeeding for 5-6 months. Three out of four mothers practiced early complementary feeding.

But a study by Riusjm et al in Spain in 2013 found that factors associated with early discontinuation of breastfeeding were: pregnancy induced by assisted reproduction methods and maternal smoking.

As per Objective 3: To determine the association of breastfeeding problems with socio-demographic characteristics of mothers of infants and birth characteristics of infants.

The results of the present study findings indicated that none of the variables were significantly associated with the breastfeeding problems.

A systematic review done in Sweden by Mangrio E et al, in 2018 in 27 articles got similar results to the present study findings. They reported that the association of breastfeeding cessation between the mothers young age, low level of education, return to work within 12-week postpartum, caesarean birth and inadequate milk supply was found to have a low level of evidence.

But a study by Onah S in Nigeria in 2014 found that factors such as low maternal education, higher socioeconomic status, nonvaginal birth and use of prelacteal feeds were significant predictors of lower exclusive breastfeeding practice.

As per Objective 4: To determine the association between breastfeeding problems and status of early weaning.

The results of the present study findings indicated that there is significant associationbetween breastfeeding problems and factors of early weaning.

Currently, no similar or contradictory studies that assessed the association between breastfeeding problems and factors of early weaning were obtained.

CONCLUSION AND RECOMMENDATIONS:

Women commonly experienced breastfeeding problems in the postpartum period, but solution approaches developed specifically for these problems were limited. Nursing professionals in the postnatal wards with adequate knowledge of breastfeeding problems and factors of early weaning in the exclusive breastfeeding period, play a key role in improving the exclusive breastfeeding rate and preventing the potential breastfeeding problems. The students should be empowered to conduct breastfeeding clinics, mother and baby clinics in community, to assess the breastfeeding problems and to improve the rate of exclusive breastfeeding during early 6 months.

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Received on 18.07.2025 Revised on 23.08.2025

Accepted on 22.09.2025 Published on 03.11.2025

Available online from November 12, 2025

A and V Pub J. of Nursing and Medical Res. 2025;4(4):130-132.

DOI: 10.52711/jnmr.2025.29

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