Validity of Maternal Assessment of Infant Breastfeeding Behavior: A Cross‐cultural Comparison

Abstract

We evaluated the validity of two potential ‘screening’ questions asked of primiparous mothers about a breastfeeding episode on days 0 and 3 post‐partum (pp) in Peru (n=154) and the US (n=248). A dichotomous measure (suboptimal vs. optimal infant breastfeeding behavior) based on Infant Breastfeeding Assessment Tool scores recorded by trained observers was the reference. Sensitivity (Se) and Specificity (Sp) of maternal assessment of suckling behavior (suckled well continuously/intermittently vs. otherwise; MASB) and maternal satisfaction (very satisfied/satisfied vs. otherwise; MAS) with a breastfeeding episode were calculated for independent and parallel use. Depending on the day pp, Se of MASB was 36–63% in Peru and 44–57% in the US; Sp was 97% in Peru and 97–98% in the US. Se of MAS was 61–85% in Peru and 48–58% in the US; Sp was 64–73% in Peru and 89–92% in the US. Parallel use of both questions improved Se in the US (55–73%). Increasing the cut‐off of MASB improved Se on both days in both samples (85–99%), but reduced Sp (31–69%). The use of these screening questions may help identify breastfeeding dyads who would benefit from further lactation support, especially in settings where availability of specialized lactation evaluation is limited.Supported by grant R40MC04294 from the Department of Health and Human Services, Maternal Child Health Branch and by the Gifford Center for Population Studies at UC Davis.