# Supporting Breastmilk Feeding for Infants in Foster Care: A Scoping Review

## TL;DR

This review explores how to support breastfeeding and expressed breastmilk for infants in foster care, highlighting policy gaps and the need for training and guidelines.

## Contribution

The study identifies key barriers and facilitators to breastfeeding in foster care and emphasizes the need for evidence-based policies and multidisciplinary support.

## Key findings

- Foster parents lack knowledge about the safety of expressed breastmilk.
- Multidisciplinary collaboration is essential to support breastmilk provision in foster care.
- Current policies and guidelines do not prioritize breastfeeding for infants in foster care.

## Abstract

Worldwide, around 2.7 million children are not in the care of their parents, and access to breastmilk is often absent from foster care policies. We aimed to explore the evidence available on how foster families, health and social workers and mothers with infants in care can be supported in providing breastfeeding and expressed breastmilk (EBM), and to identify barriers and facilitators for breastfeeding and EMB in foster care. The JBI methodology for scoping reviews was used. Three academic databases and grey literature were searched in March 2023, and data extraction charts were used. The findings were synthesised using thematic analysis. In total, 11 papers were included, 5 peer‐reviewed papers and 6 from the grey literature. Five themes were identified in the analysis: ‘Is this safe?’, ‘Substance use: Protecting the breastfeeding rights of mothers and infants’, ‘Making milk accessible through breastfeeding and EBM’, ‘Where are the policies’? and ‘Attitudes around breastfeeding’. The findings showed concern from foster parents around the safety of breastmilk and the challenges of supporting breastmilk provision when infants are in foster care. Training, positive attitudes and multi‐disciplinary team involvement can support breastfeeding and the breastfeeding rights for infants in foster care. Health and social care professionals who support mothers and foster families with breastfeeding and EBM feeding lack knowledge and guidance in how to do this safely and with a rights‐based approach. We found that facilitating breastfeeding is not prioritised when an infant is placed into foster care and that the breastfeeding rights of mothers and infants require urgent attention in policies and guidelines to facilitate safe and person‐centred infant feeding.

Foster carers need further support to enhance their knowledge regarding the safety of handling and giving expressed breastmilk.Mothers who wish to continue breastfeeding when their infant is placed in foster care need support from services, if no other risk factors exist.Multi‐disciplinary collaboration across health and social care is required to support provision of breastmilk to infants in foster care.Evidence‐based guidelines are necessary to facilitate mothers with their establishment and continuation of breastfeeding and expressed breastmilk for their infants in foster care.

Foster carers need further support to enhance their knowledge regarding the safety of handling and giving expressed breastmilk.

Mothers who wish to continue breastfeeding when their infant is placed in foster care need support from services, if no other risk factors exist.

Multi‐disciplinary collaboration across health and social care is required to support provision of breastmilk to infants in foster care.

Evidence‐based guidelines are necessary to facilitate mothers with their establishment and continuation of breastfeeding and expressed breastmilk for their infants in foster care.