Feasible Breastfeeding Research Questions for Pediatric Residents
Pediatric residents should focus on implementation science questions examining how primary pediatric providers can effectively promote breastfeeding during routine preventive visits, as this represents a critical knowledge gap with untested potential for cost-effective intervention. 1
High-Priority Research Areas with Clinical Impact
Provider-Based Interventions in Clinical Settings
The most actionable research question involves testing whether structured breastfeeding counseling by pediatricians during well-child visits increases breastfeeding duration beyond 6 months. 1 This addresses a fundamental gap: no studies have evaluated whether advice by the infant's primary pediatric provider during routine preventive visits is effective on its own in increasing breastfeeding rates. 1
Specific feasible questions include:
Does a standardized 5-minute breastfeeding assessment and counseling protocol at 2-week, 2-month, and 4-month visits increase exclusive breastfeeding rates at 6 months? 1 This leverages existing well-established preventive visit infrastructure. 1
What are the barriers preventing pediatricians from implementing breastfeeding support during routine visits, and can simple office-based interventions overcome them? 1 Research is needed to examine barriers to effective program use and their cost-effectiveness in diverse clinical settings. 1
Skin-to-Skin Contact Implementation Studies
Residents can investigate whether extending skin-to-skin contact duration beyond current hospital practices (targeting >20 minutes uninterrupted) increases exclusive breastfeeding duration. 2 Evidence shows that skin-to-skin contact lasting longer than 20 minutes after birth increases exclusive breastfeeding duration by 1.35 months and delays weaning by 2.10 months. 2
Practical questions:
Does implementing a protocol to minimize early interruptions of skin-to-skin contact in the first 2 hours increase successful first breastfeed rates? 3 Early interruptions reduce chances of early breastfeeding, with 60% of first interruptions occurring before the first breastfeed. 3
Can resident-led education of labor and delivery staff about delaying non-urgent neonatal care reduce skin-to-skin interruptions? 3 In observational studies, 56.7% of newborns experienced at least two interruptions during the first 2 hours, mainly for neonatal care. 3
Maternal Responsiveness and Feeding Practices
Residents can examine whether longer breastfeeding duration predicts specific responsive feeding behaviors that reduce childhood obesity risk. 1 Longer breastfeeding duration is associated with greater responsiveness to infant fullness cues and lower use of pressuring feeding practices. 1
Feasible questions:
**Do mothers who breastfeed >6 months demonstrate measurably different feeding responsiveness at 12 months compared to those breastfeeding <3 months?** 1 Studies show mothers who breastfed >6 months reported lower pressure to eat in 12-24 month-olds. 1
Can brief anticipatory guidance about responsive feeding during breastfeeding visits improve maternal feeding practices after weaning? 1 This addresses the mechanism linking breastfeeding to later feeding behaviors. 1
Quality Improvement Projects
Residents can conduct chart reviews examining whether their practice follows evidence-based breastfeeding support recommendations and identify modifiable gaps. 1, 4, 5
Specific projects:
What percentage of infants with poor weight gain receive direct observation of breastfeeding technique before formula supplementation is recommended? 4 Guidelines recommend evaluating breastfeeding technique directly, including latch quality, positioning, and milk transfer during actual feeding sessions. 4
How often do providers use LactMed to verify medication compatibility before advising temporary breastfeeding cessation? 1, 5 Most maternal medications and vaccinations are compatible with breastfeeding, yet unnecessary disruption occurs. 1, 5
Do discharge packs containing formula samples correlate with lower exclusive breastfeeding rates at 1-month follow-up in your practice? 1 Commercial discharge packs are associated with reduced exclusive breastfeeding at 1 month and any breastfeeding at 4 months. 1
Methodological Considerations for Resident Research
Study Design Feasibility
Cross-sectional surveys and retrospective chart reviews are most feasible for residents, while prospective interventions require institutional support. 1
Survey studies examining maternal knowledge, attitudes, and barriers to breastfeeding can be completed within a single clinic rotation. 1 These identify local factors affecting breastfeeding rates without requiring long-term follow-up.
Chart reviews assessing adherence to WHO Ten Steps to Successful Breastfeeding provide actionable quality improvement data. 1, 5 These practices are associated with higher exclusive breastfeeding rates at discharge and 8 weeks postpartum. 5
Common Pitfalls to Avoid
Do not design studies requiring >6 months of follow-up without dedicated research coordinator support, as resident clinical schedules make sustained data collection unrealistic. 1 Most resident research must be completable within 3-4 months.
Avoid questions requiring randomization of clinical care without IRB approval and attending physician oversight. 6, 7 Quality improvement projects using existing best practices are more feasible than true experimental designs.
Do not ignore confounding variables like maternal education, parity, and socioeconomic status when analyzing breastfeeding outcomes. 1, 2 Multivariate analysis is essential, as skin-to-skin contact and maternal education independently influence exclusive breastfeeding duration. 2
Practical Implementation Strategies
Partner with hospital lactation consultants to access existing breastfeeding data and leverage their clinical expertise. 1, 5 Skilled lactation support is essential for breastfeeding success and provides valuable research collaboration opportunities. 5
Focus on modifiable factors within the resident's sphere of influence: provider counseling techniques, office protocols, and patient education materials. 1, 5 Systemic barriers like workplace policies and paid maternity leave, while important, are beyond typical resident research scope. 1
Use validated instruments when measuring breastfeeding outcomes: WHO growth charts for infant growth, standardized feeding questionnaires (CFQ, IFSQ), and objective measures like exclusive breastfeeding rates at specific time points. 1, 4 This ensures comparability with existing literature and strengthens findings.