# data[].attributes.headline
Dear PPD and Gang Poem (Artifact #1) (Davis, 2015)

# data[].attributes.subject
Dear PPD and Gang Poem (Artifact #1) (Davis, 2015)

# data[].attributes.body
Dear PPD and gang,

I don’t know and can’t understand why,
You chose me, the wrong guy.
I am so numb, I can not even cry,
You sucked out of me all my energy supply.

You are a monster, there is no match to you,
You accompany me wherever I go and whatever I do.
You stole my mind, and my soul too,
My nest you ripped apart through and through.

You robbed so much from all I hold so precious and dear,
Abandoned me from all whom I love and care.
You tortured me mercilessly with your terror and fear,
You left me alone with pain so impossible to bear.

You have beaten me to the core,
The little spirit from my heart you tore.
I am choking, I can not survive anymore.
This nightmare is impossible to endure.

But as powerful and strong you think you can be,
I am stronger than you regard me.
And when I say I give up it’s YOU talking PPD,
So I will show you at last I will be free.

You won the battle but I won the war,
I am stronger than you ever before.
Do not dare show up anymore
Because you will not win, I am a brave warrior!

~ By Warrior Mom, Kathy Davis (Davis, 2015)

I chose to include this poem as I think the authenticity included in the words, brings value to healthcare practitioners in working to understand what someone with PPD may be dealing with. This poem encompasses raw emotions felt by the mom with PPD while also displaying a positive attitude in fighting PPD. It is both informative and inspirational.

# data[].attributes.attachment_link.title
Dear PPD & Gang -- A Poem About Surviving Postpartum Depression | POSTPARTUM PROGRESS

# data[].attributes.attachment_link.description
The Postpartum Progress Private Forum is a special place. Hundreds of moms come together online, day in and day out, to support one another through their battles with perinatal mood and anxiety disorders. The conversations there are uplifting and full of hope. Recently, a mom on our forum shared a beautiful poem with us and …

# data[].attributes.headline
Image of newborn being held (Artifact #1) (Miller, 2018)

# data[].attributes.subject
Image of newborn being held (Artifact #1) (Miller, 2018)

# data[].attributes.body
To me, this image from 'Neonatal Abstinence Syndrome: Transforming Care for Newborns and Their Families' (Miller, 2018) demonstrates the complex yet crucial role, we have as healthcare practitioners in supporting our youngest clients through significant adversities. Babies born with NAS/NOWS typically require more comforting then babies born without NAS/NOWS due to the signs and symptoms they are experiencing attributed to their withdrawal. Thus, as healthcare practitioners and future nurses, it is important that we understand the complexities of Neonatal Abstinence Syndrome and Neonatal Opioid Withdrawal Syndrome, so we can provide the best care possible to our patients who are not yet able to verbally advocate or express their needs.

# data[].attributes.headline
Artifact #1 (Campaign for Trauma-Informed Policy and Practice, n.d.)

# data[].attributes.subject
Artifact #1 (Campaign for Trauma-Informed Policy and Practice, n.d.)

# data[].attributes.body
I chose to include the quote above as I feel it genuinely speaks to the importance of a healthcare system that has Trauma Informed Approaches to Care seamlessly woven throughout it. In addition, I believe that this quote touches on principles of relational inquiry through the focus on collective healing and acknowledging lived experiences, proving incredibly powerful for healthcare organizations to begin fostering more supportive and inclusive environments.

# data[].attributes.headline
Turn on the Lights Song (Artifact #2) (Bowen, 2008)

# data[].attributes.subject
Turn on the Lights Song (Artifact #2) (Bowen, 2008)

# data[].attributes.body
The lyrics of this song are incredibly meaningful. The artist shares that the song was written after a particularly challenging time for his wife after the birth of their son. The lyrics share about the artist's experience trying to support his wife through PPD which displays the relational inquiry piece of PPD and the greater impacts it has on more than just the person living with the condition.

# data[].attributes.headline
I Am Not Okay Song (Artifact #3) (Roll, 2024)

# data[].attributes.subject
I Am Not Okay Song (Artifact #3) (Roll, 2024)

# data[].attributes.body
This artist is a huge advocate for mental health awareness and safe consumption and his music speaks to a lot of stigmatized issues. In this song, he sings about admitting he is not okay, but that everything will work out in the end. To me, this song represents hope and a sort of light at the end of the tunnel in regards to the journey with mental health concerns. This song also normalizes and reduces stigma through the utilization of a creative form about mental health struggles which fosters a safer more supportive environment for those struggling from mental health related concerns such as postpartum depression.

# data[].attributes.attachment_link.title
Jelly Roll - I Am Not Okay (Official Lyric Video)

# data[].attributes.body
Although this video isn't recent, it is incredibly relevant and timely given the continuing opioid crisis, which also impacts neonates. The mother's statement during this video is very powerful in sharing the guilt a parent may live with after a baby is born with NAS/NOWS, thus also displaying the importance of Trauma Informed Approaches to Care. Furthermore, it shares the story and perspective of the mother and how she was told to remain on the opioid she was using when she found out she was pregnant as trying to quit could jeopardize her pregnancy. Overall this video highlights the importance of empathy and also displays common signs/symptoms of NAS/NOWS from a personal and relational perspective.

# data[].attributes.attachment_link.title
When babies are born withdrawing from opioids

# data[].attributes.body
I chose to include this artifact because I feel like many practitioners, myself included, can be overwhelmed when we begin conversations surrounding Trauma Informed Approaches to care. However, I believe that this visual provides a simpler way to deconstruct what Trauma Informed Care actually incorporates. Instead of many extra steps; it simply involves the integration of universal trauma prevention/screening and trauma-specific interventions and treatment. I believe that this visual artifact provides a tangible way for students to incorporate trauma informed techniques and strategies into practice.

# data[].attributes.attachment_link.title
Indigenous Women’s Stress and Postpartum Depression: Discussions from the Canadian Maternity Experiences Survey and Indigenous Maternity Narratives | International Journal of Indigenous Health

# data[].attributes.attachment_link.description
This doctoral research highlights Indigenous women’s experiences of stress and postpartum depression (PPD) through secondary quantitative analysis of the Public Health Agency of Canada’s Canadian Maternity Experiences Survey (2009) and qualitative Indigenous maternity narratives. Indigenous women’s responses to the survey demonstrate that Indigenous women experience 1.9 times higher odds of PPD and are 1.5 times as likely to be diagnosed with depression prior to pregnancy, compared to Canadian women. Indigenous women are also 1.3 times as likely to experience higher levels of stress and 3.3 times as likely to experience three or more stressful life events. While the survey demonstrates higher rates of stress and PPD, it is not culturally or contextually relevant. Therefore, Indigenous maternity narratives from 10 Indigenous mothers in 2015 further contextualize experiences of stress and PPD to include narratives related to adverse social determinants of health and impacts of colonialism. The research includes a discussion on the limitations of previous maternity research and the limits of clinical-medical assessments and diagnosis of stress and PPD in Indigenous populations. The research concludes with recommendations for additional maternity experiences research and ways to support Indigenous women, infants and children, birth partners, families, and communities.

# data[].attributes.headline
Research Article #1 (Ogundiran & Gigli, 2025)

# data[].attributes.subject
Research Article #1 (Ogundiran & Gigli, 2025)

# data[].attributes.attachment_link.title
Exploring the role of different coping styles in mediating the relationship between dyadic adjustment status and postpartum depression among postnatal women: a single-centre, cross-sectional study

# data[].attributes.attachment_link.description
Objectives Postpartum depression (PPD) is a prevalent complication of childbearing, with numerous risk factors associated with its onset. Although the risk factors for PPD among postpartum women have been studied, the mechanisms underlying these factors remain inadequately understood. This study aimed to investigate the direct and mediating roles of different coping styles in the relationship between dyadic adjustment status and PPD among women 6 weeks postdelivery. Design Single-centre, cross-sectional study. Setting A tertiary care setting in Chengdu City, Sichuan Province, China, from July 2022 to January 2023. Participants The study involved 626 women 6 weeks post-delivery. Outcome measures The Dyadic Adjustment Scale, the Simplified Coping Style Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS) were used to evaluate the dyadic adjustment status, coping styles and the depressive condition of postpartum women, respectively. Data analysis encompassed correlation and mediation analyses based on structural equation modelling. Results EPDS scores were significantly correlated with all four dimensions of dyadic adjustments status as well as with both positive and negative coping styles. Dyadic consensus ( β = −0.16, p=0.005), affectional expression ( β = −0.14, p=0.008) and dyadic cohesion ( β = −0.10, p=0.037) directly correlated with PPD after adjusting for covariates. For dyadic satisfaction, the mediating effects of positive and negative coping styles on PPD were −0.04 (95% CI: −0.08 to –0.01) and −0.07 (95% CI: −0.11 to –0.03), respectively. Moreover, both positive and negative coping styles were identified as mediators in the relationship between dyadic cohesion and PPD, with mediating effects of −0.01 (95% CI: −0.03 to –0.00) and −0.09 (95% CI: −0.14 to –0.04), respectively. No mediation was found in the association between affectional expression and PPD. Conclusion Our findings suggest that both positive and negative coping styles mediate the relationship between dyadic adjustment status and PPD, especially concerning dyadic satisfaction and dyadic cohesion. The data were collected and collated by the research team. Due to specific privacy and confidentiality restrictions, they are unavailable for public access.

# data[].attributes.headline
Research Article #2 (Velez et al., 2021)

# data[].attributes.subject
Research Article #2 (Velez et al., 2021)

# data[].attributes.headline
By Design Painting (Artifact #1) (Maarschalk, 2017)

# data[].attributes.subject
By Design Painting (Artifact #1) (Maarschalk, 2017)

# data[].attributes.body
I chose to include this painting as an artifact due to the symbolism and deeper meanings captured in this beautiful piece. Often, Colostrum, is referred to as Liquid Gold by healthcare professionals due to the many uses for it and health benefits associated with its use. By having the feeding baby and the mother's breast painted in gold colouring, I feel that this painting encompasses the immense value of breastmilk and breastfeeding. I believe that the smaller child holding onto the feeding mom, also helps to normalize breastfeeding around loved ones and the bonding experience that it can be.

# data[].attributes.headline
Secondhand Smoke Song (Artifact #1) (Ballerini, 2015)

# data[].attributes.subject
Secondhand Smoke Song (Artifact #1) (Ballerini, 2015)

# data[].attributes.body
Music is very powerful in talking about subjects through creativity in a way that de-stigmatizes subjects that are usually heavily stigmatized. Secondhand Smoke, a song by Kelsea Ballerini, alludes to the trauma that can occur during childhood and the longterm impacts this can have, similar to ACEs. Additionally, the name "Secondhand Smoke", represents the way others harmful actions can linger and cause longterm health effects, the same way secondhand cigarette smoke does. Overall, this song is powerful in its representation and advocacy surrounding ACEs and childhood trauma (Ballerini, 2015).

# data[].attributes.attachment_link.title
Kelsea Ballerini - Secondhand Smoke (Official Audio)

# data[].attributes.headline
Research Article #1 (Williams et al., 2023)

# data[].attributes.subject
Research Article #1 (Williams et al., 2023)

# data[].attributes.attachment_link.title
Peripartum Traumas and Mental Health Outcomes in a Low-Income Sample of NICU Mothers: A Call for Family-Centered, Trauma-Informed Care

# data[].attributes.attachment_link.description
Postpartum depression (PPD), postpartum anxiety (PPA), and post-traumatic stress disorder (PTSD) among birthing people have increased substantially, contributing to adverse maternal/infant dyad outcomes, with a high prevalence in the neonatal intensive care unit (NICU). Despite calls for trauma-informed care in the NICU and high rates of post-traumatic stress, little research has examined the rates of or the relationships between peripartum mood and adverse child experiences (ACEs) in NICU mothers or evaluated which peripartum traumas are most distressing. This study employed structural equation modeling (SEM) to explore whether peripartum-related traumas and NICU-related stressors mediated the associations between ACEs and mental health outcomes in 119 lower-income, racially diverse mothers in a Level IV NICU. Mental health concerns were prevalent and highly comorbid, including 51.3% PPA, 34.5% PPD, 39.5% post-traumatic stress, and 37% with ≥4 ACEs. The majority (53.8%) of mothers endorsed multiple peripartum traumas; NICU admission was the most common trauma (61%), followed by birth (19%), pregnancy (9%), and a medical event in the NICU (9%). Our SEMs had good fit and demonstrated that ACEs predicted peripartum distress. Trauma-informed care efforts should employ transdiagnostic approaches and recognize that women commonly present to the NICU with childhood trauma history and cumulative peripartum traumas.

# data[].attributes.headline
Aesthetic Project- Beaded Bottle Badge Reel (Artifact #2)

# data[].attributes.subject
Aesthetic Project- Beaded Bottle Badge Reel (Artifact #2)

# data[].attributes.body
For the aesthetic project required in this class earlier in the semester, I chose to create a beaded baby bottle that I then attached to a badge reel so I can keep this piece with me throughout my placements. As a Native woman, beading has been a huge piece of my personal cultural reclamation journey and has allowed me to grow a deeper connection with my culture and my community. However, while acknowledging the western lens in my daily life through education and healthcare, I chose to bead a bottle as that was a western addition to feeding practices. Thus this badge reel highlights the importance of recognizing the benefits and value all cultures and beliefs bring to our society.

# data[].attributes.headline
Research Article #1 (Jackson et al., 2024)

# data[].attributes.subject
Research Article #1 (Jackson et al., 2024)

# data[].attributes.attachment_link.title
Accessing Trauma- and Violence-Informed Breastfeeding Support from Primary Care Providers among Women with Histories of Intimate Partner Violence: An Exploratory Interpretive Description Study - PubMed

# data[].attributes.attachment_link.description
TVIC may aid in the development of trusting therapeutic relationships, in turn improving access to breastfeeding support, breastfeeding self-efficacy, and breastfeeding success for women who experience violence. Further research on the implementation and evaluation of TVIC for perinatal breastfeedin …

# data[].attributes.headline
Research Article #2 (Monteith et al., 2024)

# data[].attributes.subject
Research Article #2 (Monteith et al., 2024)

# data[].attributes.attachment_link.readable_text
Systematic Review

Open access

Published:

Show authors

BMC Public Health 24, Article number: 1583 (2024) Cite this article

1968 Accesses

4 Citations

1 Altmetric

Metrics

Abstract

Background

Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date. Therefore, the objective of this scoping review was to identify and summarize the qualitative literature regarding Indigenous infant feeding experiences within Canada, the United States, Australia, and Aotearoa.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews and the Joanna Briggs Institute Guidelines, in October 2020, Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for relevant papers focusing on Indigenous infant feeding experiences. Screening and full-text review was completed by two independent reviewers. A grey literature search was also conducted using country-specific Google searches and targeted website searching. The protocol is registered with the Open Science Framework and published in BMJ Open.

Results

Forty-six papers from the five databases and grey literature searches were included in the final review and extraction. There were 18 papers from Canada, 11 papers in the US, 9 studies in Australia and 8 studies conducted in Aotearoa. We identified the following themes describing infant feeding experiences through qualitative analysis: colonization, culture and traditionality, social perceptions, family, professional influences, environment, cultural safety, survivance, establishing breastfeeding, autonomy, infant feeding knowledge, and milk substitutes, with family and culture having the most influence on infant feeding experiences based on frequency of themes.

Conclusions

This review highlights key influencers of Indigenous caregivers' infant feeding experiences, which are often situated within complex social and environmental contexts with the role of family and culture as essential in supporting caregivers. There is a need for long-term follow-up studies that partner with communities to support sustainable policy and program changes that support infant and maternal health.

Peer Review reports

Introduction

Nutritional status is a key aspect of infant health with recommendations for exclusive breastfeeding for the first six months of life, which can also influence and be influenced by maternal health and wellbeing [ 1, 2]. Breastfeeding has several benefits for the health and development of infants, including a reduced risk of ear and respiratory infections, obesity, asthma, skin conditions, childhood leukemia, and gastroenteritis [ 3, 4, 5]. It also supports bonding between the child and parent with improved intimacy [ 3]. Additionally, breastfeeding has several maternal physical and mental health benefits, including a reduced risk of breast and ovarian cancer, depression, and type 2 diabetes due to immunoprotective antibodies in breastmilk [ 3]. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life and initiation within the first hour after birth; however, less than half of infants 0-6 months old are exclusively breastfed worldwide [ 6]. Many countries are not meeting the WHO recommendations, with notable differences between low, middle, and high-income countries [ 2]. Differences in breastfeeding initiation rates and duration have been observed between Indigenous and non-Indigenous groups, with 6-10% lower breastfeeding initiation rates and shorter duration for Indigenous peoples [ 7, 8, 9].

Despite the many benefits of breastfeeding, bottle feeding with milk substitutes is a common form of infant nutrition and its common usage is related to a multi-dimensional set of factors influencing infant feeding decision-making. Breastfeeding is considered a traditional practice within many Indigenous cultures; however, disruptions to traditional lifeways through colonization have influenced intergenerational knowledge sharing, particularly within high-income, settler states like Canada, the US, Australia, and Aotearoa (New Zealand) [ 10]. Rollins et al. [ 1] summarize factors that influence the global breastfeeding environment including the sociocultural and market contexts, the healthcare system and services, family and community settings, employment, and individual determinants like the mother and infant attributes. However, these core breastfeeding environments for general populations overlook key considerations for Indigenous communities given the unique historical, cultural, and socio-economic contexts specific to Indigenous groups [ 11].

Methods

Protocol and registration

This scoping review adheres to guidelines from Tricco and colleagues' [ 19] Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA) extension for scoping reviews, the Joanna Briggs Institute's Reviewer's Manual Chap. 11 [ 20], as well as Arksey & O'Malley's [ 21] foundational article on scoping studies. The protocol for the review is registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/J8ZW2) and published with BMJ Open [ 22].

Eligibility criteria

Works included in this review must have focused on Indigenous populations in Canada, the United States, Australia, and/or Aotearoa. These four countries share commonalities in that they are colonial countries in which Indigenous peoples face inequitable health outcomes [ 10, 18, 23]. The topic of interest for this review was caregivers' experiences of infant feeding within one or more of these regions. "Caregivers" refer to individuals in the infants' immediate familial and social circles who are directly responsible for the regular care of the infant. A broad definition of those involved in caregiving was used, recognizing that within many Indigenous communities, traditional adoption practices occur, or biological parents may not be the primary caregivers in part related to complex socio-ecological challenges. The experiences of healthcare professionals were not included as they were not considered "caregivers" by this definition. Works that discussed breastfeeding, as well as alternative forms of infant feeding, such as formula and cow's milk, were included. Works that only focused on the introduction of solid foods were excluded. To capture caregivers' experiences of infant feeding, qualitative and mixed-method studies that discussed experiences, perspectives, and/or practices as described by caregivers were included. Studies that used exclusively quantitative methods or that only described an outsider perspective (e.g. health professional) were excluded. Peer-reviewed journal articles and grey literature were included if they met the above criteria, were published in the English language, and were published after 1969 [ 22].

Various types of grey literature such as government documents, dissertations, and research reports by academic and non-academic institutions, including Indigenous organizations, were included. Media reports (including videos, news, and blogs) were excluded from the grey literature as they did not follow a research design with results that could be considered alongside the studies included in the review, hindering our ability to compare and critically analyze the results. Similarly, publications that consisted of only an abstract were excluded from both grey and database publications during full-text review as not enough information was present for analysis.

Information sources

The search strategy was created with guidance from a research librarian at the Gerstein Science Information Centre, University of Toronto. The complete search strategy can be found as supplementary material in our published protocol [ 22]. Search terms primarily included broad terminology for Indigenous peoples (e.g. Native American) rather than specific Nation names (e.g. Ojibwe) as this would have significantly extended the search term list while not resulting in additional sources given how sources are indexed within Library systems. A database and grey literature search were conducted for this scoping review, completed independently from one another until final data extraction when the data were combined for analysis. For both searches, the reviewers followed a step-by-step process of title and abstract screening, followed by full-text screening, and then data extraction.

The database search planning and calibration occurred in August and September of 2020, and all data were exported in English on October 20, 21, and 22 of 2020. Exportation occurred over three days given feasibility of exporting the high number of citations and time capacity of the reviewers. A total of 16734 relevant sources available in the following databases were included: Medline, Embase, CINAHL, PsycINFO, and Scopus. These databases were selected to ensure a broad range of research given the multidisciplinary nature of research on this topic. The grey literature search consisted of a targeted search of a variety of Indigenous focused websites specific to the four countries and a thorough Google search with each of the country-specific Google versions (Google.com.au, Google.co.nz, Google.ca, and Google.com) where the first 10 pages of results were reviewed (Supplementary File 1). Lastly, Indigenous Studies Portal (I-Portal) was searched as part of the grey literature as this database uses a different indexing system than other research databases. The Canadian Agency for Drugs and Technologies in Health (CADTH)'s "Grey Matters" checklist [ 24] was used in the planning and tracking of grey literature searches and findings.

The results of the database search including 16734 citations were uploaded to Covidence (Veritas Health Innovation Ltd., Melbourne, Australia), a data management platform for systematic and scoping reviews, where 3928 duplicates were automatically removed. The 284 results of the grey literature search were recorded on Google Sheets (Alphabet Inc. California, USA) and 146 duplicates were manually removed by the reviewers. Due to the large number of results retrieved in the database and grey literature search, a hand-search of reference lists was not conducted.

A list of key words developed by HM were searched on each site and can be found in Supplementary File 1. The grey literature search was completed by HM, CC, and HS with all reviewers assigned to search a Country-specific Google database for one of the included countries. Using a template created by Stapleton [ 25] at the University of Waterloo based on methods described by Godin et al. [ 26], the reviewers kept track of which search terms were searched on the websites, the number of results retrieved, and the number of items screened and saved for further full-text analysis. If a website did not have a search bar, relevant tabs were examined for research, resources, and other publications. I-Portal was originally searched on August 15th, 2021 (yielding 10 results), however the search was revised to remove Indigenous search terms as the database was already Indigenous-specific. The search was repeated on August 18th, 2021, and yielded 77 additional results. The grey literature search was completed between May 25, 2021 - August 18, 2021. No search limitations or filters were used for the grey literature search or the database search.

The database abstract screening was initially completed by HM and CC starting in October 2020. They were then joined by HS and CL in February 2021. To ensure all reviewers had a shared understanding of the eligibility criteria, two search results were screened together and each reviewer discussed their reasoning for inclusion or exclusion. HM also hosted an introductory meeting to review the screening process using Covidence Software [ 27] in detail. All 12806 database results were saved in Covidence [ 27].

Abstract and full-text screening was completed in Covidence by two independent reviewers. Any conflicts at the screening stage were resolved by AH after all the results had been screened by two reviewers. Full-text screening was completed by HM, AH, and CC, and when conflicts arose, the reviewers met to discuss the difference in opinion until a consensus was reached. A third reviewer joined to offer impartial opinions for full-text conflicts.

Grey literature results were not imported to Covidence. Instead, the team used Google Sheets to organize the publications. Similar to the database review process, each study was screened by two independent reviewers and conflicts were resolved by a third party and discussed for consensus. Full-text review of the grey literature was completed by HM, AH, CC, and HS.

Data extraction and analysis

HM compiled a list of variables to extract (Supplementary File 2), and the data extraction was completed by HM, AH, and CC in Covidence for database results and Google Sheets for the grey literature. The extraction template was reviewed and tested by all three reviewers using the same two articles. Discussion about any areas of confusion followed by minor edits to the data extraction template were completed prior to extraction.

Only one reviewer extracted data from most publications, however in circumstances where an article was complex or data extraction was not clear given the format of the article, two reviewers extracted data from the publication. An additional subset of five publications were also randomly double-reviewed by HM to ensure consistency in data extraction. There were an additional two articles that were excluded at this step after review and discussion by AH and HM.

Review findings using the extraction template (supplementary file 2) were exported into Microsoft Excel (Microsoft Corporation, Washington, USA) and reviewed by HM. HM compiled all data and completed summary figures for variables of interest. The primary analysis consisted of a qualitative review of the included papers' results and recommendations using a thematic synthesis informed by grounded theory and meta-ethnography, where the included papers are synthesized together, and interpreted using descriptive and analytical themes [ 28]. Similar to grounded theory, this process was inductive and identifies themes through comparisons. HM reviewed all extracted data from the excel files, coding for overlapping themes and taking notes throughout. The full-text of the extracted papers were then revisited to identify overall concepts, followed by descriptive themes. Categorization of descriptive themes was completed based on the results and interpretations of included papers. Descriptive themes were refined through additional comparisons between papers. The same analytical process was used for both database and grey literature results, and final analysis involved the integration of themes from the database and grey literature papers. Supplementary file 3 provides a summary table of the included papers in this scoping review.

Characteristics of included articles

Of the final sample of 46 articles from which data was extracted (Fig. 1), there were studies from each of the four countries, with the most studies (39%) published from Canada. In addition, this qualitative literature on infant feeding included several Indigenous groups within the four countries. The studies retained in this review included authors who identified as either Indigenous or non-Indigenous, and several did not mention positionality (Fig. 2). 13% more grey literature studies discussed positionality and had Indigenous sole authorship compared to the database papers. Regarding methodologies utilized, several described Indigenous methodologies and used thematic analysis as an analytic tool (Figs. 3 and 4). However, a third of the studies did not describe their theoretical foundations for the qualitative inquiry. Over 60% of the studies were published in the fields of public health and/or nursing as per the authors stated fields of study and/or the Journal's field, and although there were studies published from 1984 to 2019, 50% of the retained papers were published after 2010.

PRISMA flow diagram for studies identified, screened, and included in this review from both database and grey literature searches. Note that records not retrived are those in which the full-text was not accessible. This diagram was created from the PRISMA 2020 statement [ 29]

Results

Analysis revealed a variety of important themes that aligned with Indigenous and public health perspectives on health, including the socioecological model. There were twelve final overarching themes including colonization, social perceptions, family, professional influences, culture and traditionality, environment (i.e. built environment), autonomy, survivance, infant feeding knowledge, cultural safety, milk substitutes, and establishing breastfeeding with evidence of connections among these themes. These themes are shown in Fig. 5 in a circular pattern where the themes intersect with the infant and caregiver represented at the centre. This model is conceptually aligned with that of Dodgson et al. [ 30], who considered the "contextual influences within the social structures of family and community, Ojibwe culture, and mainstream culture."

Scoping review research model of themes

The twelve final themes are shown as the main influences on infant feeding experiences. The themes are arranged in a circular pattern with the infant and caregiver represented at the centre, emphasizing the connection between all of the themes

Theme one: colonization

There were 14 papers that discussed colonization of Indigenous peoples as a key factor influencing infant feeding decisions and experiences (Fig. 6) [ 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43]. Colonization has meant the dispossession of land and limited access to culturally safe healthcare, malnutrition, and loss of language through residential schools, loss of culture and traditional knowledge through assimilation and separation of families, disrupting breastfeeding practices and limiting income for infant formula. Eni et al. [ 36] described the policies leading to evacuation from communities to tertiary-care hospitals for birthing as the medicalization of birthing practices, which creates various challenges for First Nations women in Canada. One participant also shared about the impacts of intergenerational trauma related to colonization on breastfeeding, ''You can't teach about breastfeeding technique and think things will change. It's the spirit that's been affected, our experience with trauma. Our women need to relearn how to bond with their children.''.

A qualitative study with Aboriginal Australian first-time mothers noted the disruptions to breastfeeding practices over time, providing a historical chart detailing how infant feeding practices changed as a result of colonial influences [ 38]. Brittany Luby [ 39] described how hydroelectric flooding from 1900 to 1975 in Northwestern Ontario reduced breastfeeding practices for Anishinabek mothers and their infants. Although not all studies specifically discussed history and colonization, those that considered the broader historical context highlighted how important this issue is in understanding the factors that lead to infant feeding decisions, particularly those that do not align with breastfeeding as a traditional feeding practice.

Theme two: culture and traditionality

Culture, including traditionality, was the second most described theme throughout all papers, identified both directly and indirectly in 31 papers (Fig. 6) [ 30, 31, 32, 34, 35, 37, 38, 39, 40, 41, 42, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63]. The Navajo Infant Feeding Project focused on cultural beliefs influencing infant feeding practices within three Navajo communities in the United States [ 48] and emphasized breastfeeding's significance for nutritional, physical, and psychological health where mothers not only pass along physical health benefits, but also their wellbeing to their children. The Baby Teeth Talk Study in Cree communities in Northern Manitoba, Canada, has identified breastfeeding as a cultural intervention for the prevention of early childhood caries [ 52]. Several studies included a variety of generations in data collection, contributing to rich discussion of how breastfeeding rates and connection to traditionality has changed in some communities [ 48, 57, 64, 65]. For example, grandmothers living on the Fort Peck Reservation in Montana, US, were interviewed about their perspectives on infant feeding [ 65]. In one of the ethnographic studies, there was a specific focus on the Ojibwe culture relating to infant feeding practices from the perspective of mothers, professionals who were also community members, and Elders [ 35]. This study emphasized the holistic and collective worldview of the community, influencing women's roles within the family and how teachings were passed on from generation to generation [ 35]. This was considered to be important in influencing effective and culturally safe breastfeeding promotion. Within the Northwest Territories, Canada, Moffitt and Dickinson [ 53] supported breastfeeding knowledge translation tools for Tłı̨chǫ women with one of the themes focused on factors that "pull to breastfeeding," including breastfeeding as a traditional feeding method. In general, Indigenous communities described breastfeeding as a cultural practice; however, how this is supported and the traditional knowledge surrounding this practice may differ from community to community. Therefore, health providers must be aware of community-specific protocols and support these within programs and recommendations.

Theme three: social perceptions

Dodgson et al. [ 30] described how in an Ojibwe community in Minnesota, US, participants noted the dominant societal influences in contrast to community traditions, with women making an effort to engage in traditional practices. The sexualization of breasts in mainstream society sometimes influenced Indigenous mothers' infant feeding experiences [ 36], although Ojibwe caregivers in Minnesota attributed shyness with breastfeeding to traditional value opposed to sexualization of breasts [ 30]. Eni et al. [ 36] included sexual objectification of the feminine body as a subtheme in their study, describing how this social perception damages maternal mental health, creating a barrier to breastfeeding. While shifting social norms is a significant challenge, breastfeeding supports can address concerns about the sexual objectification of breasts by creating safe spaces for parents to talk about the challenges and ensure that parents have access to mental health resources.

Theme four: family

Dodgson et al. [ 30] described family as a pattern that influences breastfeeding intersecting with the social structures of the community, culture, and the broader society. There were 33 other papers that described the influence of family on infant feeding practices making this the most discussed theme (Fig. 6) [ 30, 31, 32, 33, 36, 38, 39, 40, 43, 44, 45, 46, 47, 48, 49, 50, 51, 53, 54, 55, 57, 58, 59, 60, 61, 65, 66, 67, 68, 69, 70, 71, 72, 73]. Native American mothers living in six communities highlighted the importance of family as a key theme [ 47]. One mother shared, "For me, it's my mom definitely [whose advice is most important] because she has had three kids and I lived with her or near her for all of my kids. So I've always gone to her first for advice." This was echoed by many other participants with a paraprofessional adding, "family [advice is most important], because they are around their family most. And they always hear from their aunties, or from grandma, baby's fussing, baby must be hungry, baby needs this and baby needs that." The Baby Basket Program in Cape York, Australia identified that empowering families was the foundation of the program to ensure that mothers and their partners were equipped for the arrival of their babies [ 50]. Family often plays an integral role in supporting mothers in infant feeding practices. Bauer and Wright [ 45] note that even when mothers don't have other supports or conditions in place to support breastfeeding, they may still choose to breastfeed if their family is supportive. However, when this support is lacking, mothers find it challenging to breastfeed [ 31, 36]. Some studies identified the significance of family in the study design, integrating family caregiver perspectives in data collection [ 64, 65]. Therefore, health programs and research studies should consider the role and experience of non-primary caregivers within family networks for infant and maternal health and nutrition.

Theme five: professional influences

Theme six: environment

Theme seven: autonomy

This theme describes parents' freedom to make infant feeding decisions that fit for them and their priorities. Maternal desire to breast- or bottle-feed was discussed in select papers in this review [ 45, 51]. In addition, other papers describe parents' freedom to do activities outside of infant feeding in the early months of baby's life with discussion of time required to breastfeed or prepare bottles for feeding [ 31, 58, 72, 74]. A key informant in a study with an Aboriginal community in Northern New South Wales, Australia, shares, "they want to breastfeed, but then it comes down to when they want to go out, or keep up with their man [ 32]." Some parents report that they experienced judgements from others or feel forced into making a specific decision on infant feeding method, highlighting a desire to have support and freedom to make their own decisions [ 36, 56].

Theme eight: infant feeding knowledge

Traditional breastfeeding knowledge is important for many communities; one Anishinaabe community knowledge keeper shared that "breast milk is a gift and a medicine a mother gives her child" [ 35]. This study also discusses feeding patterns as shared by Elders and traditional teachers. Traditional knowledge considers holistic perspectives of health where caregivers are also focused on the baby's spiritual wellbeing [ 48, 56].

Theme nine: milk substitutes

This theme particularly overlaps with autonomy as parents balance infant feeding decisions with breastmilk supply, work, school, and other personal commitments.

Theme ten: cultural safety

Indigenous caregivers interact with a variety of health services postnatally; however, there is a need to address cultural safety within the healthcare system. Twelve retained papers highlighted this theme either directly as one of their themes or as part of another theme (Fig. 6) [ 30, 31, 44, 47, 50, 64, 66, 67, 69, 71, 73, 74]. One health worker in Victoria, Australia, shared,

"I can't say often enough or long enough, loud enough the ideal for children 0-8 is to have access to maternal and child health. You might say 'oh yes, they've got access to mainstream and they're culturally going to put up a few Indigenous prints in their rooms' It's not the same. Our families are telling us with their feet it's not the same."

Mothers expressed a desire for more traditional infant feeding knowledge within services and culturally relevant supports [ 47, 64]. A study that focused on a baby basket program to support families in a Murri (Local Australian Aboriginal Group) Way identified how important culturally safe language and relationships are for families,

Theme eleven: survivance

A grandmother in the Northwest Territories of Canada noted the disembodiment caused by residential schools as expressed as a disconnection between physical experiences and relationships,

Traumatic experiences, like residential schools, can have a lasting impact on how caregivers navigate motherhood and infant feeding, and the support they receive from family members.

Theme twelve: establishing breastfeeding

There are several practical challenges that mothers encounter while breastfeeding like pain, latching issues, and low milk supply, discussed in 11 of the studies (Fig. 6) [ 48, 51, 54, 56, 58, 61, 66, 68, 71, 72]. A mother shared,

Although these challenges are most discussed at the beginning of breastfeeding, sometimes concerns arise when babies are older.

Overall, many caregivers reported that breastfeeding is difficult; therefore, supports that consider the variety of challenges that can arise are needed.

Study recommendations

The studies included in this review were published over three decades starting in 1984 until 2019 and were completed with various Indigenous communities in four countries. We anticipated that earlier work would demonstrate markedly different infant feeding recommendations than more recent research; however, this was not necessarily the case. For example, cultural safety is a more recent discussion within the health literature; however, although we see some discussion of this in more recent studies, studies in the 80's and 90's also highlight the importance of incorporating traditional teaching and consulting community members [ 37, 48]. Therefore, supporting Indigenous self-determination where health professionals provide culturally appropriate care is essential.

In addition to topics related to cultural safety, various studies highlight a need for community-driven and local knowledge to inform programs and policies related to infant nutrition [ 31, 47, 57, 64, 75]. Several studies also focus on infant feeding specific programs and behavioral changes in their recommendations [ 47, 50, 65]; however, many of these studies also highlight the need to expand beyond the individual's role in decision making and address the broader social and environmental factors such as the workplace, healthcare infrastructure, social perceptions, among others, that influence infant feeding decisions. For example, Eni et al. [ 36] note that there are a complexity of factors resulting in various breastfeeding environments. These structural, social and cultural contexts are discussed throughout several of the grey literature texts as well [ 32, 33]. It is also important to note that in the most recently published database paper, maternal mental health is directly addressed in the recommendations and this is the only paper with this focus for next steps [ 65]. Interventions that target socio-ecological factors based on the included papers' recommendations for infant feeding are summarized in Fig. 7.

(Adapted from Rollins et al. 2016)

The components of Indigenous infant feeding environments informed by community-based interventions

Discussion

This scoping review presents and summarizes the findings reporting Indigenous infant feeding experiences within the qualitative literature in Canada, the US, Australia, and Aotearoa. Twelve themes were identified which summarize the literature including culture and traditionality, colonization, family, environment, social perceptions, professional influences, milk substitutes, breastfeeding initiation, cultural safety, survivance, infant feeding knowledge, and autonomy. The most prevalent themes discussed by caregivers and researchers in the included papers were family and culture/traditionality. The frequency of these two themes highlight the significant impact of family and culture/traditionality on infant nutrition decision-making for Indigenous caregivers and overlaps with components of the socio-ecological model [ 77]. This focus on family and culture/traditionality also emphasizes the importance of familial relationships and a collective mentality within traditional life ways for many Indigenous communities in these regions on infant nutrition and care practices.

In their informative global breastfeeding paper, Rollins and colleagues' [ 1] conceptualize the components that contribute to the breastfeeding environment at multiple levels, overlapping with the social determinants of health. In this review, we observed that caregivers report similar components of the breastfeeding environment; however, these components seem to be described collectively, rather than as separate contexts. This is evident in the recommendations proposed by authors with a large focus on local and community-specific leadership, multidisciplinary interventions, and cultural safety in response to historical traumas, particularly within the healthcare system (Fig. 7). This aligns with Indigenous epistemology with an emphasis on the collective and interconnectedness of all things where power is manifested together, not over one another, and is based in local land-based knowledge [ 78, 79].

A primary recommendation echoed within many of these studies was the need for community engagement in program and policy development [ 34, 47, 50, 64]. This may need to be expanded upon to support Indigenous self-determination of policy and programs related to infant feeding where community members are not only engaged but leading the way forward in maternal and infant health. It is important to note that there have been changes over time in how these recommendations and perspectives are discussed and the role of the health professional, particularly related to cultural safety. For example, although similar concepts are discussed in Neander and Morse's paper published in 1989, 'cultural safety' is not used as the terminology, which has been expanded upon in recent years by Indigenous and non-Indigenous scholars [ 37, 80, 81].

Related to this focus on health professionals and cultural safety, it's important to distinguish that in many of the positive experiences expressed by participants in the studies, these interactions seemed to be primarily with professionals interacting closely with families. For example, midwives, who make home visits, were often included as part of positive experiences. In the literature, there is an emphasis on including practitioners who can build strong relationships with families through home visits and regular community engagement in routine services, which supports cultural safety within the healthcare system [ 82, 83]. Health professional regulatory bodies should consider implementing practice competencies that support professionals to build and navigate strong and ethical relationships with clients/patients. Similarly, healthcare settings that serve Indigenous peoples should consider processes and therefore, facility infrastructures that enable close family-client-professional interactions. An example of this implementation with positive client experiences is the Toronto Birthing Centre, which uses an Indigenous framework and has birthing rooms with space for family [ 84].

The studies in this review are written within various fields of research; therefore, there were differences in methodological reporting. Future qualitative work should be thorough in reporting theoretical foundations to provide clarity of how the analyses and overall projects are approached (Fig. 4) [ 85]. Given the limited studies that report author/researcher positionality (Fig. 2), this may be an important addition in forthcoming work as a means of respecting Indigenous and qualitative literature conventions where we recognize that positionality influences ontological origins [ 86]. We challenge the academy to recognize that Indigenous and local knowledges are required within Indigenous health research and dissemination practices, while acknowledging our own limitation in this review of a single country authorship team.

This systematic scoping review utilized a rigorous search strategy that limited the possibility of missing relevant publications; however, it was time intensive. PRISMA-ScR guidelines were followed with two independent reviewers at each stage, enabling reproducibility of this review. The inclusion of the grey literature is a strength in this study as it captured important papers that were not published in peer-reviewed journals, often from Indigenous authors and communities (many of which were graduate dissertations), which was a priority in this review. A possible limitation is the exclusion of work that only discussed the introduction to solid foods; it is possible that this excluded an important conversation about the differences of introducing solids, like traditional foods from an Indigenous group's perspective. In addition, the topic of this review is multidisciplinary; therefore, it is possible that although effort was made to include a broad range of research field databases in the search, relevant sources may have been missed.

In conclusion, this scoping review highlights important considerations for infant feeding environments within Indigenous communities with a focus on family and culture. Based on caregiver experiences, Indigenous breastfeeding supports must be community led with a focus on local capacity and traditional teachings. An emphasis on an intergenerational perspective that considers structural and systems approaches including cultural safety within healthcare, addressing maternal mental health, and consideration of sustainability over time is encouraged. Future work should focus on these key areas through strength-based research approaches, grounded in strong relationships and long-term follow-up.

Data availability

All data generated or analysed during this study are available from the corresponding author on reasonable request.

References

Download references

Acknowledgements

We wish to acknowledge the important contribution of Halima Abubakar in the review process. Given the knowledge specific to Indigenous communities discussed in this scoping review and out of respect for Indigenous research conventions, the authors position themselves within the research to explain the lens from which they approach and understand the research process. TG and AH are non-Indigenous scholars and faculty members based at the University of Toronto, which rests on lands that are the traditional home of the Huron-Wendat, the Seneca, and the Mississaugas of the Credit. All other authors have had student or supporting roles throughout this work and situate themselves as follows: HM is a settler of Scottish, Irish, French, German, and English ancestry residing in Haudenosaunee and Anishinaabe territory, which is part of the dish with one spoon agreement; CC is a settler living in Treaty 7 Territory, with ancestral roots in Germany, Scotland, and the Ukraine; AS is an Odawa Kwe from Wikwemikong, Manitoulin Island, Ontario. Currently, residing in the Tiohtià:ke in Kanien'kéha unceded territory; and HS is living in Treaty 13 territory with ancestral roots in Afghanistan. The remaining co-authors identify as non-Indigenous scholars.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

1. Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, University of Toronto Medical, King's College Circle, Sciences Building, 5th Floor, Room 5253A, Toronto, ON, M5S 1A8, Canada

Hiliary Monteith, Hosna Sahak, Christina Liu & Anthony J. G. Hanley

2. Department of Anthropology, University of Toronto Mississauga Campus, Terrence Donnelly Health Sciences Complex, Room 354, 3359 Mississauga Rd, Mississauga, ON, L5L 1C6, Canada

Carly Checholik & Tracey Galloway

3. Department of Family Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada

Amy Shawanda

4. Epidemiology Division, University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada

Anthony J. G. Hanley

5. Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada

Anthony J. G. Hanley

Contributions

As the first author, HM conceptualized this work and provided leadership throughout. She participated in every aspect of this review, wrote the initial manuscript, and completed revisions. CC contributed to the screening and full text review of this work. She also contributed to the analysis, and the writing and review of the manuscript. TG supported the protocol of this review and provided guidance throughout analysis. She also contributed to the final manuscript. HS supported screening and full text review. She also provided edits for the manuscript. AS provided feedback on the analysis for this review and contributed to the writing of the manuscript. CL supported screening of papers and provided edits to the final manuscript. AH provided guidance throughout the duration of this review, supported decision making, and provided edits on the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Anthony J. G. Hanley.

Ethics declarations

Ethics approval and consent to participate

As this review involves material previously published or in the public domain, ethical approval is not required.

Consent for publication

Not applicable.

Competing interests

Authors have no competing interests to report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Reprints and permissions

About this article

Cite this article

Monteith, H., Checholik, C., Galloway, T. et al. Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: a scoping review of the qualitative literature. BMC Public Health 24, 1583 (2024). https://doi.org/10.1186/s12889-024-19060-1
Download citation
Keywords

# data[].attributes.attachment_link.title
Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: a scoping review of the qualitative literature - BMC Public Health

# data[].attributes.attachment_link.description
Background Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date.

# data[].attributes.headline
Image of Student at Ontario Shores (Artifact #2)

# data[].attributes.subject
Image of Student at Ontario Shores (Artifact #2)

# data[].attributes.body
Above is a photo of me at Ontario Shores, during my mental health clinical placement. This photo is a significant artifact reflecting my journey learning about the longterm mental health impacts of ACEs, while also being able to observe resilience in the patient population, despite the challenging adversities they have experienced.

# data[].attributes.headline
Research Article #1 (Alford et al., 2024)

# data[].attributes.subject
Research Article #1 (Alford et al., 2024)

# data[].attributes.attachment_link.title
The relationship between adverse childhood experiences and developmental disorders: implications for family support and child advocacy

# data[].attributes.attachment_link.description
The association between developmental disorders, specifically ADHD and Autism Spectrum Disorder, and adverse childhood experiences (ACEs) is examined in this study. The National Survey of Children’…

# data[].attributes.attachment_link.title
Associations between parenting burnout and maternal adverse childhood experiences among postnatal women

# data[].attributes.attachment_link.description
This study aims at exploring the relationships between adverse childhood experience (ACEs) and parental burnout. A total of 583 postnatal Chinese mothers were recruited in this cross-sectional stud…

# data[].attributes.headline
Adverse Childhood Experiences (ACEs) References

# data[].attributes.subject
Adverse Childhood Experiences (ACEs) References

# data[].attributes.body
Artifacts:

Ballerini, K. (2015). Secondhand Smoke [Song]. On The First Time. Black River Entertainment.

Research Articles:

Alford, A. Y., Riggins, A. D., Cowan, L. T., Chopak-Foss, J., Mitchell, C. E., Nwoanumah, E. C., Oloyede, T. F., Sejoro, S. T., Azu, E. U., Kutten W. S., & Adom, D. A. (2024). The relationship between adverse childhood experiences and developmental disorders: implications for family support and child advocacy. Children’s Health Care, 53(4), 475-487. https://doi.org/10.1080/02739615.2024.2307021

Xu, Z., Mao, F., Huang, Y., Xiao, Y., & Cao, F. (2024). Associations between parenting burnout and maternal adverse childhood experiences among postnatal women.Psychology, Health & Medicine, 29(5), 988-997.https://doi.org/10.1080/13548506.2023.2248565

# data[].attributes.headline
Neonatal Abstinence Syndrome (NAS)/ Neonatal Opioid Withdrawal Syndrome (NOWS) References

# data[].attributes.subject
Neonatal Abstinence Syndrome (NAS)/ Neonatal Opioid Withdrawal Syndrome (NOWS) References

# data[].attributes.body
Artifacts:

Miller, A. (2018). [Image] Neonatal Abstinence Syndrome: Transforming Care for Newborns and Their Families. Pediatrics Nationwide. https://pediatricsnationwide.org/2018/10/22/neonatal-abstinence-syndrome-transforming-care-for-newborns-and-their-families/

PBS NewsHour. (2016). When babies are born withdrawing from opioids. [Video]. https://youtu.be/kYD73NGxpdw?si=nRVYzSpQrC6NxUX1

Research Articles:

​Ogundiran, T. J., & Gigli, K. H. (2025). Neighborhood-level social determinants of health and hospital utilization in infants with neonatal opioid withdrawal syndrome. Journal of Neonatal Nursing, 31(2), 101592. https://doi.org/10.1016/j.jnn.2024.11.007

Velez, M. L., Jordan, C., & Jansson, L. M. (2021). Reconceptualizing non-pharmacologic approaches to Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS): A theoretical and evidence-based approach. Part II: The clinical application of nonpharmacologic care for NAS/NOWS. Neurotoxicology and Teratology, 88, 107032. https://doi.org/10.1016/j.ntt.2021.107032

# data[].attributes.body
Artifacts:

Maarschalk, C [Painting]. CBC News. (2017, May 18). Breastfeeding art expo in Kelowna aims to normalize public nursing. CBC News. https://www.cbc.ca/news/canada/british-columbia/breastfeeding-art-expo-kelowna-1.4144293

Research Articles:

Jackson, K. T., Larose, S., & Mantler, T. (2024). Accessing trauma- and violence-informed breastfeeding support from primary care providers among women with histories of intimate partner violence: An exploratory interpretive description study. Canadian Journal of Nursing Research, 56(4), 284–293. https://doi.org/10.1177/08445621241280409

Monteith, H., Checholik, C., Galloway, T., Sahak, H., Shawanda, A., Liu, C., & Hanley, A. J. G. (2024). Infant feeding experiences among Indigenous communities in Canada, the United States, Australia, and Aotearoa: A scoping review of the qualitative literature. BMC Public Health, 24(1), 1583. https://doi.org/10.1186/s12889-024-19060-1​

# data[].attributes.body
Artifacts:

Bowen, W. (2008). Turn on the Lights [Song]. https://youtu.be/l107N-t-Otg?si=35udM7XNHCG-PERG

Davis, K. (2015). Dear PPD and Gang. [Poem]. https://postpartumprogress.com/dear-ppd-gang-poem-surviving-postpartum-depression

Roll, J. (2024). I Am Not Okay [Song]. On Beautifully Broken. Bailee & Buddy; This Is Hit; Republic. https://youtu.be/Qop5XLgwkNc?si=aXSHboajnKrX7H5e

Research Articles:

​Deng, J., Chen, J., Tan, Y., Guo, X., & Liu, F. (2025). Exploring the role of different coping styles in mediating the relationship between dyadic adjustment status and postpartum depression among postnatal women: A single-centre, cross-sectional study. BMJ Open, 15(1), e088699. https://doi.org/10.1136/bmjopen-2024-088699

​Leason, J. (2021). Indigenous women's stress and postpartum depression: Discussions from the Canadian Maternity Experiences Survey and Indigenous maternity narratives. International Journal of Indigenous Health, 16(2), 225–243. https://doi.org/10.32799/ijih.v16i2.33180

# data[].attributes.headline
Trauma Informed Approach to Care References

# data[].attributes.subject
Trauma Informed Approach to Care References

# data[].attributes.body
Artifacts:

Campaign for Trauma-Informed Policy and Practice. (n.d.). Trauma-informed quotes. CTIPP. https://www.ctipp.org/post/trauma-informed-quotes

​Horsch, A., Garthus-Niegel, S., Ayers, S., Chandra, P., Hartmann, K., Vaisbuch, E., & Lalor, J. (2024). Childbirth-related posttraumatic stress disorder: Definition, risk factors, pathophysiology, diagnosis, prevention, and treatment. American Journal of Obstetrics and Gynecology, 230(3), S1116–S1127. https://doi.org/10.1016/j.ajog.2023.09.089

Research Articles:

​Goddard, A. (2021). Adverse childhood experiences and trauma-informed care. Journal of Pediatric Health Care, 35(2), 145–155. https://doi.org/10.1016/j.pedhc.2020.09.001​

Williams, A., Parlier-Ahmad, A. B., Thompson, E., Wallace, R., Perrin, P. B., Ward, A., & Hendricks-Muñoz, K. D. (2023). Peripartum traumas and mental health outcomes in a low-income sample of NICU mothers: A call for family-centered, trauma-informed care. Children, 10(9), 1477. https://doi.org/10.3390/children10091477

# data[].attributes.attachment_link.readable_text
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Abstract

Adverse childhood experiences (ACEs) refer to the abuse, neglect, and traumatic experiences in childhood that directly affect long-term adolescent and adult health. Understanding the ACE Pyramid and the physiological stress response has guided research toward a better understanding of the long-term mental and physical health consequences from psychological impacts early in life. Trauma-informed care becomes critical for pediatric clinicians to operationalize in practice. The four R's approach-realize, recognize, respond, and resist re-traumatization-can be used by pediatric providers as guidance. The trauma-informed care approach includes the realization of how ACEs affect health, the recognition of pediatric clinical symptom presentation and screening protocols for ACEs, and the health care provider's ability to respond and not re-traumatize patients when delivering evidence-based care. As recent events have triggered worldwide mental and emotional trauma in youth, clinicians must start operationalizing trauma-informed care into practice, as future presentations of trauma are expected.

Keywords: Adverse Childhood Experiences Study; Adverse childhood experiences; toxic stress; trauma-informed approach; trauma-informed care.

PubMed Disclaimer

Similar articles

Continuing conversations about adverse childhood experiences (ACEs) screening: A public health perspective.

Dube SR. Dube SR. Child Abuse Negl. 2018 Nov;85:180-184. doi: 10.1016/j.chiabu.2018.03.007. Epub 2018 Mar 17. Child Abuse Negl. 2018. PMID: 29555095

Trauma-Informed Care in Pediatrics: A Developmental Perspective in Twelve Cases with Narratives.

Strait J, Meagher S. Strait J, et al. Perm J. 2020;24:19.045. doi: 10.7812/TPP/19.045. Epub 2019 Dec 6. Perm J. 2020. PMID: 31852045 Free PMC article. Review.

Cited by

A Systematic Review of Qualitative Studies Exploring Lived Experiences, Perceived Impact, and Coping Strategies of Children and Young People Whose Parents Use Substances.

Muir C, Adams EA, Evans V, Geijer-Simpson E, Kaner E, Phillips SM, Salonen D, Smart D, Winstone L, McGovern R. Muir C, et al. Trauma Violence Abuse. 2023 Dec;24(5):3629-3646. doi: 10.1177/15248380221134297. Epub 2022 Nov 17. Trauma Violence Abuse. 2023. PMID: 36384375 Free PMC article. Review.

Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC).

Price MD, McDermott KM, An D, Aslam U, Slidell MB, Nasr IW. Price MD, et al. J Pediatr Surg. 2024 Sep;59(9):1865-1874. doi: 10.1016/j.jpedsurg.2024.04.002. Epub 2024 Apr 9. J Pediatr Surg. 2024. PMID: 38705831

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Adverse Childhood Experiences and Trauma-Informed Care - PubMed

# data[].attributes.attachment_link.description
Adverse childhood experiences (ACEs) refer to the abuse, neglect, and traumatic experiences in childhood that directly affect long-term adolescent and adult health. Understanding the ACE Pyramid and the physiological stress response has guided research toward a better understanding of the long-term ...

# data[].attributes.headline
Trauma Informed Approach To Care Podcast

# data[].attributes.subject
Trauma Informed Approach To Care Podcast