10  •  2023  •  Developmental Observer

A B S T R A C T  —  N I D C A P  T R A I N E R S  M E E T I N G  2 0 2 3

Background
Although exclusive breastfeeding is recommended for the first 
six months of life, breastfeeding rates in most developed coun-
tries are low. Sensory over-responsivity (SOR) is a neuro-de-
velopmental condition characterized by exaggerated behavioral 
responses to sensory stimuli not typically perceived as irritating, 
aversive, unpleasant, or painful. SOR was found to severely inter-
fere with everyday activities and quality of life, including having 
an impact on attachment patterns and maternal competencies. 
SOR and its link to breastfeeding-related pain have not yet been 
examined as potential barriers to exclusive breastfeeding.

Aims
To explore whether mother breastfeeding-related pain, sensory 
over-responsivity and daily pain sensitivity are associated with 
non-exclusive breastfeeding six months after birth.

Methods
Mothers of full-term infants were recruited two days after birth 
in a maternity ward. For the assessment of breastfeeding-re-
lated pain, mothers completed the Visual Analogue Scale and 
the Short Form-McGill Pain Questionnaire at enrollment (T1), 
and at 6 weeks after birth (T2). At 6 months (T3), mothers 
completed the Pain Sensitivity Questionnaire and the Sensory 
Responsiveness Questionnaire (SRQ) assessing SOR, provided 
information about their breastfeeding status, and were then 
divided into two groups accordingly: Exclusive breastfeeding 
(EBF) and Non-exclusive breastfeeding (NEBF).

Results
A total of 164 mothers reached the third time point: EBF 
(n=105), NEBF (partial breastfeeding or formula feeding only) 
(n=59). The incidence of SOR was significantly higher among 
NEBF mothers compared to EBF mothers (25.4% vs. 11.4%, 
respectively, p=.02). Moreover, between T1 and T2, 72.3% of 
the EBF mothers had reported at least 30% pain reduction, 
compared to 44.8% of the NEBF mothers (p=.001). Results also 
revealed positive correlations between breastfeeding-related 

pain and the SRQ-aversive score both at T1 (.268<r<.378; 
.003<p<.028) and T2 (.296<r<.380; .003<p<.024).  
Logistic regression modeling revealed that both breastfeeding-
related pain reduction between T1 and T2 and SOR were 
found to predict NEBF at 6 months (p<.001), indicating a 
3.2-times (p=.001) and 2.5-times (p=.041) odds ratio for NEBF 
respectively.

Conclusion
SOR and sustained breastfeeding-related pain predict NEBF  6 
months after birth and may emerge as meaningful breastfeed-
ing barriers. Our findings highlight the importance of early 
identification of women with sensory responsiveness chal-
lenges for achieving higher exclusive breastfeeding rates. Early 
interventions, including modulation of unpleasant and over-
whelming sensory stimulation in the NICU, as well as individ-
ualized breastfeeding support tailored to the mother's unique 
sensory profile, are encouraged.

Relevance to NIDCAP
Breastfeeding rates of premature infants are lower than the 
WHO recommendations despite its proven benefits, specifical-
ly for this sensitive population. Promoting breastfeeding in the 
NICU is a significant challenge that involves both medical and 
emotional aspects of the infant, the mother, and their devel-
oping relationship. The NIDCAP approach to care emphasizes 
the provision of an optimal sensory environment for the de-
veloping infant, as well as the support for early mother-infant 
interactions. Increased attentiveness to the mother's sensory 
experience may be especially important in the context of 
breastfeeding in the NICU, where mothers might be exposed to 
unfamiliar, distressing and overloading environmental stimuli. 
Adaptive responses to the mother's sensory needs and envi-
ronmental adaptation may impact breastfeeding success and 
as a result increase breastfeeding rates in the NICU and after 
discharge.

Breastfeeding-Related Pain, Sensory Over-
Responsivity (SOR), And Exclusive Breastfeeding 
6 Months After Birth: A Cohort Prospective Study

DOI: 10.14434/do.v16i1.35772Freund-Azaria A1,2, Bart O1, Regev R3 and Bar-Shalita T1

1Occupational Therapy Department, School of Health Professions, Faculty of Medicine Tel-Aviv University, 
Ramat Aviv, Tel Aviv, Israel. 2Department of Neonatology, Meir Medical Center, Kfar-Saba, Israel.  
3Clalit health organization and neonatal follow-up clinic, Meir Medical Center, Kfar-Saba, Israel.