Hrev_master Healthcare in Low-resource Settings 2025; volume 13:12748 Mothers’ breastfeeding techniques and its correlation to their infants’ nutritional status: a study in a rural area Nopi Nur Khasanah,1 Andini Eka Sari,1 Iskim Luthfa,1,2 Kurnia Wijayanti1 1Faculty of Nursing, Universitas Islam Sultan Agung, Semarang; 2Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia Abstract Proper breastfeeding techniques are important to maintain ade- quate breast milk supply. The study aimed to determine the brea- stfeeding techniques of mothers in rural areas and discover the cor- relation with the nutritional status of their infants. This research involved 107 mothers with infants aged 0-6 months and data was collected using observation sheets. The Spearman-Rho test was used to analyze the relationship between the breastfeeding techni- que and the nutritional status of the infants. Most respondents were mothers aged 26 to 35 with high school-level education and daily lives as housewives. Most of the infants were 3 months old (27.1%), female (57.9%), and some of them were macrocephaly (31.8%), underweight (26.2%), stunted (16.9%), and wasted (12.3%). Additionally, most mothers had an inappropriate brea- stfeeding technique (60.7%) and statistically, there was no correla- tion with the nutritional status of their infants aged 0-6 months (ρ>0.05). The results of this study require health workers to opti- mize the nutritional needs of infants in rural areas by providing effective educational strategies on proper breastfeeding techniques, regardless of other factors influencing nutritional status. Introduction Adequate nutrition for infants aged 0-6 months is important for their growth, development, and health maintenance.1 Lack of nutrition can lead to different forms of undernutrition, such as wasted (underweight for body length), stunted (low body length for age), and underweight (underweight for age).2 Breastfeeding plays a supportive role in providing nutrition for infants aged 0-6 months.3 Furthermore, proper breastfeeding techniques are related to nutritional balance because proper techniques can maximize breastmilk supply to babies.4 World Health Organization (WHO) recommends exclusive breastfeeding from 0-6 months and complementary foods in paral- lel with breastmilk for up to 2 years.5 The United Nations Children’s Fund (UNICEF) also noted that exclusive breastfee- ding of infants under 6 months has reached 48% worldwide, almost reaching the World Health Assembly 2025 target of 50%.6 This trend has also been observed in Indonesia, which shows a positive trend in the annual percentage of exclusive breastfeeding of infants under six months of age. According to the Directorate of People’s Welfare Statistics of Indonesia,7 the number of infants under six months who breastfed exclusively has reached 73.97%, where the highest percentage is in the province of Central Java (80.2%). This study focuses on breastfeeding techniques because although the percentage of breastfeeding is high in Indonesia, there are still many stunting and wasting incidents. Improper brea- stfeeding techniques contribute to poor breastmilk transfer from mothers to their infants, which leads to infants’ nutritional defi- ciencies.8 Globally, stunting and wasting have affected and threa- tened an estimated 22.3% and 6.8% of children under five years in 2022, respectively.9 In 2022, the prevalence of stunting was appro- ximately 21.6% in Indonesia and 20.8% in Central Java Province. Meanwhile, the prevalence of wasting in 2022 was 7.7% in Indonesia and 7.9% in the Central Java province. Although there has been a decrease in stunting rates since 2021, there has also been an increase in wasting rates. Therefore, the problem of mal- nutrition persists worldwide and locally. We conducted a preliminary study in May 2023 in several Correspondence: Nopi Nur Khasanah, Faculty of Nursing, Universitas Islam Sultan Agung, Semarang, Indonesia. Tel.: +6285640256378. E-mail: nopi.khasanah@unissula.ac.id Key words: breastfeeding, infant, mothers, nutritional status. Contributions: all the authors made a substantive intellectual contribu- tion. All the authors have read and approved the final version of the man- uscript and agreed to be held accountable for all aspects of the work. Conflict of interest: the authors declare no potential conflict of interest. Funding: the Research and Community Service Institutions of Sultan Agung Islamic University with the contract number 40a/B.1/SA- LPPM/VII/2024. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Ethics approval and consent to participate: the health research ethics committee at the Nursing Faculty of Sultan Agung Islamic University approved this study with the number 928/A.1-S1/FIK-SA/V/2023. Informed consent: all respondents signed the informed consent form after the researcher explained that their breastfeeding technique would be observed during the data collection. Acknowledgments: the authors would like to acknowledge the parents, especially the babies’ mother for their participation in this study, the sup- port of the integrated service post cadres in community health service (Puskesmas), and Indra Tri Astuti, RN for her thoughtful review of the study result. Received: 25 June 2024. Accepted: 19 August 2024. Early access: 3 October 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2025; 13:12748 doi:10.4081/hls.2024.12748 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [page 14] [Healthcare in Low-resource Settings 2025;13:12748] rural villages. The nutritionist of the community health center (Puskesmas) said that 77.92% of infants received exclusive brea- stfeeding but there was still a risk of stunting (12.8%). We found that the main problems influencing exclusive breastfeeding were pain and soreness during breastfeeding. Some breastfeeding mothers said that they do not understand the proper breastfeeding technique. This issue must be corrected, as the mothers must know the correct technique and position when breastfeeding and can practice it when breastfeeding their infants. Therefore, at the end of the data collection process, the researcher taught the correct breastfeeding technique when mothers directly breastfeed their infants. That was a reward or expression of gratitude because of their willingness for their breastfeeding process to be observed. Most mothers in the preliminary study expressed their hope for one-on-one education to increase their knowledge regarding cor- rect breastfeeding techniques. Increasing maternal knowledge was not the main purpose of this study because our need is accurate data related to the breastfeeding steps that are currently still not right so that the preparation of educational interventions can be more effective and appropriate according to the steps that are not right. The breastfeeding technique is considered correct when there is a good attachment between the mother and infant and they show the correct position.8 Mistakes in breastfeeding techniques can have negative impacts, such as asphyxia (lack of oxygen for the baby),10 nipple sores, breast swelling, and discomfort for the mother during breastfeeding, which can prevent optimal brea- stmilk flow and result in nutritional deficiencies in the baby.11 This research analyzes the relationship between breastfeeding techniques and nutritional status in infants 0-6 months of age. The specific objectives of this study are to identify the breastfeeding techniques employed by mothers and the nutritional status of infants aged 0-6 months. Materials and Methods Ethical considerations The health research ethics committee at the Nursing Faculty of Sultan Agung Islamic University approved this study with the num- ber 928/A.1-S1/FIK-SA/V/2023. All respondents signed the infor- med consent form after the researcher explained that their breastfee- ding technique would be observed during the data collection. Subject Researchers used the entire population of breastfeeding mothers with infants aged 0-6 months in several villages in one district in a health center area. Based on data from the health cen- ter, 180 infants were exclusively breastfed, but the data did not match the reality. The inclusion criteria in this study were all brea- stfeeding mothers with infants aged 0-6 months in the Puskesmas area and mothers who could breastfeed and were willing to be respondents by signing a consent form. The exclusion criteria for this study were sick infants (may cry or be fussy when breastfed), infants using pacifiers, and breastfeeding mothers who were ill and may not be able to breastfeed their infants optimally. This research used purposive sampling, and 107 infants met the inclusion crite- ria. This study was carried out in a Puskesmas in a rural area from March to December 2023. Data collection This research used a cross-sectional quantitative correlation approach to determine the relationship between the variables. The instrument used to collect information regarding correct breastfee- ding techniques was an observational form, and the nutritional sta- tus instrument used was an observation sheet consisting of the baby’s weight, body length, and head circumference. Infant weight measurement used a weight scale that has been calibrated, while a flexible tape measure was used to measure body length and head circumference. Researchers used the same tool for all infants. Data were collected by watching mothers breastfeed their infants and assessing them using a form. Researchers also measu- red the infant’s weight, body length, and head circumference to determine the nutritional status. The data collection was assisted by an observer which has previously been explained about this study so that they have the same perception as the researcher. The observer was a sixth-grade female nursing student who passed an anthropometry skill examination. The implementation stages were as follows: i) the researchers visited the respondents at their homes and provided them with a consent form to become respondents (informed consent), ii) the researchers asked the respondents to conduct their breastfeeding habits regarding position, sucking, and attachment for their infants (one-day observation), iii) the observer looked and checked the respondent’s accuracy when breastfeeding. After that, the researcher assisted by the observer measured the infants’ body weight, body length, and head circumference, then looked at their nutritional status using a growth table. The resear- chers then checked the completeness of the data collected. Finally, the researchers gave rewards to the respondents. Data analysis The univariate analysis in this study described the correct brea- stfeeding steps, breastfeeding position, and breastfeeding atta- chment. Data that describe the correct breastfeeding techniques with nutritional status in categorical form were analyzed using pro- portion analysis and expressed in a frequency distribution table. Bivariate analysis in this study was carried out to determine the correlation between breastfeeding techniques and nutritional status in babies aged 0 to 6 months. The Spearman’s Rho test was used in this research because the type of data was on a nominal-ordinal scale. We used an observational sheet of the breastfeeding techni- que from IDAI (2013) to analyze the techniques and separate them into proper and improper. Researchers observed mothers while breastfeeding their babies and matched them with the observation sheet: if the mother breastfeeds correctly according to the observa- tion sheet, then it is called the correct breastfeeding technique. Conversely, if there is at least one error or discrepancy with the observation sheet, then it is stated that the breastfeeding technique is incorrect. Furthermore, the Regulation of the Minister of Health of the Republic of Indonesia Number 2 of 2020 concerning Child Anthropometry Standards was used to assess the nutritional status of infants. Measurement of nutritional status is based on body weight and length parameters,12 researchers use three indices, including Weight-For-Age (WAZ), Length/Height-For-Age (HAZ), and Weight-For-Length/Height (WHZ). The determination of categories is based on the threshold values in the regulation (Z- score) (Table 1). Results The results of this study show the characteristics of the respon- dents and their infants (Table 2), mothers’ breastfeeding technique (Table 3), and the relationship between mothers’ breastfeeding technique and their infants’ nutritional status aged 0-6 months Article [Healthcare in Low-resource Settings 2025;13:12748] [page 15] (Table 4). The results presented in Table 2 show that most of the respondents were 26-35 years old (59.8%), had senior high school degrees (64.5%), and were housewives (67.3%). Meanwhile, most of the infants were 3 months old (27.1%), female (57.9%), and had a normal head circumference (66.4%). The results also revealed that some of the infants were underweight (23.4%), stunted (14.0%) and wasted (10.3%). Some infants had abnormal head cir- cumference (33.7%) and most of the mothers’ breastfeeding techniques were improper (60.7%). Table 3 below lists the characteristics of mothers during the breastfeeding process. Table 3 reports that most mothers did not wash their hands before starting breastfeeding (52.3%), did not try to release the infant’s suction with their little fingers (44.9%) so that the infants suckled the breast until they released on their own, and did not pro- vide stimulation to the baby before starting breastfeeding (40.2%) because mothers assume that the infants looked thirsty. In addition, some mothers did not ensure that the infant’s lower lip was curled out (3.7%), the infant’s mouth was wide open (0.9%), and did not lubricate the nipple with breastmilk (0.9%). Table 4 below shows the analyzing results of Spearman’s Rho test. Table 4 shows no significant relationship between the brea- Article Table 2. Respondent characteristics and the results of their breastfeeding techniques (n=107). Characteristics Breastfeeding techniques Frequency n (%) p Improper n (%) Proper n (%) Mother's age 17-25 23 (21.5) 13 (12.1) 36(33.6) 0.821** 26-35 37 (34.6) 27 (25.2) 64(59.8) 36-45 5 (4.7) 2 (1.9) 7(6.5) Mother's education Elementary school 8 (7.5) 1 (0.9) 9(8.4) 0.399** Junior high school 16 (15) 12 (11.2) 28(26.2) Senior high school 40 (37.4) 29 (27.1) 69(64.5) College 1 (0.9) 0 (0) 1(0.9) Mothers’ occupation Working mothers 29 (27.1) 6 (5.6) 35(32.7) 0.001* Housewives 36 (33.6) 36 (33.6) 72(67.3) (r=0.30) Infant's age 1 month 14 (13.1) 8 (7.5) 22(20.6) 0.747** 2 months 10 (9.3) 6 (5.6) 16(15.0) 3 months 16 (15.0) 13 (12.1) 29(27.1) 4 months 14 (13.1) 6 (5.6) 20(18.7) 5 months 11 (10.3) 7 (6.5) 18(16.8) 6 months 0 (0.0) 2 (1.9) 2(1.9) Infant’s gender Female 38 (35.5) 24 (22.4) 62(57.9) 0.893* Male 27 (25.2) 18 (39.3) 45(42.1) Infant’s head circumference Microcephaly 1 (1.5) 1 (2.4) 2(1.9) Normal 42 (64.6) 29 (69.0) 71(66.4) 0.545*** Macrocephaly 22 (33.8) 12 (28.6) 34(31.8) *Contingency coefficient test; **Kendall’s tau-b test. Table 1. Categories and thresholds of children’s nutritional status. Index Category Threshold (Z-Score) Weight-for-Age (WAZ) Severely underweight < -3 SD Underweight -3 SD < -2 SD Normal -2 SD +1 SD Risk of overweight >+1 SD Length/Height-for-Age (HAZ) Severely stunted < -3 SD Stunted -3 SD < -2 SD Normal -2 SD +3 SD Tallness >+3 SD Weight-for-Length/Height (WHZ) Severely wasted < -3 SD Wasted -3 SD < -2 SD Normal -2 SD +1 SD Possible risk of overweight >+1 SD +2 SD Overweight >+2 SD +3 SD Obese >+ 3 SD SD, Standard Deviation. [page 16] [Healthcare in Low-resource Settings 2025;13:12748] stfeeding technique and the infant’s nutritional status. In addition, Kendall’s tau-b result shows no significant relationship between the characteristics of the respondents and the breastfeeding techni- que. Meanwhile, the Contingency coefficient test results show a weak positive correlation between mothers’ occupation and brea- stfeeding techniques, which means that housewives tend to do more proper breastfeeding techniques but the relationship is not very strong. Discussion Maternal and infant characteristics related to mothers’ breastfeeding technique The first maternal characteristic is age, which is often related to a person’s experience: the older a person gets, the more kno- wledge and information they obtain from external and internal sources.13,14 In this study, most mothers were in the young adultho- od category (26-35 years), characterized by independence and pro- blem-solving.15,16 However, we found that most of the mothers practiced improper breastfeeding techniques, proven by ineffective infant suckles because they breastfeed according to what they understand and see from their surroundings. This finding indicates that mothers need education on breastfeeding techniques. Furthermore, most of the respondents who practiced improper breastfeeding techniques had a senior high school education. Education is a developmental process that improves skills. Mothers with higher education levels may find it easier to care for their children, especially regarding the precision and attention required to provide adequate nutrition, including exclusive brea- stfeeding.17,18 In addition, knowledge will provide mothers with an understanding of the benefits and importance of their children’s nutritional needs.19 However, based on our findings, the level of education may not always determine sufficient knowledge about breastfeeding techniques because it is a specific knowledge that needs skills and support from health workers and their families.20 Then, most of the respondents were housewives and the num- ber of those who practiced proper versus improper breastfeeding techniques was the same. High work activity, either being a full- time housewife or working mothers at the office, can make women pay less attention to the information around them.21 A previous Article Table 3. The characteristics of mothers’ breastfeeding techniques (n=107). Steps to breastfeeding Not done n (%) Done n (%) Washing hands with soap and water 56 (52.3) 51 (47.7) Lubricating nipples with breastmilk 1 (0.9) 106 (99.1) Position baby “tummy to tummy” 0 (0.0) 107 (100.0) Putting the thumb on the top of the breast and cup other fingers around the bottom of the breast (C-hold) 0 (0.0) 107 (100.0) Triggering the rooting reflex by gently stroking the infant’s cheek with the nipple 43 (40.2) 64 (59.8) Make sure the infant's mouth is wide open before the nipple enters 1 (0.9) 106 (99.1) Bringing the infant's head closer to the breast after a wide-open mouth 0 (0.0) 107 (100.0) Make sure a large portion of the lower areola into the infant’s mouth 0 (0.0) 107 (100.0) Make sure the infant’s lower lip curled out 4 (3.7) 103 (96.3) Making sure the infant’s chin firmly touches the breast 0 (0.0) 107 (100.0) Releasing the infant's sucking with the mother’s little finger 48 (44.9) 59 (55.1) Table 4. The correlation between breastfeeding technique and nutritional status in infants aged 0-6 months (n=107). Characteristics of infants’ Breastfeeding techniques Frequency n (%) p nutritional status Improper n (%) Proper n (%) Weight-for-age index Underweight 17 (26.2) 8 (19.0) 25 (23.4) 0.402*** Normal 43 (66.2) 30 (71.4) 73 (68.2) Risk of overweight 5 (7.7) 4 (9.5) 9 (8.4) Length/height-for-age index Severely stunted 3 (4.6) 1 (2.4) 4 (3.7) 0.467*** Stunted 11 (16.9) 4 (9.5) 15 (14.0) Normal 47 (72.3) 36 (85.7) 83 (77.6) Tallness 4 (6.2) 1 (2.4) 5 (4.7) Weight-for-length/height index Severely wasted 4 (6.2) 2 (4.8) 6 (5.6) 0.181*** Wasted 8 (12.3) 3 (7.1) 11 (10.3) Normal 46 (70.8) 29 (69.0) 75 (70.1) Possible risk of overweight 4 (6.2) 5 (11.9) 9 (8.4) Overweight 1 (1.5) 0 (0.0) 1 (0.9) Obese 2 (3.1) 3 (7.1) 5 (4.7) ***Spearman’s Rho test. [Healthcare in Low-resource Settings 2025;13:12748] [page 17] study found that the children of mothers who are full-time house- wives have a higher chance of experiencing stunting.22 However, exclusive breastfeeding practice was higher among housewives compared with working mothers.23 Our findings show a weak posi- tive correlation between housewives and correct breastfeeding techniques. This shows the importance of a mother being at home, especially until completing exclusive breastfeeding. Indonesian government through the House of Representatives supports the exclusive breastfeeding program by passing the Maternal and Child Welfare Bill which regulates working mothers entitled to maternity leave for up to 6 months.23,24 Furthermore, health wor- kers need to play an active role in providing education on correct breastfeeding techniques noting that improper breastfeeding techniques in this study were very likely caused by mothers not receiving information. Education programs can be added to discharge planning or provided regularly as an independent nur- sing intervention in maternity wards, Puskesmas, or the communi- ty. Most of the infants in this study were three months old and still showed improper positioning and attachment during breastfeeding. Three-months infants can already hold their heads parallel to their bodies and ideally can attach properly when breastfeeding compa- red to infants aged 1-2 months.25 Meanwhile, babies older than 3 months are in the growth spurt phase, where they are often fussy, which affects the mother’s breastfeeding technique because the infants suckle according to their comfort.26 Mothers are generally anxious when facing a fussy baby, so they may breastfeed without thinking of proper attachment during breastfeeding.27 Furthermore, most of the infants in this study were female. Naturally, both fema- le and male infants have the ability and instinct to breastfeed although the male infants need more energy28 and have a higher risk of stunting29 than female infants. Male infants have very diffe- rent amounts in growth speed30 but the problems in breastfeeding are not always related to gender because each infant is unique and has different characteristics. Instead, breastfeeding problems can be caused by infants’ health factors or mothers’ experiences. Another indicator for assessing the infants’ nutritional status is head circumference.31 The study result showed that an infant expe- rienced microcephaly and around a third of the total infants expe- rienced macrocephaly and were breastfed improperly. Routine monitoring of changes in head circumference can help identify nutritional problems or suboptimal development in infants.32 The head circumference of infants gives an idea of the brain’s growth.3 In the case of this study, it is possible that the head circumference of infants with microcephaly was caused by other factors, such as disease or concomitant conditions, such as neurological diseases, genetics, birth conditions, syndromes, and possible developmental disorders.33 Macrocephaly may be caused by genetic factors, which is commonly caused by poor appetite.34 Poor appetite leads the infants to difficulty gaining weight, called ‘failure to thrive’, and sometimes can be associated with brain issues. Overview of mothers’ breastfeeding techniques In this study, mothers often miss washing their hands before breastfeeding, whereas washing hands with soap and water is the most affordable and effective way to stop the spread of infection.36 Another step in breastfeeding that was mostly missed by mothers in this study was releasing infants’ sucking. A study said that it is unnecessary to release the infant’s sucking because they will spon- taneously release the nipple.37 However, if breastfeeding lasts too long (more than half an hour) or too short (less than 4 minutes), this may indicate a problem with attachment.38 Releasing the baby’s sucking at the best time and good steps39 may be needed before mothers fall asleep to avoid the risk of the baby choking.40 Another skipped breastfeeding technique by mothers in this study was not stimulating the sucking reflex. Sucking reflex stimulation can make infants easier in finding the nipple, reduce fussiness, and create comfort during breastfeeding that will disappear at six months of age.41 Proper breastfeeding techniques, including correct position and good attachment, are the keys to successful breastfeeding so that nutrient transfer to infants can be optimal.8 Effective positio- ning and latching help the infant to suck effectively, maintain mothers’ breastmilk production; and prevent breastfeeding pro- blems, such as sore nipples, mastitis, or low breastmilk supply. However, the results of this study show that proper breastfeeding techniques practiced by some mother did not significantly impact their infants’ nutritional status. The nutritional status of infants in this study may influenced by other factors such as genetics, the health status of the infants, the caring experience of mothers, and the parents’ culture.39,40 The correlation between mothers’ breastfeeding technique and their infants’ nutritional status aged 0-6 months This research found that the nutritional status of infants aged 0-6 months varied: some had low weight for age index and some were risk overweight. Based on body length measurements, some infants experienced severely stunted or abnormal body lengths. The weight for length index of some infants varied: some were severely wasted and some were obese. The results of the Spearman’s Rho test showed a p-value>0.05, which indicates that the correlation between mothers’ breastfeeding technique and infants’ nutritional status is insignificant. Therefore, we further explained the results of this study based on cross-tabulation analy- sis. Based on the weight for age index, despite most infants being in the normal category, they received improper breastfeeding techniques from their mothers. The researchers argued that the infant’s weight was normal because the mothers persevered with breastfeeding, even though they felt pain due to poor attachment during breastfeeding. The cross-tabulation analysis showed that some mothers who practiced proper breastfeeding techniques still had an underweight or risk of overweight infants. This incidence may be caused by other factors, such as genetics, birth history (abnormal or premature), and growth hormone problems.41 When comparing each data of abnormal weight for age index, most infants were underweight and experienced ineffective breastfee- ding techniques. Therefore, although statistically insignificant, improving breastfeeding skills is still important. The following characteristic of infants’ nutritional status is the length for age index. Infants will experience an increase in body length of around 1.5 to 2.5 cm every month from birth to 6 months.42-46 Breastfeeding can optimize infant growth and develop- ment through the rich nutrients in breast milk, such as protein.4 The results showed that most infants had normal body length and stati- stically no significant relationship with mothers’ breastfeeding technique. Clinically, the cross-tabulation analysis revealed that most infants that had an abnormal body length were experienced stunted and their mothers used improper breastfeeding techniques. It is still important to increase breastfeeding skills even though other factors may influence less optimal growth, which triggers abnormalities in the length of the infants’ body, such as maternal factors, gender, health insurance ownership, or use of blood sup- plement tablets.42,43 Based on the weight for length index, most infants were nor- mal and some were abnormal (wasted). This finding showed the Article [page 18] [Healthcare in Low-resource Settings 2025;13:12748] importance of proper breastfeeding techniques despite this study result showing a statistically insignificant between infants’ weight for length index and mothers’ breastfeeding techniques. From this research, we conclude that errors in breastfeeding techniques alone did not cause inadequate nutrition in infants because the cross- tabulation results found that some infants from mothers who prac- ticed proper breastfeeding techniques had a lack of adequate nutri- tion. Meanwhile, infants of mothers who practiced improper brea- stfeeding techniques still have a normal weight. Uninterrupted breastfeeding can fulfill the infants’ nutritional needs through inco- ming breast milk even if the mother practices ineffective breastfee- ding techniques.47-49 The respondents stated that they would conti- nue to breastfeed their infants even if they felt pain to fulfill their infants’ nutrition needs. Therefore, adequate nutrition of infants whose mothers practiced improper breastfeeding techniques might come from incoming and continuous breast milk (Figure 1).50 The researchers recognized several limitations to this study. First, 73 respondents should be excluded because the infants’ age was more than 6 months at data collection. Second, some potential respondents rejected to participate in this study because the data collection schedule coincided with work hours. Third, this study needs more details and better control of all variables that could influence infants’ nutritional status, such as genetics, infant health factors, and maternal factors (parity status and previous breastfee- ding experiences). Conclusions This study observed common mistakes among mothers when breastfeeding their infants, including missing washing hands, not lubricating the nipples with breastmilk, missing rooting reflex sti- mulation before breastfeeding the infants, and not releasing infants’ sucking with a finger. Although the mothers practiced improper breastfeeding techniques, their infant’s nutritional needs were still met. However, other factors, such as genetics, environ- ment, or birth history may cause nutritional problems in infants whose mothers practiced improper breastfeeding techniques. There is no relationship between mothers’ breastfeeding technique and their infants’ nutritional status, but clinically, proper breastfeeding technique is needed for successful breastfeeding and to ensure the infants’ adequate nutrition. Mothers can optimally practice effecti- ve breastfeeding techniques if they and their support systems (husband and family) are provided with education or counseling sessions by health workers. Mothers can also participate in group discussions to share knowledge and experiences as a form of caring for fellow breastfeeding mothers. Article Figure 1. The graphical of the finding. [Healthcare in Low-resource Settings 2025;13:12748] [page 19] References 1. Potter PA, Perry AG, Stockert PA, Hall AM. Fundamentals of nursing. Tenth Edition. Elsevier; St. Louis, USA; 2021. 2. Mayar F, Astuti Y. Peran Gizi Terhadap Pertumbuhan dan Perkembangan Anak Usia Dini. J Pendidik Tambusai 2021;5:9695-704. 3. Richardson B. Pediatric primary care: practice guidelines for nurses. Jones and Bartlett Learning; Burlington, USA; 2018. 4. Kementrian Kesehatan RI. Buku Bagan: Manajemen Terpadu Balita Sakit. 2022. 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