1. Objectives

To assess the effects of baby-led versus scheduled (or mixed) breastfeeding on successful breastfeeding for healthy term infants

2. How studies were identified

The following databases were searched in February 2016:

• Cochrane Pregnancy and Childbirth Group’s Trials Register
• CENTRAL (The Cochrane Library 2016)
• MEDLINE
• EMBASE
• CINAHL
• EThOS
• Index to Theses
• ProQuest

Relevant journals and conference proceedings were handsearched and trials included in the WHO’s Evidence for the Ten Steps to Successful Breastfeeding (WHO, 1998) were also assessed for inclusion

3. Criteria for including studies in the review

3.1 Study type

Randomized controlled trials, including quasi-randomized and cluster-randomized trials

3.2 Study participants

Breastfeeding women and breastfeeding healthy term infants (born at 37 to 42 weeks’ gestation)

(Studies could include both singleton and multiple births)

3.3 Interventions

Baby-led breastfeeding compared with scheduled or mixed patterns of breastfeeding, and scheduled breastfeeding compared with mixed patterns of breastfeeding

(Baby-led breastfeeding was defined as where the frequency and duration of breastfeeds were baby-led or on demand; scheduled breastfeeding was defined as where the frequency and duration of breastfeeds were scheduled, timed or restricted; and mixed patterns of breastfeeding was defined as where the frequency and duration of breastfeeds was a combination of, or alternated between, baby-led and scheduled breastfeeding)

3.4 Primary outcomes

• Proportion of women breastfeeding exclusively up to six months
• Proportion of women breastfeeding up to 24 months

Maternal secondary outcomes included sore nipples, breast engorgement, and satisfaction. Neonatal secondary outcomes included hypoglycaemia, hypernatraemia, growth (head circumference, length, weight), and jaundice

4. Main results

4.1 Included studies

No studies meeting inclusion criteria were identified. Ten trials were assessed in full-text:

• Four trials did not examine patterns of breastfeeding
• Two trials examined different schedules of breastfeeding but did not include baby-led breastfeeding
• One trial was excluded due to potential confounding by study site and another was excluded due to potential confounding by time period of the intervention compared with the control
• In one trial the gestational age of the infants was not 37 to 42 weeks
• For one trial, it was not possible to judge whether or not inclusion criteria were met

4.2 Study settings

Three comparisons were planned: i) baby-led compared with scheduled breastfeeding; ii) baby-led compared with mixed patterns of breastfeeding; and iii) scheduled breastfeeding compared with mixed patterns of breastfeeding

5. Additional author observations*

Currently there are no data from randomized trials on the effects of baby-led versus scheduled (or mixed) breastfeeding on successful breastfeeding for healthy term infants. Further high-quality research with clearly defined patterns of breastfeeding is needed. The mother’s perspective on baby-led breastfeeding should also be considered in future trials.