Breastfeeding with Extra Care: A Qualitative Insight of Mothers of Children with Down Syndrome in Rwanda.

BACKGROUND: Breastfeeding children with Down syndrome (DS) is challenging due to the infants' physiological characteristics and increased caregiving demands. Evidence from Sub-Saharan Africa, including Rwanda, remains limited. This study aimed to explore the breastfeeding experience and coping strategies among mothers of children with DS in Rwanda. METHODS: A qualitative descriptive study was conducted using in-depth interviews with 23 purposively selected mothers of children with DS. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis to identify patterns and meanings within mothers' breastfeeding experiences. RESULTS: Four main categories and eight subcategories emerged: 1. challenges in initiating and sustaining breastfeeding, 2. physical and time-related burdens, 3. emotional challenges and distress among mothers, and 4. coping strategies to sustain breastfeeding. Mothers reported delayed initiation of breastfeeding, shortened breastfeeding episodes due to persistent feeding difficulties, increased time demands, physical discomfort, financial strain, family conflicts, and significant emotional distress. Lack of adequate information and assistance, and delayed diagnosis further intensify these challenges. Despite these hurdles, mothers employed adaptive coping strategies to sustain breastfeeding. CONCLUSION: Early diagnosis and management for Down syndrome and strengthening specialized lactation support may improve breastfeeding experiences and outcomes in low-resource settings.