What are the implications of Zika Virus for infant feeding? A synthesis of qualitative evidence concerning Congenital Zika Syndrome (CZS) and comparable conditions

Abstract

If a mother contracts the Zika Virus before or during pregnancy, then there is a risk of the child developing Congenital Zika Syndrome (CZS). An infant can then experience problems feeding due to the specific physical and developmental consequences of Congenital Zika Syndrome (CZS), such as microcephaly, dysphagia and an increased likelihood of choking. This qualitative evidence synthesis accesses direct and indirect evidence to inform WHO infant feeding guidelines. We conducted a qualitative evidence synthesis of the values and preferences of relevant stakeholders (e.g. pregnant women, mothers, family members and health practitioners) concerning infant (0–2 years) feeding in the presence of: 1) CZS (the‘direct evidence’); 2) severe disability and nonprogressive, chronic encephalopathies (‘indirect evidence’), which present with similar problems. Authors’ findings were extracted, synthesised using thematic synthesis techniques, and confidence in the findings were assessed using GRADE-CERQual. Six CZS-specific studies (all from Brazil) were included in the direct evidence, with a further eight indirect studies reporting feeding difficulties in infants with severe disability and nonprogressive, chronic encephalopathies. Included studies highlighted: breast-feeding represented the preference for all mothers in the studies in both reviews, and the inability to do so affected bonding between parents and child, and generated fear and anxiety relating to feeding choices, especially around the risks of choking and swallowing; the perception that health professionals were often unable to offer appropriate advice; the potential value of training; and a strong desire to achieve individual maternal autonomy in infant feeding decisions. Confidence in most findings ranged from low to moderate. The evidence base has limitations, but consistently reported that parents of children with feeding difficulties due to Congenital Zika Syndrome, or similar, need information, advice and counselling, and substantial emotional support. Parents perceive that these needs are often neither recognised nor satisfied; optimal feeding and support strategies for this population have not yet been identified.

Might Zika virus‐associated microcephaly's severity impact deciduous tooth eruption and orofacial structures?

“…This process allows for developing the individual's stomatognathic system through the resulting sucking stimulation. In addition, there is a greater maternal connection with the child (Carroll et al, 2020; Cavalcanti et al, 2020).…”

Congenital Zika Syndrome and Disabilities of Feeding and Breastfeeding in Early Childhood: A Systematic Review

“…However, we could not determine whether the infants with CZS had dysphagia problems or whether the early introduction of formula feeding was a cause of breastfeeding cessation. Additional explanations could be the mother’s lack of cooperation, her mental distress and the lack of breastfeeding promotion programs for mothers of children with CZS [ 50 , 51 ]. In addition, the use of pacifiers is a widespread cultural habit when raising Brazilian children [ 52 ].…”

Qualitative evidence syntheses of attitudes and preferences to inform guidelines on infant feeding in the context of Ebola Virus Disease (EVD) transmission risk

“…It is published and available at PROSPERO 2019 CRD42019143387. Subsequently, the World Health Organisation asked the review team to focus on non-HIV transmissible infections [ 18 ], Zika virus [ 19 ] and Ebola virus. This review therefore represents the third of three related qualitative evidence syntheses following the same overall protocol.…”