Assistência profissional especializada em amamentação: uma revisão de escopo

Abstract

Human milk is considered the gold standard for feeding newborns and infants, with recommendations for exclusive breastfeeding until six months of age and continued breastfeeding alongside complementary foods up to two years of age or beyond. In addition to its nutritional and immunological benefits, breastfeeding involves relational dimensions between the lactating person and the child. Despite the international recognition of Brazilian policies aimed at the promotion, protection, and support of breastfeeding, the country still faces challenges in achieving the exclusive breastfeeding targets recommended by international organizations. In this context, the importance of professional breastfeeding support stands out. However, in Brazil, professional and continuing education in breastfeeding still lacks specific regulation and guidelines. This study understands specialized breastfeeding support as an evidence-based clinical practice involving individualized assessment, specific clinical reasoning, advanced technical skills, and longitudinal follow-up. Considering the relevance of this support for breastfeeding outcomes and for the experiences of lactating individuals, the following question arises: what scientific evidence exists regarding specialized professional breastfeeding support? Objective: To map scientific evidence on specialized professional breastfeeding support provided to pregnant and postpartum individuals within healthcare services. Method: This scoping review was conducted according to the JBI Manual for Evidence Synthesis and the PRISMA-ScR checklist. The study protocol was registered in the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/7FJMK). The research question was structured according to the PCC strategy: “What evidence exists regarding specialized professional breastfeeding support for pregnant and postpartum women in healthcare services?” Searches were conducted in December 2025 in the CINAHL, PubMed, and Virtual Health Library (VHL) databases using controlled descriptors from DeCS and MeSH. Study selection was carried out in the RayyanⓇ software by six researchers. Data extraction and synthesis followed the JBI instrument, with narrative presentation of the identified evidence. Results: A total of 3,201 records were identified. After removing duplicates, 2,058 remained for title and abstract screening according to the research question and eligibility criteria. This process resulted in 15 studies, of which 2 were excluded, leaving 13 studies as the final corpus. Among them, 7 were review studies (including one scoping review and the others systematic reviews with meta-analysis). The remaining studies included exploratory designs: 3 randomized clinical trials, 2 prospective quasi-experimental studies with intervention and control groups, and 1 ecological observational study. Most studies originated from high-income countries. The body of evidence addressed specialized support and breastfeeding outcomes, indicating favorable results associated with such support. Outcomes explored included breastfeeding practices and knowledge, attitudes and beliefs about breastfeeding, and maternal breastfeeding self-efficacy. Analysis of the material resulted in a structured descriptive synthesis organized into the following themes: “Specialized professionals and programs”; “Contexts, approaches, and effects of specialized breastfeeding support”; and “Individualized and partially culturally sensitive support. ” These thematic axes were constructed from interpretive cores that guided their naming. Notably, in the third axis, although support is recognized for considering individual and cultural aspects, this sensitivity appears partial, revealing limitations in more broadly incorporating family, social, and economic contexts into care. Final considerations: The number of studies specifically addressing specialized breastfeeding support was limited, and most focused on the practice of professionals certified by the International Board of Lactation Consultant Examiners. Investigations were primarily centered on describing strategies, timing, and forms of professional practice. The discussion of specialized training was not addressed in the included studies, indicating an urgent need to expand evidence in this area.