The Effect of Media Distractions on Women During Breastfeeding and Infant Care: A Descriptive Cross-Sectional Study

Abstract

Background:

In modern world, the pervasive use of media technologies has seen a significant increase across various domains. The study aimed to assess the level of distraction among lactating women during feeding and infant care, along with exploring associated factors.

Methods:

This cross-sectional study included 120 lactating mothers who visited comprehensive health centers in Zanjan City in 2023. The inclusion criteria were lactating mothers older than 18 years, who were within 42 days postpartum. A multistage sampling method was used for participant selection. Data were gathered using a standard maternal distraction questionnaire and analyzed using descriptive statistics, independent t-tests, and analysis of variance (ANOVA) test with a confidence level of 95%.

Results:

The study found that smartphone use (69.7%) was the most common source of distraction for mothers during breastfeeding, while reading books (17.5%) was the least distracting. In addition, 85% of mothers watched television while caring for their babies (except during breastfeeding), and a significant percentage used landline phones (92.5%) and mobile phones (79.2%). It was noted that older mothers tended to be less distracted during feeding or baby care compared with young mothers. Furthermore, maternal attention during baby feeding increased with higher education levels and having more children (p < 0.05).

Conclusion:

The study concludes that young mothers with lower levels of education experience significantly high levels of distraction while caring for their babies or breastfeeding. Given the substantial availability of media products, interventions are needed to raise mothers' awareness about the importance of maintaining eye contact with their babies and implementing strategies for managing distractions.

Background

The significance and impact of breastfeeding on the immediate and long-term health of both mothers and children, as well as on families and society, have been substantiated and are universally acknowledged.¹ The Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) endorse exclusive breastfeeding for the initial 6 months of a baby's life, followed by its continuation up to the first year and beyond as per the mother's preference.² Despite the emphasis on exclusive breastfeeding for the first 6 months of a child's life, according to a report from the World Health Organization, the pattern of breastfeeding in some countries is not satisfactory. Only 41% of children worldwide are exclusively breastfed until the end of the sixth month.³ Breastfeeding can be effective in reducing the risk of childhood and adult diseases.⁴ In addition, breastfeeding provides more opportunities for mother–infant bonding.⁵

Disruption in mother–child interaction during the postpartum period affects the child's growth and development.⁶ Today, with the remarkable advancements in the production and availability of various media products, the use of media technologies has increased in many areas, including health care, commerce, and family purchases.⁷ Despite the potential benefits of using media technologies, preliminary evidence suggests a reduction in mother–child interactions when using these technologies.⁸ Media-induced distraction, including the use of mobile phones, refers to a person's inability to concentrate or perform assigned tasks due to media use. In other words, individuals exhibit attention to unrelated phenomena, such as using a mobile phone, during the execution of their tasks.⁹ According to a study, 67% of breastfeeding mothers in Japan used media technologies during the first month after childbirth while breastfeeding.¹⁰

Golen and Ventura reported that 52% of mothers experienced at least one instance of distraction during infant feeding.¹¹ In addition, in Ventura's study and her colleagues, 26% of distractions were attributed to technology use. Mothers at higher parity reported more types of distractions during infant feeding. Mothers who believed their infants had a larger appetite reported higher levels of technological distractions.¹² Since maternal distractions during infant feeding are associated with child health indicators, including delays in infant language and cognitive development, it is crucial to address and minimize these distractions to support the healthy development of infants.¹³ Furthermore, limited information is available regarding the extent of distractions in breastfeeding mothers. The present study was conducted with the aim of determining the level of distractions in lactating mothers during infant feeding and care, as well as the factors associated with these distractions.

Method

The aim of study

The study aimed to assess the level of distraction among lactating women during feeding and infant care, along with exploring associated factors.

Design and setting of the study

The current study was a cross-sectional descriptive study conducted in 2023 with the aim of determining the level of distractions in lactating mothers during infant feeding and care, as well as the factors associated with these distractions. The study was conducted among mothers who attended comprehensive health centers in the city of Zanjan, Iran. The research population included all lactating mothers who met the criteria for attending these centers.

The characteristics of participants

The inclusion criteria for the study encompassed the following. Mothers who had given birth and had passed a minimum of 2 weeks and a maximum of 42 days since childbirth, mothers who practiced exclusive breastfeeding or combination feeding (both breast milk and formula), mothers 18 years or older, residing in the city of Zanjan, and willingness to participate in the study. Incomplete questionnaires were excluded from the study.

The sample size was estimated using Stata software based on the reported frequency of technological distractions in the study by Ventura and colleagues (p1 = 0.26, p2 = 0.74, alpha = 0.05, power = 0.95), and it was determined to be 120 participants.

Procedure

In Iran, all pregnant and postpartum women are covered by health care facilities, and they can be identified in the integrated health system using their national identification numbers. In this study, eligible lactating mothers were selected using a multistage sampling method. In the first step, Zanjan City was categorized into four socioeconomic and residential status levels based on municipal zoning to ensure sample diversity. Zanjan City is divided into four municipal areas with 35 health care centers. In the second step, three health care centers were randomly selected in each municipal area. In the third step, the sample size was calculated based on the proportion of individuals covered by each center. Then, eligible individuals in the selected centers were chosen through routine visits until the desired sample size was reached using the convenience sampling method.

The data collection tools

The data collection tools in this study included a questionnaire gathering demographic information (age, education, occupation, number of children, type of delivery, gender of the infant) and the Maternal Distraction Questionnaire (MDQ) to assess maternal distractions.

The MDQ

The MDQ was designed by Ventura.¹⁴ MDQ is a self-report questionnaire that covers various activities that mothers may engage in during interactions with their infants. It consists of 14 questions. The first part contains 10 questions related to the frequency of common activities such as watching television (TV), talking or texting on the phone, using a computer, or reading a magazine while mothers are feeding or caring for their infants. Each question is scored on a 5-point Likert scale from 1 (never) to 5 (always). The second part includes four questions to quantify the overall attention or distraction of the mother during interactions with the infant, rated on a scale from 1 to 5. An individual can indicate the intensity of distraction or attention, where selecting 1 suggests no distraction at all, and choosing 5 indicates complete distraction.

The question regarding the level of attention to the infant during feeding and care interactions is scored in reverse, with 1 indicating low attention and 5 representing very close attention. The questionnaire has been assessed for validity and reliability by Golen and Ventura, with a Cronbach's alpha of 0.86 for technological activities, 0.95 for nontechnological activities, and an internal consistency coefficient of 0.86.

The Persian version of this questionnaire was utilized in the current study following translation and validation. The translation process included the forward and back-translation of the questionnaire, conducted in five stages according to the BEATON method, after obtaining permission from the questionnaire's developers.¹⁵ The first stage involved forward translation into Persian, the second stage comprised qualitative review and synthesis of the Persian translations, the third stage included back-translation, the fourth stage involved the alignment of Persian and English translations by a research expert committee, and finally, the fifth stage comprised testing the prefinal summarized version.

Qualitative face validity of the questions was assessed by 10 research units in terms of difficulty level, appropriateness, and clarity. For quantitative face validity, questions were rated on a 5-point Likert scale, ranging from completely important (score 5) to not important at all (score 1). A total of 30 research units were then asked to score the expressions. In quantitative face validity, the item impact index was >1.5 for all questions. Therefore, all questions were deemed suitable for subsequent analyses and were retained.

The content validity of the questionnaire was assessed both quantitatively and qualitatively. For qualitative content validity, the questionnaire was given to 10 experts, including three specialists in reproductive health, two midwives, two epidemiologists, two neonatal specialists, and one pediatric nurse. These experts were asked to provide their written opinions regarding the content of the questions, specifically addressing the level of grammatical accuracy and the use of appropriate expressions.

Following the receipt of qualitative feedback from experts and subsequent revisions, quantitative content validity was performed as a complementary method. The content validity ratio for each complete question and item was 0.94, a value consistent with the acceptable criterion in Lavsheh's table. To calculate the content validity index (CVI), each item was independently rated on a 4-point Likert scale for simplicity, relevance, and clarity. In the present study, the CVI scores for individual questions were all above 0.89, indicating their appropriateness.

Factor exploratory analysis was used to examine the structural validity and determine the factorial dimensions of the questionnaire using SPSS version 16. Typically, for factor analysis, a sample size of 5–10 subjects per item is considered sufficient.¹⁶

A sample size of 100 participants was determined for this stage. Exploratory factor analysis for latent variables was conducted using principal component analysis with varimax rotation, eigenvalue greater than 1, and a cutoff point of 0.5 in the scree plot. A minimum factor loading of 0.2 for each question in the factor matrix and the rotated matrix was considered. The Kaiser–Meyer–Olkin (KMO) test, Bartlett's test of sphericity, and the scree plot were used to assess sample adequacy and determine the number of factors. In the current study, the KMO test yielded 0.67, Bartlett's test had a significance level of 0.283, and the p-value for the scree plot was 0.001.

The KMO sampling adequacy index in this exploratory factor analysis model was above 0.60, indicating the sufficiency of the data for analysis. The Bartlett's test of sphericity was also significant, signifying an adequate correlation among variables for conducting factor analysis. The entered variables in this analysis loaded on two factors, collectively explaining 46.16% of the variance. The scree plot visually confirmed the presence of these two factors. Therefore, the final questionnaire, consisting of 10 questions with a 5-point Likert scale ranging from 1 (never) to 5 (always), along with 4 questions assessing the overall attention/distraction of the mother during feeding and other caregiving interactions, has been validated.

The internal consistency of the questionnaire was assessed using Cronbach's alpha coefficient, yielding a total alpha of 0.75, indicating good reliability. To determine the questionnaire's stability in terms of reproducibility, the intraclass correlation coefficient (ICC) was calculated for all domains and individual items. In this phase of the study, 20 breastfeeding women completed the final questionnaire twice with a 2-week interval for the test–retest analysis. The results demonstrated an ICC of 0.75 for all items, indicating satisfactory reliability within the items across the two administrations.

The statistical analysis method

Data analysis was conducted using SPSS version 16. Descriptive statistics were utilized to determine the level of maternal distraction using the scale's scores. The Kolmogorov–Smirnov test indicated a normal distribution of scores for the overall attention/distraction scale. Comparison of total scores based on demographic variables was performed using independent t-tests and analysis of variance (ANOVA) at a 95% confidence level.

Results

Demographic characteristics

The results showed that the majority of participants fell into the age group of 31–40 years (42.5%), had an education level higher than a diploma (39.2%), were unemployed and homemakers (83.3%), delivered their first child through cesarean section (55.8%), had their firstborn (45.0%), and had a male child (54.2%). In addition, in this study, 20 individuals (16.7%) used mixed feeding and 100 individuals (83.3%) exclusively breastfed their infants (Table 1).

Table 1.

Demographic Characteristics of Breastfeeding Mothers Participating in the Study (n = 120)

Variables	Frequency	Percent
Age (year)
<20	11	9.2
21–25	21	17.5
26–30	35	29.2
31–40	51	42.5
>41	2	1.7
Education level
Primary	37	30.8
Secondary	36	30.0
High	47	39.2
Job
Employee	20	16.7
Housewife	100	83.3
The number of children
1	54	45.0
2	45	37.5
>3	21	17.5
Type of delivery
NVD	53	44.2
CS	67	55.8
Baby gender
Male	65	54.2
Female	55	45.8
Type of baby feeding
Exclusive breastfeeding	100	83.3
Partially breastfeeding	20	16.7

CS, C-section (or cesarean birth); NVD, natural vaginal delivery.

Attention/distraction

The average overall distraction of mothers during breastfeeding was 2 out of 5, and the average attention and focus of mothers during breastfeeding were 4.4 out of 5.

Table 2 results show that 58.3% of mothers had watched TV at least once while breastfeeding. Distraction during breastfeeding was reported as 25% due to using a computer, 69.2% due to talking on the phone, 64.2% due to using a mobile phone, and 17.5% due to reading a book.

Table 2.

Frequency of Maternal Distraction During Breastfeeding or Bottle-Feeding

Distraction	Never n (%)	Rarely n (%)	Sometimes n (%)	Most of the time n (%)	Always n (%)
Watch TV (e.g., videos, shows, or movies)	50 (41.7)	39 (32.5)	21 (17.5)	6 (5)	4 (3.3)
Use a computer (e.g., check email, surf the internet, work)	90 (75.0)	24 (20.0)	6 (5.0)	0	0
Talk on the phone	37 (30.8)	48 (40)	23 (19.2)	8 (6.7)	4 (3.3)
Text or use apps on a mobile device or tablet	43 (35.8)	36 (30.0)	25 (20.8)	14 (11.7)	2 (1.7)
Read a book, magazine, or newspaper (not on a mobile device or tablet)	99 (82.5)	13 (10.8)	7 (5.8)	1 (0.8)	0

TV, television.

The highest distraction during breastfeeding was related to phone use, while the lowest was associated with reading a book (Table 2).

The results in Table 3 indicate that 85% of mothers had watched TV at least once while caring for the infant, other than during breastfeeding. In addition, 65% reported distraction while caring for the infant at least once due to computer use, 92.5% due to talking on the phone, 79.2% due to using a mobile phone, and 40% due to reading a book. The highest distraction while caring for the infant was associated with phone use, while the lowest was related to reading a book (Table 3). The average overall distraction of mothers while caring for the infant was 2.4 out of 5, and the average attention and focus of mothers on the infant during caregiving was 4.1 out of 5.

Table 3.

Frequency of Maternal Distraction During Caring for or Spending Time with Their Baby Excluding Feeding Time

	Never	Rarely	Sometimes	Most of the time	Always
Watch TV (e.g., videos, shows, or movies)	18 (15)	48 (40)	38 (31.8)	14 (11.7)	2 (1.7)
Use a computer (e.g., check email, surf the internet, work)	42 (35)	30 (25)	32 (26.7)	13 (10.8)	3 (2.5)
Talk on the phone	9 (7.5)	39 (32.5)	50 (41.7)	18 (15)	4 (3.3)
Text or use apps on a mobile device or tablet	25 (20.8)	48 (40.0)	26 (21.7)	15 (12.5)	6 (5)
Read a book, magazine, or newspaper (not on a mobile device or tablet)	72 (60)	21 (17.5)	22 (18.3)	5 (4.2)	0

TV, television.

The results in Table 4 demonstrate that the average distraction and attention of mothers to the infant during feeding and caregiving were significantly associated with age. As the age increased, the average attention of mothers to the infant increased, while the level of distraction decreased. Individuals younger than the age of 30 had higher distraction than those aged 30 and older (p ≤ 0.013). In addition, the average attention of mothers to the infant during feeding was significantly associated with their level of education and the number of their children. As the level of education and the number of children increased, the attention of mothers to the infant during feeding also increased. The average distraction and attention of mothers to the infant during feeding and caregiving did not show statistically significant differences based on the mode of delivery, mothers' occupation, and the gender of the infant (p > 0.05).

Table 4.

The Comparison of Distraction and Attention Scores of Mothers During Baby Feeding and Baby Care in Terms of Demographic Characteristics

	Breastfeeding/Bottle-Feeding		Baby Care
Variables	Attention Mean (SD)	Distraction Mean (SD)	Attention Mean (SD)	Distraction Mean (SD)
Age (year)
<20	3.0 (1.0)	2.54 (1.43)	3.45 (0.82)	3.36 (0.92)
21–25	2.66 (1.52)	3.57 (1.74)	2.76 (1.33)	3.47 (1.07)
26–30	1.40 (0.77)	4.37 (1.08)	2.54 (1.72)	4.80 (0.47)
31–40	1.98 (1.25)	4.50 (0.98)	2 (1.24)	4.78 (0.46)
>41	1.50 (0.70)	4.0 (1.41)	1.50 (0.70)	4.50 (0.70)
p value	0.001^*	0.001^*	0.013^*	0.001^*
Educational level
Primary	2.29 (1.41)	3.81 (1.56)	2.54 (1.40)	4.21 (1.0)
Secondary	1.91 (1.22)	3.97 (1.50)	2.61 (1.45)	4.25 (0.99)
High	1.87 (1.15)	4.46 (0.92)	2.17 (1.44)	4.72 (0.57)
p value	0.266	0.062	0.319	0.011
Job
Employee	2.15 (1.13)	4.0 (1.33)	2.25 (1.33)	4.50 (0.76)
Housewife	1.99 (1.29)	4.14 (1.35)	2.45 (1.46)	4.41 (0.91)
p value	0.607	0.674	0.573	0.680
The number of children
1	2.09 (1.18)	3.81 (1.53)	2.55 (1.44)	4.16 (1.00)
2	1.95 (1.36)	4.26 (1.21)	2.42 (1.45)	4.55 (0.81)
>3	1.95 (1.28)	4.57 (0.92)	2.04 (1.39)	4.80 (0.40)
p value	0.840	0.058	0.394	0.008^*
Type of delivery
NVD	2.13 (1.31)	3.90 (1.41)	2.32 (1.35)	4.35 (0.92)
CS	1.92 (1.22)	4.28 (1.27)	2.49 (1.51)	4.47 (0.85)
p value	0.376	0.128	0.519	0.467
Baby gender
Male	1.84 (1.18)	4.12 (1.37)	2.49 (1.41)	4.32 (0.93)
Female	2.21 (1.32)	4.10 (1.32)	2.32 (1.47)	4.54 (0.81)
p value	0.108	0.955	0.534	0.172

Significant (p < 0.05).

CS, C-section (or cesarean birth); NVD, natural vaginal delivery; SD, standard deviation.

Discussion

The results of the present study indicate that more than half of the mothers experienced at least one form of distraction while breastfeeding, with the highest percentage related to phone use and the lowest to reading a book. The percentage of distraction during caregiving to the infant was higher than during breastfeeding. In addition, as the average age increased, the attention of mothers to the infant during feeding or caregiving increased. Concerning infant feeding, the average attention of mothers increased with higher levels of education and an increased number of children. The findings suggest that demographic factors, such as age, education, and the number of children, play a role in maternal attention and distraction during infant feeding and caregiving.

In a study similar to Ventura et al. in 2017 in the United States, the prevalence of maternal distraction during infant feeding was investigated in a sample of mothers with children younger than 6 months. The overall prevalence of distraction was 43%, with 26% attributed to technological distractions. Interestingly, 92% of mothers reported experiencing at least one form of distraction during infant feeding, and 83% cited distractions due to technology.¹² In another study by Golen et al. in 2015 in the United States, it was reported that 52% of mothers with children younger than 6 months engaged in distracting activities during breastfeeding, with watching TV being the most common distraction. In addition, during approximately one-third (32.4%) of breastfeeding sessions, mothers reported using technological distractions. The overall prevalence of maternal distraction during at least one breastfeeding session was 83%, with technological distractions accounting for 78%.

Maternal distraction showed a significant association with parity and age, with higher distraction levels observed in multiparous women and older age groups. However, there was no statistically significant correlation between maternal distraction and maternal education, gender, or infant weight.¹¹ Tomfohrde et al. in 2016 demonstrated that more than 90% of mothers usually use social media or email during breastfeeding. In addition, 28% of women reported “always” using social media or email during breastfeeding. The main reasons for using social media during breastfeeding included “trying to stay awake,” “ignoring the passage of time and giving the infant enough time to breastfeed as much as desired,” “overcoming breastfeeding discomforts,” “searching for news,” and “finding information about breastfeeding and infant care.”¹⁷

While these studies align with the prevalence of maternal distraction in the present study, there are discrepancies in some factors related to maternal distraction. Cultural and social differences among mothers in different studies may contribute to these inconsistencies. In addition, societal conditions and technology use may change over time. The attention mothers give to their infants during early interactions plays a crucial role in cognitive development, psychomotor skills, and providing a secure foundation for children.¹⁸ However, when mothers use smartphones during breastfeeding, their attention to infants decreases,¹⁹ and many parents report that the use of smartphones and other technological devices disrupts family interactions.²⁰ These studies suggest that mothers' interactions with their children in today's digital world may pose new challenges for infant upbringing and maternal–infant relationships. Therefore, addressing these issues and enhancing mothers' awareness of effective technology use in meeting infants' needs are essential. For the healthy and intelligent upbringing of children, parents should pay special attention to early interactions and view technology as a supportive tool rather than an obstacle in family communications.

Limitations

The present study focused only on mothers who were within 42 days postpartum. In addition, a self-report questionnaire was used to collect data, which might overlook certain aspects of maternal distraction or be influenced by the self-report nature of the responses. The study design was cross-sectional, and causal relationships between maternal distraction and various factors, long-term changes, and the impact of time were not examined. Given these limitations, caution should be exercised in interpreting the study results, and further research considering these limitations is recommended.

Conclusion

It can be concluded that the level of distraction among young mothers with lower education levels during infant care or breastfeeding is significantly high. Considering the significant advancements in the production and availability of various media products, interventions to increase mothers' awareness of the importance of eye contact with infants and strategies for managing distractions are essential.

Footnotes

Acknowledgments

We would like to thank the Social Determinants of Health Research Center, Zanjan University of Medical Sciences, and vice-chancellor of research and technology for their financial support to carry out the study. We would like to thank the Clinical Research Development Center of Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, for their collaboration and computer advice.

Authors' Contributions

This study was one part of the MSc thesis of E.A. The conception, design of the study, and data collection process were undertaken by E.A. The first supervisor was A.M. who contributed to the design of the study and data analysis. E.J. as the advisor contributed to all the stages of the study. Setting the tables, interpretation, and reporting of the results were supervised by A.M. and E.A. All authors contributed to the drafting and revising of the article and agree with the final version of the article to be submitted to the journal; they also meet the criteria of authorship.

Ethical Approval and Consent to Participate

This article was part of the MSc thesis and approved by the Ethics Committee of the Vice Chancellor for Research of Zanjan University of Medical Sciences, Iran, with the approval number . All procedures of the study were in accordance with the protocol of the regional ethics research committee and with the Declaration of Helsinki 1964. After informing the study's purposes, written consent was obtained from all women. They were informed that their participation was voluntary, confidential, and anonymous, and were apprised of their right to withdraw from the research at any time (all the women provided written informed consent).

U.S.-Sanctioned Countries' Statement

All authors declared that they are primarily involved in medical research in research centers and that they are not directly supported by the government.

Disclosure Statement

No competing financial interests exist.

Funding Information

This article was part of MSc thesis and funded by the Research Deputy of Zanjan University of Medical Sciences, Iran, with the approval number (The code “A-11-344-29”).

References

Calil

VMLT

, Krebs

VLJ

, Carvalho

WBd

. Guidance on breastfeeding during the Covid-19 pandemic. Rev Assoc Méd Brasil, 2020; 66:541–546; doi: 10.1590/806-9282.66.4.541

Crowe

, Hanley

. Optimizing support for breastfeeding as part of obstetric practice. Obstet Gynecol, 2018:E187–E196. Available from: https://www.acog.org/clinical/clinical-guidance [Last accessed: November 15, 2023].

Agho

, Ahmed

, Fleming

, et al.; on behalf of the Global Maternal and Child Health Research Collaboration (GloMACH). Breastfeeding practices among adolescent mothers and associated factors in Bangladesh (2004–2014). Nutrients, 2021; 13(2):557; doi: 10.3390/nu13020557

Dieterich

, Felice

, O'Sullivan

, et al. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin, 2013; 60(1):31–48; doi: 10.1016/j.pcl.2012.09.010

Davis

, Sclafani

. Birth experiences, breastfeeding, and the mother-child relationship: Evidence from a large sample of mothers. Can J Nurs Res, 2022; 54(4):518–529; doi: 10.1177/08445621221089475

Pearson

, Lightman

, Evans

. Attentional processing of infant emotion during late pregnancy and mother–infant relations after birth. Arch Womens Ment Health, 2011; 14(1):23–31; doi: 10.1007/s00737-010-0180-4

Webster

. Virtual health care in the era of COVID-19. Lancet, 2020; 395(10231):1180–1181; doi: 10.016/S0140-6736(20)30818-7

Hood

, Zabatiero

, Zubrick

, et al. The association of mobile touch screen device use with parent-child attachment: A systematic review. Ergonomics, 2021; 64(12):1606–1622; doi: 10.080/00140139.2021.1948617

Brooks

, Longstreet

, Califf

. Social media induced technostress and its impact on internet addiction: A distraction-conflict theory perspective. AIS Trans Hum Comput Interact, 2017; 9(2):99–122. Available from: https://aisel.aisnet.org/thci/vol9/iss2/2

10.

Inoue

, Hashimoto

, Ohira

. Mothers' habitual smartphone use, infants during breastfeeding, and mother–infant bonding: A longitudinal study. Nurs Health Sci, 2021; 23(2):506–515; doi: 10.1111/nhs.12837

11.

Golen

, Ventura

. What are mothers doing while bottle-feeding their infants? Exploring the prevalence of maternal distraction during bottle-feeding interactions. Early Hum Dev, 2015; 91(12):787–791; doi: 10.1016/j.earlhumdev.2015.09.006

12.

Ventura

, Teitelbaum

. Maternal distraction during breast-and bottle feeding among WIC and non-WIC mothers. J Nutr Educ Behav, 2017; 49(7):S169.e1–S176.e1; doi: 10.1016/j.jneb.2017.04.004

13.

Kavšek

. The comparator model of infant visual habituation and dishabituation: Recent insights. Dev Psychobiol, 2013; 55(8):793–808; doi: 10.1002/dev.21081

14.

Ventura

, Hupp

, Gutierrez

, et al. Development and validation of the Maternal Distraction Questionnaire. Heliyon, 2020; 6(2):e03276; doi: 10.1016/j.heliyon.2020.e

15.

Beaton

, Bombardier

, Guillemin

, et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 2000; 25(24):3186–3191; doi: 10.1097/00007632-200012150-00014

16.

Osborne

, Costello

. Sample size and subject to item ratio in principal components analysis. Pract Assess Res Eval;, 2004; 9:11. Available from: https://www-proquest-com-s.web.bisu.edu.cn/docview/2366904332?pq-origsite=gscholar&fromopenview=true

17.

Tomfohrde

, Reinke

. Breastfeeding mothers' use of technology while breastfeeding. Comput Hum Behav, 2016; 64:556–561; doi: 10.1016/j.chb.2016.07.057

18.

Davis

, Delfosse

, Ventura

. Infant age moderates associations between infant temperament and maternal technology use during infant feeding and care. Int J Environ Res Public Health, 2022; 19(19):12858; doi: 10.3390/ijerph191912858

19.

Nomkin

, Gordon

. The relationship between maternal smartphone use, physiological responses, and gaze patterns during breastfeeding and face-to-face interactions with infant. PLoS One, 2021; 16(10):e0257956; doi: 10.1371/journal.pone

20.

Wong

, Tung

, Rao

, et al. Parent technology use, parent–child interaction, child screen time, and child psychosocial problems among disadvantaged families. J Pediatr, 2020; 226:258–265.