Association and influencing factors of knowledge, attitude and practice of breastfeeding among caregivers of children with cow’s milk protein allergy

Cow’s milk protein allergy (CMPA) is a common early food allergy in infants that can harm various organs. Preventing CMPA is crucial for global public health, and breastfeeding is an effective preventive measure. This study examined caregivers’ knowledge, attitudes, and practices (KAP) regarding CMPA in infants, identify influencing factors, and inform targeted interventions to reduce CMPA incidence. A survey assessed breastfeeding knowledge, attitude, and practices of caregivers of infants with cow’s milk protein allergy. Survey scores served as dependent variables. Statistically significant independent variables from univariate analysis were included in multiple linear regression. Non-parametric tests compared scores among caregivers with varying characteristics, examining attitude’s mediating role between knowledge and practice. All 1067 distributed questionnaires were returned. Caregivers exhibited relatively low breastfeeding knowledge (scoring rate 57.1%) and practice (50.0%) scores, with moderate attitude scores (66.7%). Both knowledge and attitude positively affected practice (P < 0.001), with attitude showing weak mediation. Professional caregivers scored higher in knowledge (P < 0.05) and attitude (P < 0.01), while higher-educated caregivers scored lower in practice (P < 0.001). Caregivers who received professional guidance or were encouraged by professionals to breastfeed showed significantly better breastfeeding behavior (P < 0.05 and P < 0.001, respectively). Both of them are protective factors for breastfeeding behavior in caregivers of infants with CMPA. The caregivers with sunken or short nipples have low knowledge levels (P < 0.01), and their breastfeeding practices, along with those of caregivers who had cesarean sections, are harmful (P < 0.001 and P < 0.05, respectively). The caregivers with a family history of food allergies showed more positive attitudes towards breastfeeding (P < 0.05), while those who had experienced mastitis scored higher in breastfeeding practices (P < 0.001). Both factors are seen as protective for breastfeeding attitudes and practices. Breastfeeding practices for CMPA infants in Wuhan require improvement. While caregiver knowledge and attitudes positively influence practice, societal/institutional support is essential, particularly for educated/working mothers. Hospitals should enhance the promotion and education of natural childbirth as a preferred option for expectant mothers, prioritize breastfeeding education, and offer personalized support to boost confidence in special groups. A supportive environment from society and families is crucial to enhance breastfeeding practices and reduce CMPA.