Showing posts with label extended breastfeeding. Show all posts
Showing posts with label extended breastfeeding. Show all posts

Monday, April 14, 2014

Yes, I'm "Still" Breastfeeding My Toddler

My third son, G, is now 31 months (that's 2 years and 7 months for those less month-county than I am). I had originally thought I would nurse him until he was two, as I had his older brother. However, during my fourth pregnancy, my milk dried up for the most part, several months before G turned two. I allowed him to continue to comfort-nurse and drink any colostrum he could extract, but I knew he wasn't getting all the benefits of breastmilk I had hoped to keep providing.

After Baby Y was born, when G was around 25 months, my breasts sprang back to life, overflowing with milk once again. I hadn't planned to "tandem nurse" - breastfeed more than one child at a time - but it sort of just happened that way. I hadn't stopped G from comfort nursing, and when he was actually getting milk again, he loved nursing even more.

In the early days, when Y was very little and needed to nurse often, I tried a few times to nurse the baby and G simultaneously. It was awkward and uncomfortable for me, but it was also the easiest way to please both of them.



Now, though, five months on, I don't try to nurse them simultaneously anymore. I leave the baby somewhere safe and happy, and I take G to his bed or mine. I find I don't mind nursing G by himself once in a while. It's a wholly different experience from nursing the baby. G only nurses once a day, at naptime, and not even every day. It's so easy to get him to lie down in bed and try to take a nap if I offer to let him nurse! It's incredibly cute how excited he gets when I agree to nurse him. He races down the hallway exclaiming, "I gonna nurse! You gonna nurse me! I gonna nurse! I gonna nurse in my bed!"

I've asked him what the milk tastes like, but all I get in response is "milk." Which is hard to argue with.

For those who are concerned about having enough milk for a toddler and a baby, you can absolutely nurse two children. Remember that your body makes milk based on the demand, so if you have a toddler and a newborn both demanding milk, your breasts will produce enough milk for both. See my series on nursing through pregnancy for more information about tandem-nursing a toddler and a newborn. My milk supply this time around is copious, partly because of my daily pumping in the first few weeks postpartum and partly because I nurse my toddler several times a week in addition to the baby's exclusive breastfeeding.

I never set out to be nursing a 2-1/2-year-old. I didn't have a specific plan for how or when to wean him completely. When his baby brother was born relatively close to his second birthday, I didn't think it was fair to G for Y to usurp his place at the breast at the same time he usurped his place as "the baby." We had long since night-weaned, so I didn't have the stress of trying to nurse two kids through the night. That might have affected how I felt about continuing to nurse him. Now, I would rather just nurse him once every couple of days than to deal with the tantrum and tears when I refuse. I'm sure if I refused enough times in a row, he would stop asking, but I don't see a reason to put us both through that stress right now.

I think when we talk about nursing an older toddler, one who speaks in complete sentences and has a mouthful of teeth and eats plenty of healthy foods and drinks water and juice and other milks, it's hard for people who haven't been there to understand that we're not just walking down the street, picking up a random toddler, and nursing him. We don't start out nursing a toddler. In fact, many women don't plan to nurse a toddler. Some mothers can barely look beyond the next day or the next week when they begin nursing their newborns. The progression from newborn to infant to toddler is so gradual that it seems natural once we're doing it. There's no switch that flips at one year or two years or 27 months or 33 months or September 4th or July 17th when it is suddenly no longer appropriate, necessary, or reasonable to be nursing a child. Most children will gradually wean on their own between two and four years of age, too busy with life to stop to nurse. But those children who continue to ask for it obviously still have a deep-seated need for the closeness of Mom, the sweetness of milk, the comfort of suckling, their first memories of shelter from the big, bad, scary world.

I think there's also a perception that when we say we're "still" nursing our two-year-old, or 27-month-old, or 34-month-old, that we mean we are nursing him like we would an infant, that he's coming to us six or eight or 12 times a day to feed, but it's not so. Most older toddlers nurse maybe once or twice a day, perhaps to help them fall asleep, or to go back to sleep at a night-waking. They may nurse more when they're sick, and it is a wonderful gift to give your sick child, the warm, disease-fighting, easy-to-digest milk tailored to his needs. But it's not the same as a newborn nursing for his sole source of nutrition, or an infant who only supplements his milk diet with solid foods.

How old is too old to still be nursing? Some would say once a baby has teeth, he should stop breastfeeding. Some say when the baby can ask for it, she should be weaned. Some say once he can ask for it in a complete sentence, he's too old. I think there's no rule. A child is too old to nurse when his own mother decides she is no longer happy or comfortable nursing him. A child is too old to nurse when he decides he doesn't need it anymore.

There was a wonderful research article written by anthropologist Katherine Dettwyler almost 20 years ago in which she set out to determine when a human child would naturally wean absent social constructs and societal pressure. Using several different methods based on other primates' weaning ages, she concluded that humans would naturally wean between 2.5 and 7 years of age, probably closer to the 4-6-year range. This is when the first permanent teeth start to come in (six-year-old molars erupt and baby teeth start falling out). She also examined other factors such as weight, length of gestation, and immune system development. All methods agree on that range.

I did not expect to continue to nurse G this long, but now I understand how it happens. You just... don't wean. Allowing a child to decide when he is finished nursing is called "child-led weaning" and is the most gentle and biologically normal way to slowly back away from breastfeeding. I don't think it will be long before I'm back to nursing just one baby. Often, G pops off and says he's done without falling asleep and without prompting. Many times, he tells me that "it's the baby's turn now" and sends me on my way. Interspersed are the days when he peacefully drifts off to sleep, one hand holding his blanket-lovey, the other resting gently on my breast. On those days, I unlatch him carefully (mindful of that mouthful of teeth), with a finger between his molars. Sometimes, he wakes up and runs off. Other times, he smacks his lips and re-settles, then sleeps for an hour or two on his own.

Will I still be nursing him when he's three? I don't know. I don't think so. I don't have a plan for when he has to stop breastfeeding. I'm sure he doesn't either. But the day will come, probably sooner than later, when Y gets all the milk to himself, and then some day, a few years down the line, my milk will dry up for good and I'll be done nursing forever. I see no reason to rush toward that day, and neither do my babies.

Saturday, July 27, 2013

Nursing During Pregnancy: Can I Continue to Nurse My Older Child after the Baby is Born?

Let's talk about breastfeeding and pregnancy! There are several issues at work here, and I'll be talking about a few of them over the course of this week. 

The questions I'll be covering are:
Can I Continue to Nurse My Older Child after the Baby is Born?

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Today's Question: Can I Continue to Nurse My Older Child after the Baby is Born?

If you're planning to nurse through your pregnancy, which we've established is safe and possible for most women, the next question that will logically arise is, What happens once the baby is born? Can and should I continue to nurse my toddler?

The short answer is, Yes! You absolutely can nurse more than one child at a time. Women with twins (and even triplets) do so successfully, and women also successfully and happily nurse a toddler and a newborn at the same time. Your body will make as much milk as your nurslings demand, so if two babies (or a baby and a toddler) are demanding milk, your body will increase production to meet that demand.

Nursing more than one child at a time is called "tandem nursing." You can nurse at literally the same time, with one child on each breast, or you can have them take turns.

Most women who have tandem nursed a toddler and a newborn have reported it to be a positive experience. It enables them to maintain that closeness with their toddler and continue to supply breastmilk to him or her, and it helps them to foster a bond between the toddler and the baby, as the toddler gets to "share" milk with the new baby brother or sister.

A few things to note if you decide to try tandem nursing:

1.  Feed the baby first.
Toddlers can eat solid foods, drink other milks and water, and should not need to nurse as much or as often as a newborn. Make sure you are meeting your newborn's nursing needs over those of your toddler, since nursing is your newborn's only source of nutrition. If your toddler is jealous of the time the baby has at the breast, you can make that time special for your toddler as well. Create a special "nursing basket" of activities you two can do together while the baby nurses, such as books to read or videos to watch, and bring those things out only when you sit down to nurse the baby.

2. Colostrum and newborn milk have laxative properties.
Breastmilk changes as your baby grows. The milk your body was making for your toddler was different from the milk your body will now make for your newborn. Colostrum and early milk have laxative properties, which means your toddler's stools may become looser when he starts getting that sweet, runny newborn milk. Just as a word of warning!

3. Your toddler will likely want to nurse more.
It's very likely that the increased flow of milk your toddler gets now that your body is back to making milk for a full-time nursing newborn will make him want to nurse more often. He will enjoy the flavor and volume of the milk. It is up to you to set limits on his nursing so that your newborn still gets "first dibs" on your milk.

What if I don't want to tandem nurse?
If you decide you don't want to try tandem nursing, you should wean your toddler at least six weeks before you expect the baby to be born. You want to establish the habit of not nursing before he sees a baby brother or sister nursing regularly. Some toddlers will be curious about nursing even if they've been weaned for a long time, and some will even ask to try it. This did not happen with my sons, but I have heard of this from other mothers. Some choose to allow the toddler to try nursing. Most toddlers who have been weaned for more than a month or two (or even a week or two) don't remember how to latch and cannot draw out any milk and quickly lose interest. If they do manage to get milk, many are no longer accustomed to the taste and find their usual foods more interesting.

If you have any questions about nursing during pregnancy, feel free to ask in the comments or on the Facebook page.

Did you nurse through your pregnancy? What issues, if any, did you encounter? Have you tandem nursed? Would you encourage another mother to try tandem nursing if she is unsure? What additional advice do you have for nursing through pregnancy or tandem nursing?

<< Previous: What are Some Other Concerns about Nursing through Pregnancy?

Friday, July 26, 2013

Nursing During Pregnancy: What are Some Other Concerns about Nursing through Pregnancy?

Let's talk about breastfeeding and pregnancy! There are several issues at work here, and I'll be talking about a few of them over the course of this week. 

The questions I'll be covering are:
What are Some Other Concerns about Nursing through Pregnancy?

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Today's Question: What are Some Other Concerns about Nursing through Pregnancy?

Now that we've addressed the efficacy of breastfeeding as contraceptive and of some of the safety concerns related to breastfeeding and pregnancy, let's look at some of the other issues some women have with nursing during pregnancy.

1. Sore breasts/nipples

Pregnancy can cause your breasts to be tender and your nipples to be sore whether you're breastfeeding or not. Many women report that nursing becomes very painful during pregnancy because of extremely sensitive nipples or nipple/breast tenderness. Not everyone will experience this, just as not everyone will experience other hormonal side effects of pregnancy. Some women find the pain bearable while others decide to wean or cut back on nursing because the pain is intolerable. Sometimes this pain can be helped a bit by ensuring that your toddler's latch is as good as possible. Toddlers can tend to become lazy about latching properly, and often we as mothers don't worry too much about correcting them because it no longer bothers us. However, a bad latch can make already existing nipple pain that much worse. If you suddenly notice sore nipples even if you've been nursing pain-free through your pregnancy so far, check for thrush. The hormonal disruptions of pregnancy can make some women more prone to yeast infections. It may also be that the nipple soreness is hormonal but is beginning later in the pregnancy. My nipples did not become appreciably sore until the second trimester.

2. Nausea

If you experience morning sickness, it can be that much harder to deal with a baby or toddler climbing you and demanding your attention. For some women, the act of nursing also increases the nausea. If your morning sickness generally goes away after the first trimester, you may find that you can stick it out knowing it will probably get better in a few weeks. Also, make sure you are sufficiently hydrated. I've found that dehydration can make the nausea much worse, and breastfeeding can add to the dehydration, especially in summer.

3. Physical discomfort

Pregnancy can cause pain in your lower back, ribs, and hips, and your growing belly may make it difficult to find a comfortable position in which to nurse. Fortunately, toddlers can be very creative about how and where they nurse, so your child may solve this problem for you! Experiment with different positions and try nursing in different places to find a tolerable and workable position.

4. Feeling "touched out"

The hormones of pregnancy make some women not want to be touched intimately, especially if they are also feeling ill from morning sickness or experiencing other bodily discomfort. The demands of a nursing toddler can compound these feelings of simply not wanting to be touched. Some women talk about how nursing makes their skin crawl. I found that occasionally I get "restless legs" while nursing. Unfortunately, there's not much to be done about this "touched out"-ness, except to try to find time for yourself if you can to settle your nerves.

5. Guilt

If you lose your milk or find you need to wean because of the pain or discomfort, you may feel guilty that you were not able to nurse your child as long as you'd hoped to. I had planned to nurse my third son until he was two, but my milk dried up about two months ago, when he was only 19 or 20 months old. I still allow him to "dry nurse" (nurse even though there's no milk) once a day for his nap for two reasons. One is so that he is not deprived of that closeness, and the other is so that he doesn't forget how to nurse, so that I can make the decision later whether to allow him to continue nursing after his brother is born. (This is called tandem nursing and will be addressed in the next section of this article.) Remember that even if you do have to wean completely before you had planned, you still gave your child as much as you could, you still love your child, and there are many other ways that you will continue to express that love. Remember, also, that when you begin nursing your new baby, you will find new ways to connect with your older child, and, if you want, you can even share some expressed breastmilk with your older child.

<< Previous: Is It Safe to Breastfeed while Pregnant | Next: Can I Continue to Nurse My Older Child after the Baby is Born? >>

Wednesday, July 24, 2013

Nursing During Pregnancy: Is It Safe to Breastfeed while Pregnant?

Let's talk about breastfeeding and pregnancy! There are several issues at work here, and I'll be talking about a few of them over the course of this week. 

The questions I'll be covering are:
Is It Safe to Breastfeed while Pregnant?

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Today's question: Is It Safe to Breastfeed while Pregnant?

The short answer is: Yes! For most women, it is perfectly fine to continue to breastfeed throughout pregnancy.

There are generally three concerns raised about breastfeeding during pregnancy. These are:

1.  Breastfeeding releases oxytocin, which also causes uterine contractions.
2.  Making breastmilk requires quite a lot of the mother's resources.
3.  Pregnancy will cause your milk to dry up.

Let's take a look at each of these concerns.

1. Breastfeeding releases oxytocin, which also causes uterine contractions. 

This is true. Oxytocin is the main hormone that stimulates the uterus to contract during labor. Oxytocin is also released during orgasm and breastfeeding and is called the "love" hormone, because it encourages the bond between mother and baby or between partners.

Some women are concerned that the oxytocin released during breastfeeding may cause her to go into labor prematurely. Indeed, nipple stimulation (which is what causes the release of oxytocin) is one method of "natural" labor induction for women near or beyond their due dates. It is important to remember that your uterus is contracting occasionally throughout your pregnancy whether you are breastfeeding or not. These are not as strong or as regular as labor contractions, but they are normal and expected and are thought to "warm up" the uterus for labor. 

As mentioned, oxytocin is also released during orgasm, and sexual intercourse is considered safe for most women during pregnancy. Breastfeeding, as well, can continue through pregnancy.

Uterine contractions brought on by breastfeeding may become a concern if you have any complications, including a history of preterm labor. Please check with your care provider if you have reason to think breastfeeding during pregnancy may not be safe in your situation.

2. Making breastmilk requires a lot of the mother's resources.

This is also true. Making breastmilk requires nutrients and calories from the mother, just as pregnancy does. Some women may be concerned that they cannot take in enough to handle this doubled demand. 

However, unless you are already malnourished, there is no reason that you cannot eat and drink enough to provide for your nursling and your developing baby. Eat to your hunger and drink to your thirst. You will probably notice an increase in appetite and thirst, but that is reasonable given the amount of calories your pregnancy and breastfeeding combined will require. This will also depend greatly on the age of your nursling and how much he or she still nurses. An older toddler who is only nursing a couple of times a day will not require many additional calories from you. If your baby is still under a year old and mostly relies upon your milk for sustenance, you may find it more difficult to keep up. If he or she is old enough, you can try offering more solid foods if you need to cut back on nursing.

3. Pregnancy will cause your milk to dry up.

This may be true in some cases. For some women, the hormones of pregnancy will cause a supply drop in preparation for the switch back to colostrum when the new baby is born, while others continue to nurse regularly and comfortably all the way through their pregnancies. For some, supply problems begin almost immediately, while for others, the supply dip or drying up occurs during the second trimester. There's no way to know in advance whether you are one of these women, and an ample supply pre-pregnancy is not a predictor. I had plenty of milk before I became pregnant and did not expect pregnancy to affect my supply. Instead, I found my supply quickly dwindled to nothing despite my toddler's continuing to nurse. I could tell that he was eating considerably more solid foods and receiving very little breastmilk. I had trouble expressing even a couple of drops of milk by the middle of the second trimester. Some women are able to combat this supply dip by using foods and herbs that can increase milk supply, but this will not work for everyone.

You need to be aware of this possibility, because if you do become pregnant while your baby is still under a year old, it may be difficult to continue to meet his needs if your milk does dry up. You should take this into consideration if you're considering allowing breastfeeding to be your only form of birth control. (See the previous post for more on breastfeeding as contraception.)

Remember that this possibility doesn't mean you shouldn't at least try to continue breastfeeding during your pregnancy, if that is your desire.

<< Previous: Can I Get Pregnant while Breastfeeding? | Next: What are Some Other Concerns about Nursing through Pregnancy?

Tuesday, July 23, 2013

Nursing During Pregnancy: Can I Get Pregnant While Breastfeeding?

Let's talk about breastfeeding and pregnancy! There are several issues at work here, and I'll be talking about a few of them over the course of this week.

The questions I'll be covering are:
Can I Get Pregnant while Breastfeeding?

***

Today's question: Can I get pregnant while breastfeeding?

The short answer is: Yes! It is certainly possible to get pregnant while you're still nursing. 

Let's break it down, though. 


Breastfeeding is a natural contraceptive, given to us by nature to assist with child spacing to encourage safer and more viable pregnancies and childbirth and to ensure that there would be adequate resources for the existing child before another was born. However, the advent of agriculture, the addition of regular complex carbohydrates to our diets, our ample food supply, and the disruption of natural breastfeeding rhythms in favor of a more "scheduled" life have all weakened breastfeeding's ability to suppress ovulation.

Breastfeeding is as effective (over 99%) as the Pill for contraception provided you meet all of the following criteria:
1. Your baby is under six months old.
2. Your baby breastfeeds at night as well as during the day and sleeps in close proximity to you.
3. You use no artificial nipples (no bottles, no pumping, no pacifiers - all feedings and comforting are at-breast).
4. Your period has not returned.

This means that some women can get pregnant even while breastfeeding and meeting these conditions, just as some women can get pregnant while taking hormonal birth control correctly. However, most women will find exclusive breastfeeding to be very effective as contraception during the first six months. If a new pregnancy is absolutely not an option for you, consider using a backup method as well, such as condoms, hormonal birth control*, or an IUD.

*A note about the Pill: There are several forms of oral hormonal birth control (the Pill). There is evidence that the estrogen in the combination pill may have an effect on milk supply. It is recommended that nursing mothers who wish to use hormonal birth control try the "minipill," which contains only progesterone. The minipill is very effective, but only if used exactly as directed, which means that you must take it at exactly the same time every day. If you don't feel that this is realistic for you, talk with your OB or midwife about other birth control options.

After six months, you cannot rely upon breastfeeding alone for contraception. Some women find they are unable to get pregnant when they are breastfeeding at all, while others begin ovulating as soon as their babies start going longer between feedings, start sleeping through the night, or begin eating solid foods in addition to breastmilk.

Also, remember that you ovulate before you have a period, meaning that it is possible to become pregnant the first time you ovulate after giving birth, even if you haven't had a period yet.

I did not use any birth control after the birth of my third child, and breastfeeding alone prevented the return of my period until my baby was 12 months old. I got pregnant when G was about 16 months old, meaning I had about four periods before conceiving. G was still nursing pretty often, including at least three or four times at night, but he was also eating solid foods. My cycles were very irregular, ranging from 33 days to 57 days, and it was quite nerve-wracking when my period was so unpredictable. I took many, many pregnancy tests during that time! That's just my experience, but I think it's a fairly common one. If you decide to go the "let's let nature take its course route," be aware that you may not know you're pregnant until you finally decide to take a test!

Next: Is It Safe to Breastfeed while Pregnant? >>

Sunday, January 13, 2013

So You Want to Stop Nursing

There will come a time in your baby's life when you no longer want to breastfeed, or he no longer wants to breastfeed, or you come to some kind of mutual agreement that breastfeeding needs to stop. Or, sometimes, it's out of your hands and a medical condition requires you to stop breastfeeding. What do you do?

Well, some of it depends on the age of your baby. Unless there is a medical condition that requires prompt weaning, I personally would not recommend weaning before at least three months of age. I encourage and champion mothers to continue to nurse exclusively until at least six months, as per the AAP, WHO, and other health organizations' recommendations. I also encourage and champion mothers to continue to nurse in tandem with feeding other foods from six months to one year, and I also encourage and champion mothers to continue nursing beyond a year until they are ready to stop.

Alternatives to Total Weaning:

A few points to consider before you decide to wean completely, whatever your reasons:
  • Sometimes cutting back to just a couple of sessions a day can make nursing more enjoyable. If your baby is over a year and eats well, you can introduce whole milk and try to cut back to only nursing once or twice a day. (This is partial weaning, and some tips for doing this will follow.)
  • Just because a doctor prescribes a medication and says you can't nurse while on it doesn't mean that it's true. Doctors don't always know which medications are truly compatible or safe for breastfeeding, and they tend to err on the side of caution. If you need to take a particular medication, first find out if there is a breastfeeding-friendly alternative, or double-check if that medication is truly dangerous to your child or your milk supply. You can check Dr. Hale's Medications and Mothers' Milk or go to the Infant Risk Center's website and look up the medication, or give the Infant Risk Center a call at  (806)-352-2519.
  • While in the thick of it, nursing for six months or a year may seem insurmountable, but it's really a very short time in the scheme of things. It will get easier as you go along, and while you may never enjoy nursing, it should become less of a chore. Stick with it for just a little longer and see how you feel.
  • It's normal to sometimes feel overwhelmed by nursing, especially if you have a baby who nurses frequently. Set yourself small goals, like one more week or one more month or even just one more feeding. Often after a few days, that feeling will pass and you'll again be content to continue nursing. Sometimes life gets complicated and it seems like weaning would be an answer to the complications, but once things lighten up, nursing won't seem like such a burden.
Okay, but you really do want to cut back or stop. How?

First of all, no matter the age of your baby, I recommend taking it in gradual steps (if possible), rather than stopping cold turkey. If you're going from mostly breastmilk to mostly formula, it's going to be very hard on you and your baby to stop very suddenly. You will become very engorged and risk developing plugged ducts and mastitis. Your baby's system will be shocked by the change and he may become physically uncomfortable as well as emotionally upset. After about three days to a week, both of you will feel better, but I do not recommend cold-turkey weaning if it can be avoided, especially with a young baby.

Immediate Weaning of a Young Baby:

If you do have to stop immediately, here are a few ideas to ease the transition.
  • If the baby won't take a bottle from Mom, try to have other people around who can help feed the baby while you wean: Dad, a baby-sitter, grandparent, etc. Sometimes a baby won't take a bottle when Mom is around because the baby wants to nurse.
  • Make sure you still give baby lots of cuddles, hugs, kisses, and love. Sometimes having to wean suddenly, especially if you didn't want to, can make it hard to find ways to connect to the baby, and you want to make sure you maintain your closeness even when you can't offer the breast. 
  • Remember: Even if you can't nurse, you can still co-sleep, do skin-to-skin, wear your baby, and find other ways to support your baby physically and emotionally. 
  • You don't want to bind your breasts because that could cause plugged ducts and mastitis. 
  • Chances are, you will become engorged as soon as you've missed the first feeding or two. You may express a small amount of milk to relieve any immediate discomfort, but removing milk will encourage your body to make more, so be careful.
  • Other ways to help with the engorgement and dry up your milk:
    • Cold compresses will help slow blood flow (and milk production) and ease some of the pain. You may also take a pain reliever.
    • Cold cabbage leaves in your bra. Buy a head of cabbage and keep it in the fridge. Pull off a leaf and break the veins, then put it on your breast inside your bra. When it warms up, put a new one. Repeat as needed.
    • Avoid warm water directly on your breasts, as this will stimulate blood flow.
    • Try to avoid foods that encourage milk production, such as oatmeal and the spice called fenugreek often found in Indian food.
    • Some women find that herbs such as sage and mint reduce their supply.
    • As a last resort, medications such as pseudoephedrine (Sudafed) may reduce milk supply as well.
  • This may be a difficult time for you emotionally. Be sure to continue to care for your baby in other ways. Ask your family and friends to help you watch out for signs of depression.
Milk Donation:

If you as the mother are the one with the medical condition requiring weaning, there are ways to continue to provide breastmilk to your child if you want. There are several mother-to-mother milk donation sites that match up willing donors with mothers in need. These include Eats on Feets, Milkshare, and Human Milk 4 Human Babies. Typically, the agreement is that one or more women will pump for the baby and supply you with their milk, and you will cover the costs of any shipping (if the donor is not local) and for storage bags. This can be a great alternative to formula, or you can feed your baby a combination of donated milk and formula.

If your baby has a medical condition that requires you to wean from breastmilk but you are not certain you want to dry up your milk, you can continue to pump and save your milk to donate via one of the sites mentioned above, or you may be able to donate to a Human Milk Banking Association of North America milk bank (HMBANA), a nonprofit organization which provides donated breastmilk to preemies and other babies in need. Helping other babies via your breastmilk may help you come to terms with the emotional loss of having to stop nursing your own baby.

Gradual Weaning of a Younger Baby:

If you do not need to wean immediately for a medical reason, weaning can be a much more gradual process.

To gradually wean a very young baby (under three months), you may just have to offer a bottle of formula instead of nursing when your baby shows signs of hunger. Slowly give more bottles and nurse less often until you've found the balance you want. Keep in mind that you may not be able to maintain a partial supply if you wean before three months postpartum. Again, I do not recommend weaning such a young baby from the breast, as those first three months are vitally important to his development, the population of his gut flora, his brain and eye growth, his immune system, and his bond with you. However, if your health or your baby's health depend on your weaning from the breast, then it may not be difficult. Some babies will reject a bottle, and it may be a matter of basically forcing the issue (a baby won't let himself starve) or finding an alternative feeding method until he is ready to take a sippy cup instead. Also, sometimes a baby will prefer one bottle over another, so it may be worth trying a few different brands.

Gradual Weaning of an Infant:

For an infant, the ease of weaning will really depend on whether your baby is willing to take a bottle, and if he tolerates the flavor of formula. As above, it may be as straightforward as replacing a breastmilk feeding with a formula feeding. Remember that until six months of age, the only thing your baby should be eating is breastmilk or formula. If he takes a bottle but doesn't like the flavor of formula, you can try mixing expressed breastmilk with formula and gradually increasing the ratio of formula to breastmilk until he's completely on formula. You may also need to experiment with the temperature of the bottle. Some babies prefer a cold bottle, while others will only take it warm. Some don't have a preference. If he doesn't take a bottle, it may be difficult to introduce one. For a baby over six months, you may try to increase his solids intake or try mixing formula with his cereals or vegetables so he gets the nutrients he needs. You can also try offering formula in a sippy cup or straw cup, as some kids won't mind drinking from a vessel completely different from the breast even if they don't like the bottle. From six months to one year, gradually increasing solids and decreasing feedings from the breast may be all you need to do, and taking several months to completely wean will make it a very gradual and comfortable process.



Remember that until one year of age, breastmilk and/or formula should still make up the majority of your baby's diet, not solid foods. Also, do not introduce whole milk until one year of age.

If your baby relies on nursing to fall asleep or stay asleep, you'll have to take that into account when you decide to wean. You may need to have someone else put the baby to bed for a few nights so that you can break the association of nursing and sleep. I'm not saying it's going to be an easy process, but after three nights to a week, your baby should be used to falling asleep without nursing. It may take a few tries to find what new technique works best, but some ideas to try are rocking, shushing, singing, using a pacifier, putting white noise in the room, swaddling (for younger babies), and patting.

Weaning a Toddler:

For toddlers, weaning may be both more difficult and more simple. Since toddlers can get all the nutrition they need from solid foods and cow's (or other whole) milk, you won't need to worry about introducing a bottle or giving formula. However, toddlers also know how to ask for (demand) what they want, and they've learned to associate nursing with comfort, care, and closeness and may ask for it even when not hungry. However, toddlers also start to understand language, so it can help to talk to them about the weaning process (in an age-appropriate way). You can use phrases like, "No nursing right now. Do you want a snack?" or "You can nurse after ____ (we get home, you eat some peas, we read this book, whatever)," for example.

Many websites will suggest that, to wean, you eliminate one session per day and offer food or water instead. This is not so simple if you're nursing "on demand" still or do not have a predictable nursing schedule. Here are a few other suggestions I can offer for weaning a toddler. I suggest choosing one of the following techniques and sticking with it for a few days, rather than trying several at once or switching from one to another randomly. As with anything else with a toddler, consistency is key.
  1. Have a designated nursing area in your house. Only nurse there. It could be a special chair, the living room couch, your bed, his bed, etc, but be consistent. "You want to nurse? Okay, let's go to the nursing chair (or Mommy's bed, or whatever)." Sometimes a toddler will be too busy to actually want to go somewhere else and nurse. This can also discourage nursing when out and about (if you want to do that) because the "nursing place" won't be available.
  2. Make a rule about when you nurse that your toddler can understand. Only nurse at night or when the sun is up. Only nurse for sleeping. Only nurse after a meal. Only nurse when we get home from X. Whatever works for your routine.
  3. Rather than cutting back on the number of sessions, cut back on the duration. Start counting, or sing the ABC's or other song, or something that your toddler will understand the "end" of. Say that when you get to the end, or when you get to X number, that he has to stop nursing, and then make him stop. You can start out by not beginning the countdown until he's been nursing for a solid amount of time, and then gradually start the countdown earlier in the sessions once he's used to stopping at the end of it. 
  4. As a last resort, you can try purposely drying up your milk. This may not eliminate the comfort-nursing, at least not at first, but if there's no milk, nursing won't be as satisfying. Again, this would be a last resort. There are herbs (such as sage and mint) that can cause your milk supply to drop, as well as medications that may have a similar effect. This information may be more useful to dry up your milk after you've weaned.
Remember that as you wean, you'll need to replace nursing with something else. Nursing isn't just about food, it's also about comfort, closeness, love, reconnecting, and snuggles. You'll need to make sure he's getting his nutrition from other sources, but you'll also need to meet his emotional needs by allowing lots of cuddles, hugs and kisses, telling him that you love him, and reassurance. 

I want to reiterate that I'm not saying weaning will be easy. Indeed, weaning can be very difficult. Yes, some kids wean themselves. Some begin to prefer the bottle over the breast and simply don't want to nurse anymore. Some mothers find that their milk supply dwindles on its own (such as during pregnancy), which discourages their babies from nursing. Some toddlers are just too busy to stop and nurse. 

If your baby isn't one of those, then weaning will be a challenge. If you decide to say no, you have to stick with it. Your toddler may scream and cry. He may throw a tantrum (he's a toddler, after all). He may hit and kick and claw at you. This depends on your kid, of course, and how he handles being told no (and how attached to nursing he is). You may need to physically separate yourself until he calms down. You will need to find ways to handle the tantrums safely. You can treat nursing and weaning just like anything else you want your child to learn: manners, how to treat friends, sharing, picking up toys, not throwing food on the floor, cooperating during diaper changes. Be consistent and firm.

You may also find that once you have gained some control of the situation, nursing will become more tolerable or even enjoyable. When you're nursing on your terms instead of your toddler's, and you don't feel that your toddler is taking advantage of you, you may find that you don't need or want to wean completely. In this case, you may also want to try the "don't offer/don't refuse" method, whereby you don't ask your toddler if he wants to nurse, but if he asks, you consent. Over time, the child may simply ask less often as he becomes busier and more interested in the world. This is called "child-led weaning," as opposed to "mother-led weaning," and it is a method that works well for some women who are not in a hurry to wean but don't mind cutting back. It also depends on how attached your toddler is to nursing.

If you have weaned or partially weaned your baby or toddler and would like to share how it went for you, please comment with your story. If you have questions for those who have been through the weaning process, please post them in the comments as well. Weaning can be a touchy subject, but at some point, all kids stop nursing, so weaning is relevant and important to discuss.

Read my story about nursing and eventually weaning my middle son, S, here. I haven't started weaning G yet, but I have been known to tell him no or put him off for a bit, either by distracting him or by offering food. He's also used to mostly only nursing in bed, so that has helped keep him from asking to nurse 20 times a day.

Monday, October 29, 2012

Breastfeeding a Toddler

GI is 13 months old and "still" breastfeeding. It's not as if I expected him to suddenly stop when he turned one. I also don't have any intention of cutting him off at some arbitrary and magical age. He and I will both know when he's ready to taper off and stop. What this means is that I am now officially breastfeeding a toddler. And that is a whole new ballgame. He's no tiny baby anymore!

Toddlers have some very clear ideas about their world. They want what they want when they want it, and they will let you know in no uncertain terms if they are unhappy with your response. And when they want to nurse, you'll know about it.

Toddlers are not newborns. They don't need to nurse on demand. They can eat solid foods, drink from a cup, and feed themselves (messily, to be sure). GI can be just as happy sitting in his high chair with some finger foods as cuddled in my arms nursing. Well, almost as happy. If he's hungry, though, food will suffice for him if it's not a good time to nurse him, or if I just don't feel like it. The only time it's nurse or bust is when he's tired and wants to fall asleep, and then I'll lay down with him in bed and let him nurse until he drifts off. Sometimes it's even that simple.

Toddlers are little people whose brains are developing at an incredible rate. One of the things they start learning is the difference between need and want. At the same time, they're learning to understand an incredible number of words. You'll notice your little one start to be able to follow directions, identify body parts, look at named people, point to pictures of objects and animals you name, and so on. This is called "receptive" language, and it develops much more quickly and earlier than "expressive" language. Expressive language is talking. A baby and toddler can understand an instruction or word much earlier than he can say it. This is frustrating, because he wants to tell you something, knows there's a way to do it, but can't make his mouth cooperate.

This is where teaching him some simple signs or syllables to express his need can be very powerful. When a baby or toddler can ask for what he wants and know that you understand his desire, his frustration evaporates. When a toddler can express his need, both of you can be on the same page. Pick a few basic expressions for your toddler to use first. I imagine "nurse" or "breastfeed" will be high on the list of frequently-requested items. I recommend the following three words: nurse, eat, and more. Those three words seem to satisfy most of my toddlers' basic requests.

So, when GI started trying to pull my shirt off whenever he wanted to nurse, I knew it was time to really start to work with him on using a hand sign or word instead. I had been trying to teach him the ASL word for "more," which is a simple sign that most toddlers can manage some form of. It looks like this:

I wanted him to use this sign when he wanted more of something, instead of grunting and whining or shrieking. Whenever he seemed to want "more" of something (especially food!), I'd first ask, "Do you want MORE?", emphasizing the word "more" and making the hand sign at the same time. When he would tentatively make the sign, I'd heap on the praise ("Very good! You want MORE! You signed MORE!"), repeat the sign, and then give him more. He eventually started to catch on. He then decided that "more" meant eating, which was fine. This evolved to his making the sign for "more" whenever he wants to nurse. But that's also fine. I understand it. He understands it. And he doesn't pull on my shirt collar anymore. Instead, he signs. It's really amazing. He even signs when he's half asleep and wants to nurse back to sleep! 

I will continue to work with him on differentiating signs, using "more" in context, as well as introducing "eat" (bringing the fingers to the mouth) and "nurse" or "milk" (opening and closing the hand as if milking a cow). The other day, he learned "water" with just a few repetitions; now that he understands that making a sign is communicating a need, he is very receptive to learning more signs. The ASL sign for water is sort of making a "W" with your fingers and tapping your index finger against your mouth. His version is to tap his mouth with one finger, but he's very clear about it. Toddlers can't really make a "W" with their fingers, so you may have to modify certain signs to make them easier. You can also make up your own signs, as long as you're consistent about how you form it and when you use them. I'm very excited to have made the first step, which is encouraging a behavior I prefer and discouraging a behavior I don't like (i.e., signing a need is preferable to shrieking).

In general, if your toddler has a nursing behavior that irritates you, you don't have to put up with it. You can talk to him, tell him that you don't like what he's doing. End the nursing session if he continues. When he behaves nicely while nursing, praise him. "I like how calmly you're nursing. Mommy likes cuddling with you like this." Or whatever. When saying "no" to something, use short, simple phrases. "No bite! Hurts Mommy!" The more words you use, the less they hear.

Toddlers are notorious for "nursing gymnastics." They don't stay in one place while they nurse. Their whole body moves, except for their mouth, attached to your nipple. Toddlers will nurse in weird positions, roll around, kick, fiddle with anything they can get their hands on (like, say, your other breast), and crane their neck to see something blocked by your body. Nursing a toddler can be uncomfortable and annoying. I'm not gonna lie.

The best way to make nursing your toddler more enjoyable is to teach nursing manners. Just as you would teach him to say please and thank you, not to hit or pinch or bite others, and to share his toys, you can teach him not to bother you while he nurses. Give him something to do with his hands, like hold a blanket or toy, or wear a nursing necklace. End the nursing session if he begins a behavior you are trying to eliminate. Toddlers are smart. They'll catch on quickly that they don't get their nursies if they pinch Mommy.

If and when you do decide to wean, having already set limits will help. You can get your toddler used to your saying "no" sometimes to nursing, to being offered food or drink instead, and to limiting the length of the nursing session. You can designate a special place in the house for nursing, such as your bed or his, or a special chair, and only nurse there. Or, you can start limiting when they nurse, such as only for naps and bedtime, or only when it's light outside, or only when brother is sleeping. You can decide what methods work best for you. I'm not saying it's going to be easy, but if you give it time and move slowly, weaning can be relatively painless, with the occasional tantrum or screaming jag. But that's true of anything when it comes to toddlers! 

I have found that I can tolerate or even enjoy nursing my toddler more when I know I have a choice about it, and when I have gained some control after a year of nursing on demand. It's certainly okay to nurse your toddler on demand, if you want to or feel he still needs it, but let's admit that it's not always practical. And I'll let you in on a little secret: once your toddler figures out he can ask for it, he'll ask for it constantly. So you'll probably need to say no once in a while!

Nursing a toddler is not weird. It is not exceptional or extraordinary or "out there." It's not unusual. It's not harmful to you or him (quite the opposite, in fact!). Nursing a toddler is worthwhile. It is rewarding in a way different from nursing a younger baby. Nursing a toddler is magic for soothing a booboo or calming a tantrum or distracting. Nursing a toddler is normal, and you should feel comfortable nursing your toddler whenever and wherever you and he want to.

Tuesday, May 15, 2012

On Labels

I've recently come up with a theory about parenting. That theory is that once you put a label on a parenting choice, once you name it, you've suddenly created a division or cause that never existed before, even if the practice itself is as old as time.

For example:

"Cosleeping."

I think waaaay more parents "cosleep" than are willing to admit it. The number of parents I've talked to who mention something about their child climbing into bed with them, sleeping on their chest, having to be coerced or bribed to stay in their own beds, only being able sleep cuddled up with one of them, only being able to fall asleep if Mommy or Daddy is lying in bed with them, only being able to go back to sleep if allowed to climb into Mommy and Daddy's beds, far exceeds the number of parents who simply say, "Yes, we cosleep." Cosleeping is a term that loosely refers to any arrangement whereby a baby, toddler, or small child sleeps with a parent. People who "cosleep" (and call it that) typically went into it on purpose; that is, they said, "Yes, we're going to let Jack sleep with us." On the other hand, plenty of parents "accidentally" cosleep, in that Jack will only fall asleep or stay asleep if nestled on Daddy's chest or with Mommy's arm around him.

I'll never forget baby-sitting a four-year-old girl when I was about 12, and part of my instructions in putting her to bed was to lie down next to her and put my arm around her until she fell asleep. I think it's fair to call that cosleeping, even if it's only for a brief period. And how many times had her parents fallen asleep like that, only to wake three hours later and groggily stumble back to their own bed? But I bet they never said "We cosleep."

Granted, there are plenty of parents who absolutely, positively do NOT allow their child to be in their bed EVER. But I bet it's fewer than you think.

But, suddenly, when you ask someone if they cosleep, or you tell someone that you cosleep, or coslept, or plan to cosleep, or are trying to stop cosleeping, it becomes a weird parenting "thing" that only some people do, the crunchy ones, the ones who can't let their kids go. Believe me when I tell you, I want nothing more than for my child(ren) to sleep in their own beds so I can stretch out comfortably at night. But I'm too lazy to wake up all the way to nurse somewhere else, so I'm stuck curling up with GI for a while longer. (I don't really mind that much. If I did, I'd have changed it by now.) But my husband and I also think it's good for our kids to know that if they need the security of Mommy or Daddy curled up next to them, they can have it. Certainly NJ and SB sleep the vast majority of nights on their own at this point, but it's a fairly common morning that sees all five of us in the same bed. But then, I'm one of "those" parents who actually admits to cosleeping.

What else?

"Extended breastfeeding."

I think waaaay more mothers continue to nurse past the first year than are willing to admit it. I think even mothers who desperately wanted to wean at a year or who think it's odd or wrong to nurse a toddler might find it more difficult than they expected to suddenly withhold the source of comfort and nutrition that their beloved baby has relied upon her whole life. I think plenty of mothers continue to nurse a couple times a day well past the first birthday, if only because they can't find a way to stop, or they realize that just because they've flipped another page in the calendar doesn't mean a switch has suddenly flipped in the baby's head that says "okay, I don't need to nurse anymore." I think plenty of toddlers get to cuddle up to Mommy's breast once or twice a day, even if Mommy doesn't come out and say, "Yes, I'm an extended breastfeeder." There's a lot of stigma against nursing a kid who can "ask" for it in the Western world, especially in the U.S., and I think it's entirely probable that if the "practice" of "extended breastfeeding" were more acceptable, we'd find out that plenty more women are doing it than we expect.

I know I purposely nursed SB long past his first year (I weaned him at 25 months). I know I have every intention of nursing GI just as long. So maybe I'm an "extended breastfeeder," but, really, I think I'm just a mom who sensed that her son still needed his "nur" well into his second year of life. Anyway, I had no idea how to get him to sleep without it.

I know other women who wanted to wean at a year. Some did it. Others found it not to be such a simple prospect, for whatever reason. Are they "extended breastfeeders"? I don't think they'd call themselves that. I think they'd just say, "Yes, I'm still nursing," if asked. And so what? Do we need to label every last parenting decision we make?

Perhaps the labels serve a purpose. If we have a label, we can bypass a great deal of explanation and jump right into the arguing. Maybe this isn't such a good thing. Maybe if we were required to still explain ourselves before the other person has labeled us, then that other person would be more understanding. Instead of saying "We cosleep because...", when the other person has already decided that you're a ridiculous person because you "cosleep," maybe we can say, "I let Horatio sleep with me for a few months because it was easier to nurse him back to sleep that way than to have to get up and traipse all over the house." See, with that second statement, you're not a "cosleeper," you're just another tired mom who's trying to get as much sleep as she can. Instead of "I believe in extended breastfeeding because...", where now the other person already thinks you're a crunchy weirdo for nursing a kid who can ask for it in a complete sentence, maybe we can say, "Esmerelda really needed to keep nursing after she turned one because I still couldn't get her to eat a lot of nutritious foods and she didn't like cow's milk." See, now instead of being an "extended breastfeeder," you're just a mom who's trying to make sure her child is getting all the nutrition she needs to grow, and who wouldn't want that?

Labels help us put people into categories, but there are so many directions to go when you're parenting, and so many ways to interpret any given practice, that we end up with a stack of labels that we carry with us everywhere we go. I'm a "cloth diapering, extended breastfeeding, extended rear-facing, cosleeping, natural-birth-having, WAHM." But, I don't cloth diaper because of any great environmental philosophy, which is the first thing that comes to most people's minds when you say you cloth diaper, and I don't even cloth diaper 100% of the time. I do it to save money and because it's kind of fun (except for the poop in the washer part...). I am an "extended breastfeeder" in the sense that I believe babies still need to nurse well into and possibly beyond their second year, but I also don't see myself continuing to nurse to three or four years, like some other "extended breastfeeders." I am an "extended rear-facer" because I know it's much safer for my child to rear-face as long as possible because his neck and spine cannot withstand a crash force when facing forward until he's at least two years old. I had a natural birth almost by accident because I was more afraid of having interventions than I was of the pain, and not because I had any kind of "earth mother" or spiritual need to have one. And, I work from home because we can't afford to live on one income at the moment, but we both feel it's important that I'm here and available to our children. And I happen to like my job, anyway. So now, see, all those labels? Worthless. Because I've explained myself anyway, and I don't exactly fit most people's idea of what those labels mean, and I'm certain that almost no one does.

Tell me, what are your parenting labels? :)

Saturday, March 24, 2012

Breastfeeding: All or Nothing?

I read an interesting point in a blog post recently, and I only wish I could remember which blog, because I read so many and rarely keep track of who said what (bad blog reading, I know). In any case, the point was that while you can choose not to breastfeed, you can't then later choose to switch to breastfeeding. However, you can choose not to formula-feed and then later choose to switch to formula if your situation calls for it. Basically, you've got to start out breastfeeding, and then make the choice either to continue or let your milk dry up and switch to formula.

This isn't exactly true, of course. It is both possible to relactate - that is, ask your breasts to start making milk again after having let your milk dry up - or to induce lactation - that is, ask your breasts to start making milk even if you never even had a baby. Some adoptive mothers do the latter, inducing lactation by tricking the body into thinking it's pregnant and then tricking the body into thinking it's delivered a baby through the use of hormone therapy and 'round-the-clock pumping. It's not easy, and it doesn't work for everybody, but it can be a very rewarding effort if you wanted to go that route. As for relactation, it's nearly as difficult. It's possible to bring your milk back in within the first few months after giving birth if you pump about every two to three hours around the clock for several weeks, as well as putting baby to breast as often as possible (if possible), but it takes serious dedication. After my first son was born and had been on exclusively formula for about four weeks, I thought about relactating. I spoke with a La Leche League leader about it, and she said I'd basically need to treat my breastpump like a newborn, pumping at least eight times in a 24-hour period (including in the middle of the night). She also said that since I had never established a full supply to begin with, it might never be possible to do so. I gave it a half-hearted effort, but never really was able to extract more than a few drops of milk, and I gave up after a couple of weeks of seeing no change.

So if you think you probably do want to breastfeed but you're not sure, you should start out doing so. Bring in your milk, breastfeed your new baby, and if for whatever reason you decide you don't want to do it, or there is a medical or psychiatric reason that you shouldn't or can't do it, you can always stop, wean to formula or bottles of donated breastmilk, and let your milk dry up. But, if you don't bring in your milk and start breastfeeding, it's pretty darn difficult, if not impossible, to change your mind six weeks in.

So in the beginning, yes, breastfeeding is "all or nothing." That is, either you do it or you don't. But, once you've established your supply and the baby has learned to feed effectively, and you give it a few weeks, or months, or years, things become a bit more flexible. For example, let's say that after six weeks, your maternity leave ends and you have to go back to work full time. You intend to pump and have your baby drink your milk from a bottle while you're separated from her. This would be ideal if you can't be with your baby all day, which many, many women can't. But, what if you just can't pump enough milk? Some women's bodies just don't respond well to the breast pump, and they can't produce enough, or they can't produce anything at all, or they can't keep up with their baby's needs by pumping. Other women's jobs are not ideal for pumping milk. Even though new federal law requires most workplaces to provide adequate break times and space for pumping milk, it still may not be entirely possible. Does this mean you have to stop breastfeeding and give your baby formula?

No!

Certainly, and I stress this because I believe it, it is most desireable to feed exclusively breastmilk for at least the first six months of your baby's life. That is the general recommendation from the AAP, the WHO, and other health services. Breastmilk is the best food for your young baby, and if you can provide it, and you will provide it, then you should provide it. The enormous benefits to your baby's (and your!) health, from nutrition to immune system to brain development to priming the digestive system, make exclusive breastfeeding the natural choice for every baby.

However, some breastmilk is better than no breastmilk. If you simply cannot provide exclusively breastmilk to your under-six-month-old baby, then continuing to nurse as much as you can is still good! Even if that means you only nurse at night, or in the morning and evening before and after work, or three times a day, or just for bedtime, some breastmilk is better than no breastmilk.

After six months or so, once you've introduced solid foods, you are no longer exclusively breastfeeding anyway. The benefits of breastmilk never go away, of course, so if you can continue to breastfeed as your baby's major source of nutrition, you should go on doing so. But, if you've given it six months and you're going a little nuts, backing off at this point is not as harmful, since your baby is eating other foods anyway. Remember that solid foods cannot and should not replace breastmilk and/or formula as your baby's major source of nutrition until after 12 months of age. Especially early on, six or seven months of age, solid foods shouldn't be more than 5 to 10% of your baby's daily intake. By one year, solid foods may be up to closer to 50% of your baby's intake. After one year, solid foods can be the majority of your baby's caloric and nutritional intake. Between six and 12 months, if you do decide to breastfeed less, you should replace most of the feedings with donated breastmilk or formula, not solid foods. One to three small meals of solids should be fine, but babies still need breastmilk or formula to thrive at that young age.

The AAP recommends breastfeeding for at minimum of one year. The WHO says two years. By one year of age, many babies are eating a fair amount of solid foods. At this point, you can choose to wean without taking away a significant portion of your baby's diet. However, if you want to continue to nurse, you certainly can. There is no psychological or physical harm to continuing to nurse to two years or beyond. The value of breastmilk and breastfeeding is not diminished just because the Earth has circled the sun one time since your baby was born. But, toddlers can survive on solid foods, assuming you are providing a variety of foods to create a balanced diet for your child. Children under two still need milk fats for brain development, either from your own milk, cow's milk, other dairy products, or another source. I am not a nutritionist or pediatrician, so I can't make a recommendation about what sort of milk to feed your toddler to replace breastmilk, but most pediatricians will tell you to give whole cow's milk to replace breastmilk or formula after one year of age.

If you do decide you want to wean at one year, you may need to start cutting back slowly. What you may find is that once you're down to two or three feedings a day, instead of six or seven, for example, or once you find that you no longer need to pump at work, breastfeeding may become an enjoyable break, rather than a burden or responsibility. Cuddling up with your toddler to nurse at bedtime or for an afternoon snack may be a time of closeness you and your toddler need during your otherwise hectic days. At this point, breastfeeding really isn't all or nothing. Weaning doesn't have to mean stopping completely, and weaning can be a slow, gentle process. I know of women who continue to nurse just once a day for months before they or their child finally drop that last feeding. I also know of women who continue to nurse six times a day, or more, throughout the second year. I found that SB gradually cut back over the course of his second year, until he was really only comfort-nursing at night. By the time I cut him off at 25 months, I didn't even get engorged, he was nursing so rarely and so little. A slow weaning process is more comfortable for both mother and child.

I don't really feel comfortable encouraging anyone to cut back on breastfeeding until her baby is at least one year of age. I wouldn't be writing this blog if I didn't feel that women should be supported and encouraged to choose exclusive breastfeeding. However, I also don't think it's fair to insist on breastfeeding as the only right choice, as if you either breastfeed or you don't. I think that places a lot of burden and blame on women who, for whatever reason, choose to use some formula. I also think it's important to let women know that breastfeeding some of the time is better than not breastfeeding at all. Just like some exercise is better than no exercise, and eating some vegetables is better than eating no vegetables, and getting some sleep is better than getting no sleep, breastfeeding some of the time is better than breastfeeding none of the time. To keep some supply, you have to breastfeed regularly, but if, for whatever reason, you don't breastfeed all of the time, that doesn't mean you have to stop completely.

I've been thinking about NJ's early weeks on this Earth, where he was getting perhaps 3 ounces of breastmilk per day when I pumped for him. I asked my LiveJournal audience if that measly 3 ounces a day mattered. I wish someone had said, "YES! Any breastmilk is better than no breastmilk!" I wish someone had said to me, "Try just nursing once a day. Maybe you'll find you want to try for a second feeding, and then a third." I wish I had known I could combination feed, or bring up my supply over time, as I healed, rather than just stopping. I wish I had known how important it could be in the future. I wish I had known how badly I would feel about stopping.

It is those regrets that drove me to two successful VBACs and two successful subsequent nursing relationships. (I've officially made it to six months of breastfeeding with GI, and we started solids a couple of weeks ago but are still mostly nursing. I'll be blogging about that soon.) It is also those regrets, and my subsequent successes, that drive me to write this blog. So I say, Yes! Do breastfeed! Give it a shot. Give it six weeks.  Breastfeeding some is better than not breastfeeding at all. Some breastmilk is better than no breastmilk. And it is not all or nothing.

Most importantly, find help and support so that you can meet whatever goals you have set for yourself. Knowing that you've reached or surpassed those goals will allow you to look back with pride rather than with regret or guilt.

Wednesday, August 3, 2011

Breastfeeding Basics - Part VI: Over One Year

I hope you've been able to keep up with my Breastfeeding Basics series and have found it helpful in some way. If you haven't been following, here are the previous parts: Intro, Part I, Part II, Part III, Part IV, Part V.

Just by chance, this final post in the series coincides with World Breastfeeding Week, so happy WBW to all the current, future, and past nursing moms out there. Keep up the good work!

If you're reading this, it's because you've reached or will soon reach that magical one-year mark, that first birthday, that amazing milestone that says, "We're still alive after a year! We survived infanthood!" Now you've got a toddler on your hands. Maybe she's not walking yet, or maybe she's been walking for a few months, but a one-year-old is, as I'm sure you've noticed, very different from a six-month-old or a three-month-old!

I'm going to call the period from one year to three years "toddlerhood" for simplicity.

Let me start by saying, "You did it!" You did it! You made it to a year!

Toddlers are busy little creatures. They're mobile, they're curious, and they want to get out there and explore. This means that during the day, they likely don't want to sit on you and nurse for long periods of time. Your toddler will be more of a snacker when she's busy, stopping by for a quick cuddle and some yummy milk, then off to find new ways to try to hurt herself or destroy your house. When she's sleepy or unhappy or missing you, she'll probably want to cuddle longer, and at times you'll love it and at other times you'll just want her to go away and leave you alone for a bit.

The difficulty with nursing a toddler is that toddlers tend to be busy even when they're nursing. They try out strange and uncomfortable positions. Many of them have the annoying habit of "twiddling," which is when they play with one nipple while nursing on the other. This can be very annoying. You don't have to let your child annoy you. If your toddler is displaying nursing behaviors that you don't like, it is absolutely your right as the mother to discourage that behavior.

This is the time to introduce "nursing manners." Just as you are beginning to teach your toddler about the right way to act in other situations, you can let her know that she needs to be respectful of you when she nurses. I highly recommend getting her in the habit of treating you nicely when she nurses, or you'll start to resent nursing her.

You may want to start to teach her how to request to nurse, if you haven't already, either by introducing a hand sign such as the ASL sign for "milk" (opening and closing the fingers as if milking a cow), or by teaching her a word to use for nursing. Some kids pick up on the word "boob" or "breast," while others come up with their own term. My son called it "nu" or "nur." I guess he was trying to say "nurse." It's probably smart to come up with a term that wouldn't be embarrassing if it were, for example, yelled at the top of someone's lungs in a busy restaurant. Hearing "baba! baba!" is far less humiliating than having your 18-month-old yell "boobs!!!" in the middle of dinner.

You may also decide that now is the time to cut back on nursing sessions, since breastmilk is no longer your toddler's only source of nutrition. I discussed weaning in the previous post. You may find that your toddler naturally starts cutting back on his own, since he's so busy much of the day learning and exploring. He will probably go through phases of deep attachment, wanting to nurse often, almost like a newborn, and other phases where you'll swear he's ready to wean completely. Both are normal developments of toddlerhood. You can take advantage of the slower periods to start weaning, if you want, or you may want to try offering the breast more often during these slower times to encourage him to keep nursing, if you are not yet ready to wean.

At this point, you'll want to assess your goals. By now, you probably have a good sense of whether you want to keep nursing for a long time or whether you've really had it. If you're not sure, I encourage you to keep at it for now. The WHO recommends nursing until at least two years of age. This is a good place to stress that the benefits of nursing and breastmilk do not vanish when your child reaches one year old. Breastmilk continues to evolve and change as your child grows, and the milk your body makes for your toddler is specially suited to toddlers' quick nursing sessions and higher caloric needs, and it still provides the antibodies, anti-inflammatory agents, and antibiotic substances that have made it so valuable ever since your baby was born.

There are also benefits to you, the mom, of continuing to nurse. The benefits you gain from nursing a baby are cumulative - that is, the longer you nurse, the lower your risks of certain cancers and other diseases. So it's worth continuing if you want to.

The biggest challenge for many moms nursing toddlers, though, is the judgment from others. Some will say that a child is too old to be breastfeeding once he can "ask" for it. Others may tell you that you are doing some kind of harm to your child by continuing to nurse. You may hear that breastfeeding has no benefits after one year, or that you'll never get the baby off the breast if you don't wean, or some other such "wisdom." None of this is true. In fact, around the world, many mothers continue to nurse their children even until four years (and some even longer than that!), and there is absolutely no evidence that it causes any psychological harm. Most children will "self-wean" (choose to stop nursing on their own) between two and four years of age, and it's up to you and your child (and no one else) when it's time to stop.

Lastly, if you plan to have more children, you may start thinking about it while you're still nursing your toddler. While breastfeeding does have contraceptive properties, it's far from 100%, and the less you nurse, the less pregnancy protection you get. If your period has returned, likely so has your fertility.

If you do conceive while you're still nursing, don't feel pressured to wean. It is safe to continue to nurse during pregnancy as long as it doesn't cause contractions or preterm labor. Your OB or midwife will let you know if she thinks it's dangerous for you to continue nursing. The flavor of your milk may change and become unpleasant to your toddler, and he may decide to wean on his own because he doesn't like the taste. Some women find that their milk dries up when they are pregnant, although some continue to allow their toddler to "nurse," even when there's no milk, just for comfort. Many women find that nursing while pregnant is very uncomfortable, either because of breast and nipple soreness caused by the hormonal changes of pregnancy, or just because they generally don't feel well. If your toddler does continue to nurse through your pregnancy, your milk will change back to colostrum sometime late in the pregnancy. Your toddler will likely enjoy this new milk very much. You can even continue to nurse both your toddler and your newborn after the birth. This is called "tandem nursing." Remember that milk production is based on demand, so if you have two children demanding milk, your body will make enough for both. Be forewarned that newborn milk may have laxative properties for your toddler!

Nursing a toddler can be both rewarding and frustrating. The frustration may be in the nursing gymnastics, the twiddling, the demands. But the reward is in the special cuddles, the smile, and, when he starts talking, the compliments! Older toddlers may even tell you what your milk tastes like to them (ice cream?), although whenever I asked my son, he always said my milk tasted like milk. Can't argue with that!

That concludes this Breastfeeding Basics series. I'm happy to answer any questions you have in the comments. Also, remember to check out my new book, The "Yes, It's Normal!" Guide to Breastfeeding!