A breastfeeding strike is when a baby refuses to breastfeed. Some people might also indicate that their baby “self-weaned”. These things can happen… sort of. But it’s really important to understand the differences and how to manage those situations, especially if you want to continue breastfeeding.

Understanding and Overcoming Nursing Strikes

A baby will sometimes refuse to breastfeed for a lot of reasons. It’s usually abrupt and can take you by surprise. When this happens, it can be so frustrating and disheartening. You might have worked so hard to finally achieve breastfeeding success, and then suddenly your baby doesn’t want it anymore?! It can be hard not to take it personally.

Please feel confident that your baby still needs you and wants you. A nursing strike does not usually mean it’s time to wean! There’s just something going on that needs to be discovered. Here are some reasons a baby might suddenly refuse the breast:

• If you changed the products you use and smell different to your baby.
• If there is a lot of stress in the home.
• If there are changes in routine.
• If the baby is suddenly spending a lot more time with another caregiver.
• If you’ve been eating something new that adds a lot of flavor to your milk supply.
• If the baby is sick.
• If the baby is going through a big developmental milestone like cutting a tooth or learning to roll over.
• If your baby bit you and you had a big reaction that might have scared them.
• If you are pregnant.
• If you have an overactive letdown.
• If you have a lower milk supply for some reason, like your ovulation returns.
• If your baby is in pain.
• If your baby has developed a preference for the bottle.
• If your baby is distracted by too many stimulating things in the environment.

Some of these things might be easy to recognize and fix, or you know they will pass. If you change back to your old lotion or stop eating tons of chicken curry, the baby might suddenly return to the breast very happily.

Some of these things might not be so easy to determine or address, so here are some tips that might be helpful:

• If you have a very powerful milk ejection or “overactive letdown”, try some of the techniques recommended in this article to help your baby feed more easily.
• If you suspect that your baby has developed a bottle preference, try making bottle-feeding less easy. Many babies develop a preference for the bottle because the milk comes out more easily. They just don’t have to work as hard! When this happens, you can back up and try again. Use the recommended methods to make bottle feeding more like breastfeeding.
• A nipple shield might be helpful if your baby has developed a strong preference for the bottle. If the recommendation above isn’t quite enough, you might try this in combination. This can be a temporary bridge back to direct breastfeeding.
• If you’re having low milk supply issues, it could be a temporary issue caused by a hormonal change like the return of ovulation. If that’s the case, it will hopefully normalize quickly and your baby can feed again. If you have low milk supply caused by other factors, you may need to do some things to increase your milk supply.
• Lots of skin-to-skin time. Staying very closely connected to your baby when you’re together might help your baby back to the breast.
  • Try using a baby carrier to keep your baby close.
  • Try sharing a warm bath with your baby.
  • Do all feedings against your bare chest. You want your baby to have positive associations with the breast even if that means getting a bottle. Sometimes you can put the bottle close to your nipple, then make the switch!
• Movement might help. Babies tend to like to be walked, rocked, patted, bounced, or swayed. If you’re wearing your baby in a carrier, try nursing there after a little walking or dancing. Or try bouncing a little or patting your baby’s bottom before attempting to latch at the breast.
• Put some drops of breast milk on your nipple so the baby gets a taste and might continue.
• If your baby is eating some solid foods, try smearing a little of their favorite food on your nipple!
• Keep it positive. Don’t force your baby to the breast if they are unhappy about it. You want to maintain positive associations with breastfeeding.
• Attempt to feed a happy or drowsy baby. Sometimes, when a baby is very relaxed or even partly asleep, they’ll latch on. It’s not usually a good idea to wait until the baby is very hungry or overstimulated. They might be too grumpy to accept at that point.
• Set up a quiet and distraction-free environment for feeding your baby.
• Try nursing in different positions. Sometimes it just takes a little change!

However long a nursing strike lasts, it’s also important to continue to pump at the times your baby would have nursed. When you can maintain that routine, you’ll continue to have pumped milk to feed your baby, and you’ll also maintain your milk supply so that when the strike is over, you can continue breastfeeding.

How to Recognize When Your Baby is Self-weaning

A nursing strike is usually sudden, too soon, and temporary. When a baby self-weans, it looks different and it happens later. A baby might gradually start to wean, but it can take many months before breastfeeding stops completely. This usually starts when a baby is between 18 and 24 months of age, but can happen a little sooner.

The baby won’t just suddenly refuse the breast completely. You might first notice that your baby is just nursing a little less often, or that the breastfeeding sessions are a little bit shorter. They might get more easily distracted during breastfeeding. They show more interest in and start eating more solid foods. Over time, eight breastfeeding sessions per day whittles down to just three, two, then one. Where it used to take 20 minutes for your baby to finish a breastmilk meal, it’s now only a two minute snack break.

Self-weaning is a gradual process that happens over many months and can be hard to recognize at first. I didn’t notice it was happening until I realized that I wasn’t nursing at all in between naps and bedtime anymore! When the baby takes the lead and weaning happens gradually, it can be a very easy process. You might not have any issues with breast pain, engorgement, or leaking, and your baby won’t have to go through a difficult transition.

If you notice that your baby is self-weaning, and you want to continue to breastfeed more, you can offer more often, or use some of the tips in the list above.

If you notice that your baby is self-weaning and you’re ready too, you can also encourage the weaning by doing a few simple things:

• Don’t offer the breast. Let your baby ask.
• If you’ve been using nursing to get your baby to sleep, try doing something different at naptime. Does your baby fall asleep in the baby carrier or the stroller? Does your baby like to cuddle or be rocked? Will they fall asleep when you read a story?
• If you usually breastfeed when your baby is waking up, try offering a snack instead.

However and why-ever your baby stops breastfeeding, it’s important to support your bond with plenty of cuddle and connection time. If your baby is self-weaning, this connection will help you both through the transition. If your baby is just on a nursing strike, that connection might help you discover what is causing the strike and bring your baby back to the breast. Your bond with your baby is what matters most!

Reference:

Why Baby May Suddenly Refuse the Breast

(Trigger warning: discussion of prematurity and NICU stays)

A NICU is a Neonatal Intensive Care Unit. These special units in the hospital are for newborn babies who need some extra care. Not all hospitals have a NICU, and they also come in different levels. No parent hopes that their newborn needs time in the NICU, but it happens. Fortunately, most of the time, a NICU stay is recommended because a baby needs a little bit of extra support but is overall healthy.

NICU Levels Explained

Most hospitals have either a Level 2 or Level 3 NICU. That means that they can support babies who are born prematurely, or have another condition that means they need extra support before they’re ready to go home. A level 3 NICU can support very early preemies or sick and fragile babies, but they might also have very healthy full term newborns who just need a little help regulating their blood sugars or to be treated for jaundice. If you are pregnant and in a situation where you know your baby is at high risk for needing high level NICU care, you might want to learn about the NICU at your hospital. The table below shows more detail about what the NICU levels mean.

Adjusting Expectations

NICU stays usually come as a surprise, and many parents feel overwhelmed and anxious when they’re told their baby needs to transfer to the NICU. Most parents feel shocked and don’t know what to do or what to expect. You probably had visions of what it would be like to meet your baby for the first time, and a NICU stay means you have to be separated and you don’t get to have your vision realized. You may not get to have that “Golden Hour” with your new baby that you were hoping for. You will have to adjust your expectations, but that can be so hard. When plans change, know that you can still find ways to connect with your baby. There are still things that you can do to provide for your baby and be there for them.

A Day in the NICU

The birth parent will still be a hospital patient, and in most cases, will be in a different part of the hospital. Some NICUs now have private rooms where parents and babies can stay together, but most of the time, the birth parent will stay in the postpartum room until they are discharged. This separation can be very difficult. Parents can visit their babies, but for the birth parent, it means having to get out of bed and get help to get there. It’s a good idea for parents to have a conversation about how they might want to handle a NICU stay. If Mom can’t get to the NICU right away, should Dad go to be with the baby? With smart phones, you can have a video call to stay in touch that way. Later, both parents will be able to visit with their baby.

By most accounts, NICU nurses, lactation consultants, and staff members are especially compassionate and accommodating. Parents are usually encouraged to be at their baby’s side whenever they want. When the baby is stable enough, you may even be encouraged to hold your baby skin-to-skin. Both parents can provide this kind of care. There is plenty of evidence showing the benefits of skin-to-skin care for even very fragile newborns in the NICU. Breastfeeding rates and breastmilk supply are improved, the baby’s vital signs can improve, and it’s even associated with improved neurodevelopment as the baby matures. The NICU staff can help you do this safely. They understand that you are going through a very difficult time and you might feel nervous about holding your baby. They also understand that your baby benefits from having you close.

So you might be holding or touching your baby, or just being there next to your baby. Some parents spend the day at their baby’s bedside while reading or watching TV or even getting some work done. Some parents spend time pumping milk for their baby at the bedside. A lot of parents feel they are most successful with pumping when they can be close to their baby

Once the birth parent is discharged from the hospital, they may spend more or less time in the NICU depending on how they feel and their circumstances. It also might depend on the type of NICU available. If the baby has a private room and a bed is provided for parents, some parents choose to spend most of their time at the hospital.

A nurse will probably teach you about your baby’s basic care needs and even encourage you to help with their care. Most NICUs also have a lactation consultant on staff who can help you with your feeding goals.

Breastmilk in the NICU

Breastmilk is great for all babies, but it’s especially beneficial for premature and sick babies. Milk Banks collect donor human milk with the primary goal of supplying NICUs with human milk as medicine for the most vulnerable babies. Breastmilk can mean the difference between life and death for these fragile babies. While any human breast milk is medicinal for these babies, your own milk is actually even a step above. It is especially designed to meet your baby’s very specific needs. You might be able to give your baby breastmilk directly from your breast right away, but that’s unusual in the NICU. Most often, babies are too small or weak or sick to do that. It takes a lot of energy and strength to get milk from a breast. There are many ways to give babies breastmilk:

• Gavage feeding: When babies are very small and the concern is getting them to grow, it’s important that they not burn any more calories than absolutely necessary. In this case, babies are fed breastmilk through a gavage so they don’t have to suck and swallow, burning precious calories. Gavage feeding is when they insert a very small tube into the baby’s nose and feed it down all the way into the baby’s stomach. The milk is pushed through the tube using a syringe. A registered dietician calculates the amount of milk needed for your baby to grow.
• Gavage feeding at the breast: Once a baby is strong enough to do a little work, they might be given their gavage feeding at the breast. The baby is encouraged to smell and touch and lick the breast while the milk is pushed into the tube. They can start to associate the feeling of a full belly with being at the breast and can more easily graduate to direct breastfeeding that way.
• Combination feeding: A baby might still get fed through the gavage, but may also be encouraged to try direct breastfeeding or bottle feeding for some snacks or meals. Sometimes, a baby might even get small amounts of breastmilk from a sponge, cup, spoon, or syringe.
• Bottle feeding: It’s important not to let a baby become too comfortable drinking from a bottle, so a slow-flow nipple is usually tried first. The baby has to do some work to get the milk out, making it more similar to breastfeeding. You may also learn how to position your baby so that the milk in the bottle doesn’t come out too quickly. A lactation consultant might teach you to feed your baby in a side lying position.

Exclusive Breastfeeding

The goal in the NICU is to get the baby feeding at the breast as often as possible. Most babies leave the NICU before they are at the point of exclusive breastfeeding. Most of the time, babies leave the NICU getting some or even most of their milk from the breast, but are still supplementing with pumped milk, donor milk, or formula in a bottle. It’s very possible to continue to increase the amount of milk your baby gets directly from the breast until supplementation is no longer needed. Some families struggle to do this. It can be hard to imagine changing something that’s working, so it’s important to get some support from a lactation consultant outside of the hospital. With a little help, many babies graduate from the NICU and go on to breastfeed exclusively.

Lactation Consultant in the NICU

A lactation consultant should visit with you to talk about your options for feeding your baby and provide support along the way. This will usually be a lactation consultant who works primarily in the NICU. They have some special knowledge and skills for helping these special babies and families achieve their breastfeeding goals. On the first day, you’ll probably get some good education about breastmilk, and how you might be able to provide it for your baby. The consultant might get you a hospital grade pump and get you started on a schedule for pumping. The milk you pump can be given to your baby immediately, but it’s also important to pump on a specific schedule so that you continue to make milk and develop a good milk supply. Most of the time, you’ll pump on a schedule similar to how a newborn baby would eat at the breast. They usually recommend pumping at least 8 times a day, with at least one of those sessions being in the middle of the night or VERY early morning, just like a newborn would do.

If your baby is strong enough to breastfeed directly, your lactation consultant can assess that and help you get started.

If your goal is to eventually breastfeed exclusively, there are ways to start introducing the breast so that your baby can get familiar with it and practice some of the skills they’ll eventually need to breastfeed. A lactation consultant can give you all the tools and support you’ll need to meet your goals. Even more than that, a lactation consultant can be a counselor and even a friend.

The NICU staff may come to feel like a second family. They are usually very compassionate and supportive. They are there because they love to help these tiny babies grow and thrive. They understand how the parents are likely feeling, and they want to make you feel included as part of your baby’s care team and become the leader of that team. They want to help you feel empowered to feed and take care of your baby so you feel ready to go home and do it on your own. It’s important to listen and participate while your baby is in the NICU.

Benefits of Breastfeeding

The benefits of breastmilk to the babies are very clear. It’s medicine. It helps them heal, grow, digest food effectively, and fight off infections. Providing breastmilk can also have benefits for parents. It can be psychologically very difficult to be the parent of a NICU baby. As the birth parent, you’ll be doing your own physical recovery on top of your worries and concerns for your baby’s well-being. You might feel afraid, exhausted, overwhelmed, confused, lost, and even guilty. You might worry that you did something wrong, and that it’s your fault that your baby is in the NICU. These are all very normal feelings. It is not your fault, but you do have the ability to help. It might not feel like it at first. There is a big staff of qualified health care professionals looking after your baby, but they can’t do everything.

For many mothers, pumping breastmilk for their babies from their own recovery room is a way to feel helpful, and is extremely helpful, even vital. Especially when parents can’t be with their babies, it can feel very empowering to provide them with the milk they need to get stronger. Then when you’re with your baby, having skin-to-skin time and learning to breastfeed together, you’re giving them, and yourself, even more strength and comfort.

Benefits of Support

Having a baby in the NICU can be one of the most challenging situations in a person’s life. You need support. In addition to the staff and your own support network of family and friends, most NICUs have peer support groups that they can put you in touch with. Hand to Hold is the group that provides services for NICU families in my local hospital. These volunteers are often former NICU parents who understand the difficulties and special needs of the parents who are caring for babies in the NICU. You may find a lot of comfort in talking to these parents and even other current NICU parents.

As hard as it is to have a baby in the NICU, it’s great to remember that most of the babies leave healthy and strong and go on to live long and productive lives. NICU parents also become stronger and wiser having gone through that experience so early in their parenting. There’s a lot of sadness and hardship in the NICU, but there is also a lot of joy and celebration.

Resources

Skin-to-Skin Care for Term and Preterm Infants in the Neonatal ICU | Pediatrics | American Academy of Pediatrics

Skin-to-skin ‘kangaroo care’ found to boost neurodevelopment in preemies

The focus of our last article was tandem nursing, which usually means breastfeeding a toddler and a newborn at the same time. A lot of people do not plan to breastfeed a toddler, but most babies start “toddling” between 9 and 18 months of age! The recommendation by the American Academy of Pediatrics (AAP) and many other organizations including the World Health Organization (WHO) and UNICEF is to continue breastfeeding with adequate complementary foods for at least 2 years and beyond as mutually desired.

That means that people who are following these guidelines are breastfeeding a toddler! That baby might only be 10 months old or might be two years old. Either way, this is a walking (maybe talking) kiddo that is still getting breastmilk.

I have heard something similar to this comment over and over, “If the kid can walk up and ask for milk, that’s weird and time to stop.” But is it really?

The “natural” age for weaning is a big range. It really depends on who you’re talking to, the culture and what period in time you’re talking about. There are so many interesting things to read about this. It’s been tackled from a historical perspective, an evolutionary perspective, and by biologists and anthropologists. They come to a lot of different conclusions, but the average age of weaning is somewhere between two and four years. There are places and times where children are weaned earlier than that, but also later! So breastfeeding a “toddler” is actually not at all unusual or “weird”.

Perceptions

Many people in the United States perceive that it’s unusual to breastfeed a toddler because we just don’t see it much or at all. The reality is that many people do this, but it happens at home. I did not breastfeed my toddlers in public very often, or at all.

When I had younger babies, I breastfed everywhere. I have very literally nursed babies on trains, on planes, in restaurants, libraries, parks, stores and churches. When those babies needed to eat, my milk was what was available. I never felt awkward or judged. Once they were eating some solid foods, I started offering them other snacks when we were out.

I definitely felt that nursing a toddler in public was different. I know that a part of me was worried about what people would think, and that’s just an unfortunate reality. But I also liked wearing bras and clothing that didn’t have to be breastfeeding friendly sometimes.

Also, my toddlers were easily distracted, and breastfeeding might only last for a minute or two before they were running off. That made it more frustrating for me, and I started offering a snack instead. At least they could eat that “on the go”. Nursing became something we only did at home, and it was usually just around bedtimes when they could lay down, be still, and nurse for a significant amount of time, or when they needed some extra comfort. It was especially beneficial when they were sick.

Are there benefits to continued breastfeeding?

Yes. Although toddlers have very different needs from newborns and younger babies, there is evidence that breastfeeding does continue to provide benefits. But they’re also not completely dependent on milk for their nutritional needs. Babies usually start eating solid foods at around six months of age. At first, it’s just a very small part of their daily intake, but it gradually increases until they are eating a lot of solid foods, and breastfeeding becomes a smaller and smaller part of their daily intake. This tends to happen gradually, and we don’t get to witness it happening out in the world very often.

It’s hard to say exactly what kind and how much benefit there continues to be after age two. There just isn’t much research for that, but the suspicion is that breastmilk does continue to offer some nutritional benefits that they might not get from other food sources. It also can continue to provide an emotional benefit. A two year old is still very much a baby in so many ways. They may or may not be able to communicate effectively and it can still be hard to understand what is happening if they seem upset. Nursing can be helpful in this way for sure. It’s something consistent that the baby has always had, and it’s comforting.

Nursing can also help with bonding. Of course, there are plenty of other ways to bond with our children, but this might be an easy and special way for a lot of families. For some parents who go back to work full time, breastfeeding at bedtime or in the morning is a way they choose to maintain a consistent and daily connection with their baby.

Managing judgments

If you choose to breastfeed your toddler, but worry that people might think you’re “weird”, we understand. Many other parents have had the same doubts and feelings. It can be helpful to recognize the truth of that. Many parents feel the same, which means that many parents are nursing toddlers! You can handle this however feels most right for you. Here are some ideas:

• Do it loud and proud. You can breastfeed your toddler anywhere, everywhere, however, and all the time. You might want to be a public activist and advocate for this very normal practice. Bringing attention to it can help normalize it. But we recognize that this is NOT the right path for everyone!
• Take a moderate approach. You can breastfeed your younger baby in public, but then reserve nursing your toddler for an “at home only” thing. BUT you can talk about the fact that you are breastfeeding your toddler. That helps too! I was very happy to talk to people about breastfeeding my toddlers even though I didn’t like to breastfeed them in public. I was often surprised to hear that the person I was talking to also nursed their toddler when at home. When we open up, it allows others to do the same. You might also breastfeed your toddler only in certain situations. For example, it might feel ok when you’re at a friend’s house or out at a park, but maybe not at a busy restaurant.
• Keep it to yourself. You might decide that it’s nobody’s business but your own whether or not you choose to breastfeed. This is true! It’s a very personal choice, and can definitely feel like an intimate part of your family life. It’s also very reasonable to keep it in the family.

Things to know

Breastfeeding a toddler will be different. This is so important to recognize. If you are breastfeeding a newborn, it can be so daunting to consider having to do that same thing for a year… OR MORE?! I can assure you that you won’t be doing that for very long. After the newborn period, breastfeeding gets easier. How?

• You will no longer be newly postpartum and recovering from pregnancy and birth. Your physical and emotional recovery is a big complicating factor and can make breastfeeding feel like more of a chore.
• Your baby will get better at it. They have to develop some strength, endurance, and skill for breastfeeding. It’s just like exercise. It’s harder at first, but once the strength is there, the endurance and skill increase too. When they are better at breastfeeding, things go more smoothly and more comfortably for you.
• You will get better at it. Breastfeeding is learned. You’ll figure out new and more comfortable positions that work best for you and your baby. You’ll find a routine and a rhythm and things will feel easier.
• You will do it less often. On day 1 of life, a baby’s belly is only the size of a cherry and can hold about a teaspoon of milk. Their bellies fill and empty very quickly so they eat often. By the time the baby is one month old, the belly has grown to the size of a large egg and can hold almost half a cup! That means the baby will stay full longer and need to eat less often.
• They will eat more quickly. As the baby gets better at it, they will be able to get the milk out more quickly, and once a baby is eating solid foods well, their breastmilk meals might be more like snacks. They can get what they need in less time, so you spend less time breastfeeding.
• Your milk supply stabilizes. At first, your milk supply will be very sensitive. It’s critical to stimulate the breast often and consistently to build and maintain a good supply. After a couple of months, it matures and stabilizes and you can be more flexible. By the time a baby is a toddler, most people can nurse a lot less often and be less consistent without losing the milk supply. You will also likely stop leaking!
• When your baby is not completely dependent on your milk for their nutrition, it gives you more flexibility for child care and more time that you don’t have to spend nursing or pumping for bottles.
• When your baby starts eating solid foods, it can be really stressful. They won’t always eat all the right things. They’ll have days when they seem to just throw everything on the floor, or days when they’ll only eat blueberries. If you are still breastfeeding, you can relax knowing that your baby is still getting everything they need.

It’s so hard to describe what it’s like to breastfeed a baby to someone who has never done it before. It’s also so hard to imagine what it will be like when you never have. It’s also hard to imagine that it will be different as your baby gets older, when you’re in the middle of newborn confusion and chaos. It truly is a completely different experience to nurse a toddler, and can be very easy, special, and sweet. I encourage you to remind yourself of that when things feel really hard or even painful. You can get help, and it will change.

Resources

Weaning from the breast – PMC

An Age-Old Question: What is the Natural Age of Weaning?

Infant and young child feeding – WHO

Cultural Motherhood: Weaning Part II

Tandem nursing refers to breastfeeding more than one child at a time when they are also different ages. Feeding twins or multiples is a little different. Tandem nursing is not a common practice in our modern culture, but it happens more than a lot of people think.

Should I stop breastfeeding when I’m pregnant?

If you struggle with the idea of weaning, know that there is another option. You DO NOT have to stop breastfeeding when you get pregnant again. Especially for low risk pregnancies and for people who are able to maintain good nutrition, it does not appear to be harmful to your body or to your pregnancy to continue to breastfeed your older child. It also does not seem to negatively affect the quality of the milk that your newborn will get. The milk you make for your older baby is different, but your body is incredibly sensitive and intuitive. It will understand that there is a newborn baby needing colostrum and a different kind of milk, so it will provide it. These newborns tend to do very well, and there seems to be no difference in health and weight gain for newborns of parents who are tandem nursing.

Why tandem nurse?

If you’re successfully breastfeeding a toddler or older baby when you get pregnant again, it can be a really hard thing to consider weaning for the sake of the pregnancy and the new baby. A lot of people think it has to be done, but when things are going well with breastfeeding, it’s often not something that people want to give up. It’s excellent nutrition that is very affordable. By this time, it might also be very easy and even enjoyable for you both. The babies get very efficient, and breastfeeding can be quick and easy with no mess to clean up! When older babies and toddlers are exploring solid foods and deciding what they do and don’t want to eat, it’s especially helpful to have breastmilk as a backup. It feels good to know they’re still getting complete nutrition with breastmilk if they just play with their food or throw it on the floor today. It’s normal for older babies to explore textures and tastes when they’re starting solids, but not get much actual nutrition from it. It’s great to keep things positive and continue to offer breastmilk.

Some people get pregnant again pretty quickly after the last birth, and in this case may want to continue to breastfeed for the recommended amount of time. The current recommendation from the American Academy of Pediatrics is to provide breastmilk exclusively for at least the first six months, and to continue to offer breastmilk in addition to solid foods “for at least 2 years and beyond as mutually desired”. Many other sources have published similar recommendations. So, if you have a baby that is just a few months old, and you are trying to adhere to these recommendations, it can feel like weaning during pregnancy would be too soon for your baby.

You also might feel a very strong bond with your baby through breastfeeding, and it can be very hard to consider giving that up, especially knowing that another baby is coming and you’ll have to divide your attention. You might worry about how your baby will handle it, but it can also be really hard for the parent. People often choose to tandem nurse because breastfeeding is working very well for their family.

Some parents worry that a new baby will change their relationship with their older baby. If breastfeeding has been a point of strong connection for the two of you, it can be comforting to continue breastfeeding. That might help ease some of those worries. You and your older baby can continue to share that kind of bonding and that might help make the transition a little easier for both of you.

Tandem nursing can also help make those early days and weeks of feeding a newborn a little easier. You are less likely to experience engorgement and the discomforts that go along with that transition. The older baby can be a great help in balancing the milk supply.

Is there a downside?

Tandem nursing can be fantastic for some families, but it’s not for everyone. Some people end up feeling very tired and “touched out” when they’re trying to breastfeed a baby and a toddler at the same time. It might seem like there is always someone wanting to be at the breast. Your breasts might get sore from frequent use. And some people end up experiencing some difficult emotions. Some people feel resentment towards one or the other of their children when things feel very difficult. You might feel like you can’t give enough of your attention to one of them and resent the other for that. You might have feelings of doubt or insecurities about your ability to breastfeed two children. Some people don’t have community or family support for their choice and feel rejected or judged. There are even cases where their OB and/or pediatrician express concerns or judgments about the choice. This is usually just a lack of information on their part, and not because it’s a bad choice, but it can still feel very difficult to receive that kind of reaction from a health care professional.

Also, even though it’s not harmful, it might not be the same to breastfeed throughout your pregnancy. Your milk supply might drop in one breast or both, and the composition of the milk changes due to the hormones of pregnancy. The milk might taste different to your baby. Because of these changes, some babies decide to wean themselves. When I became pregnant with my second baby, I was still breastfeeding my daughter who had just turned two. I noticed that breastfeeding started to feel painful on one side because the supply was gone. My daughter definitely noticed that there was no more milk in that breast and would get frustrated and only choose the other. At that point, I felt ready to try weaning, and my daughter agreed. It was easy because of those changes in the milk supply, and it turned out to be the right thing for us.

How to transition away from breastfeeding

Luckily, my daughter did not struggle with weaning at all. She wasn’t nursing much at that point anyway. It was mostly a comfort and an easy way to get her ready for naps and bedtime. I offered her a little bit of juice and extended snuggles instead, and she was very happy to take it. She’s very snuggly, and juice was a special treat for her, so that’s all it took!

If things had been different, I likely would have continued to breastfeed through my pregnancy, because it was a very easy and sweet thing that my daughter and I shared. I did worry that the new baby would create more separation for my daughter and me, especially without our shared experience of breastfeeding. I worried that she would feel neglected or jealous of the new baby. Luckily, we had many months for our relationship to shift, and we still had a very strong bond when my son arrived.

When the baby came, she had mostly forgotten about nursing and it didn’t bother her as much as I thought it would that he was breastfeeding. If your older child does wean close to the time that your new baby arrives, I recommend building in some things that will help your older child with the transition:

• Find new special bonding rituals for the two of you. Maintain those when the new baby arrives so they can see that they still have their own special relationship with you. You might start doing some infant massage at bedtime, or storytime if you haven’t done that yet. You might make a cup of sleepytime tea together and play a favorite game before bedtime, or take a daily walk around the neighborhood. My daughter loved to act out her favorite scenes from storybooks, so we did that everyday. Her favorite was pretending to be Curious George when he broke his leg and had to go to the “hoshtable” (hospital). We would wrap her leg with a scarf and put it in traction using the side of her crib.
• If you start out tandem nursing, and then it starts to feel overwhelming to nurse both babies, it doesn’t have to be an abrupt or dramatic loss to stop breastfeeding your older child. You can gradually remove some feedings. It’s a great idea to replace that time with something else special. You can use that time to do something else that will maintain your bond. What many parents want to avoid is their older child feeling neglected or replaced by the new baby.
• Toddlers sometimes like to be involved in the baby care, and that can help them feel included and important. You might ask them to help you when you’re feeding your newborn. They might be able to bring you a burp cloth or help hold the baby’s head or feet. They can start to understand that they have a new and very special role in the family as a big sibling.

How to tandem nurse successfully

If breastfeeding continues to go well during pregnancy and you would like to tandem nurse when your new baby arrives, here are some tips that might be helpful:

• The more experienced baby can probably nurse well under any circumstances, but newborns are still developing their strength and skill, so latch the newborn first, then allow the older baby to latch at the other breast if you’d like to nurse them both at the same time.
  If you prefer to nurse them separately, you might set up ‘special’ nursing times just for you and your older baby when someone else can be with your newborn.
• Make sure to feed your newborn “on demand”. It’s important for them to get as much milk as possible in those early weeks especially. They usually lose some weight at birth, and getting plenty of milk is important for their growth, and also for health concerns such as jaundice, digestive health, and immunity. Their meals should be prioritized. The older baby can nurse after the newborn and still get some milk.
• Your older child can be fed “on demand”, but many parents decide to set up regular times to nurse the older baby. It’s a personal preference, but a schedule can be helpful for many people.
• If you’re experiencing engorgement, it can be helpful to allow your older baby to nurse a small amount from that breast to relieve the symptoms. It can be difficult for a newborn to latch on to an engorged breast and can sometimes cause frustration and refusal. The older baby can ensure that the engorgement is relieved and that the breast is soft. This can make it easier for the newborn to get a good latch.
  If you have a very powerful milk ejection or “letdown”, a newborn might not be able to keep up with the amount of milk that is spraying out. When this happens, they can choke and gag and get upset at the breast. This can even lead to rejection of breastfeeding. If you have an older baby, you might let that baby nurse for a short time until the flow slows down, and then allow your newborn to nurse more easily.

The most important thing to take away from this is that tandem nursing is great for some families, but not for everyone. I encourage parents to listen to their own intuitions when it comes to parenting decisions like this. Tandem nursing has been done throughout our history and across many cultures, so it’s definitely something that our bodies are capable of. It can be a really good thing. It’s also true that it doesn’t work for everyone, or that it doesn’t feel right for everyone. If you feel a strong intuition to continue to breastfeed your baby and tandem nurse, you can tune out the voices that tell you it’s not healthy or wrong or weird. If someone thinks it’s unhealthy, that’s because it’s something they don’t understand. If someone thinks it’s weird, it’s just because they haven’t been exposed to it. For other people, it seems like the most reasonable and natural thing to do. I hope that you can find your own path in parenting. It doesn’t have to look like what you’ve seen before. We all have different bodies and different circumstances. There are SO many right choices!

References

Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child – PMC

Tandem Nursing – La Leche League GB

Pregnant and Breastfeeding – La Leche League GB

Breastfeeding During Pregnancy: A Systematic Review of the Literature

I love to learn about nutrition. During pregnancy, I was SO careful about what I ate, and it was easy because I had constant morning sickness and no terrible cravings anyway. No food sounded good, so I might as well eat healthy, right? Once my baby was born though, I got HUNGRY again! I ate a lot of everything. My choices weren’t all bad, but I wasn’t especially careful either, and I wasn’t worried about it. I wasn’t pregnant anymore, so no worries about the baby’s health, right?

But what about breastfeeding?

There may actually be concerns about nutrition during breastfeeding. A lot of people want to know how they’re supposed to eat for the best breast milk quality and supply. Is there anything that nutrition can actually help with though?

The answer is a little ambiguous. It’s actually hard to find any research in support of a particular kind of food being especially good for milk supply and milk quality.

This is probably a good thing from a broader evolutionary perspective. Your body is designed to protect your milk supply at all costs. Even if you were to experience a famine and find very little to eat at all, your breast milk production would probably continue for at least some amount of time. Your body will use its reserves to protect that milk supply, which of course protects the baby.

So can I eat anything I want?

Just because your milk supply and quality might not be all that affected by your nutritional choices, it can definitely make a difference in other areas. Poor nutrition makes people feel less great. You might not have much energy, or you might be especially irritable. You could have more trouble sleeping. As a brand new parent, you can definitely benefit from feeling your best, and nutrition is a great way to get there.

Your energy levels and the way you feel can definitely affect how much you’re able to breastfeed. When your body is well-fueled, you will have more energy, you can get better sleep, and you can feel more motivated to continue breastfeeding as often as you need to ensure a great milk supply, even when that means waking up often and patiently sitting through cluster feeding days.

What about the baby?

You may have plenty of good quality milk, but there are things that can affect your baby.

For example:

• Be careful with caffeine. Caffeine does get into your breast milk, but if you’re having a moderate amount, it shouldn’t be enough to affect your baby. If you drink caffeine excessively though, it could have an impact. Your baby might get irritable, fussy, jittery, or wakeful. Some babies are more sensitive to it, so be aware of your baby’s behavior related to your caffeine intake. Also, consuming more than 450mg of caffeine a day (4-5 cups) can lower the iron levels in your breast milk. Babies get the iron they need from breast milk until they can eat solid foods, and this is a very important nutrient for their development.
• Allergenic foods. Some babies are sensitive to certain things you eat that will be transported through the breast milk. For example, while rare, some babies are allergic to dairy. Your breast milk is not the problem, but when you eat dairy, the babies can show some pretty obvious signs. They may have colic, abdominal discomfort, or a skin rash. They may even vomit and have bloody diarrhea or difficulty breathing. This can be serious, and it’s important to contact your pediatrician quickly if you notice some of the symptoms. Luckily, removing dairy from your diet while you’re breastfeeding can prevent it from continuing. And if either parent or a sibling has a history of severe food allergies, it might make sense to pay close attention to what you eat and how your baby responds after their next feeding.

Nutrition for postpartum recovery

• Even though your breast milk supply might not be all that sensitive to what you eat, there are other big things going on in a postpartum body! As your body recovers from pregnancy and birth, it’s very important to nourish it well. Good nutrition can go a long way in helping with digestion, postpartum bleeding, mood swings, and energy levels. These are all areas of struggle in postpartum recovery.
• Your uterus is shrinking and moving, and your other organs are shifting back into a more normal configuration while this happens. Digestion, bowel movements, and urination can be affected by this transition. When you eat well and stay well hydrated, it helps.
• You experience a large decrease in certain hormones after birth and it can take some time for them to be more balanced. You may feel down or sad. You might get irritable. You might have trouble sleeping and have low energy levels. You may feel more anxious. You may not be able to “fix” all of these symptoms by eating well, but you can definitely ensure that you’re not making things worse, and really good nutrition can take the edge off for sure.
• Postpartum vaginal bleeding can be very heavy for a few days, and then can take several more weeks to taper off and end completely. Most people stop bleeding by six weeks. You’ll want to make sure you’re getting all the nutrients you can from your food and plenty of hydration to make sure the blood loss has minimal effect on your health and the way you feel.

Iron

It’s important to maintain good blood iron levels for a couple of reasons. When you’re having prolonged vaginal bleeding, it can cause your iron levels to drop. It’s also important that your baby has good iron levels, and that comes from your breast milk. If your iron levels get low, your baby gets less. These are some foods that are high in iron.

• Heme Iron is always best absorbed. That means iron from animal sources. And these sources provide the highest iron content:
  • Shellfish such as clams come in highest by far!
  • Then it’s organ meat. That’s right, liver, hearts, and kidneys.
  • After that, red meat.
  • Chicken thigh
  • Salmon
• Vegetable sources or NON-heme iron are MUCH lower in iron content and less absorbable, but you can get some extra iron from:
  • Unsweetened cocoa powder
  • Natto
  • Cashews
  • Cooked spinach
  • Tahini
  • Cooked beans
  • Firm tofu
  • Broccoli

You might add some of this into your rotation, and some people still need supplementation, so be sure to get advice from your provider if you’re having any symptoms of iron-deficiency anemia such as:

• Being pale or having yellow “sallow” skin
• Unexplained fatigue or lack of energy
• Shortness of breath or chest pain, especially with activity
• Unexplained generalized weakness
• Rapid heartbeat
• Pounding or “whooshing” in the ears
• Headache, especially with activity
• Craving for ice or clay – “picophagia”
• Sore or smooth tongue
• Brittle nails or hair loss

You can NEVER go wrong by having good nutrition. You’ll look better, feel better, heal and recover better, and you may even ensure that you are providing the very best breast milk possible. I like to think of good nutrition as the ultimate self-care. It does take some time and effort to eat well, but the pay off is big. You deserve it!

References

https://www.ncbi.nlm.nih.gov/books/NBK501467/

https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Infant-Allergies-and-Food-Sensitivities.aspx

https://www.hematology.org/education/patients/anemia/iron-deficiency

https://lilynicholsrdn.com/iron-absorption/

The word “supplementation” has become almost completely associated with breastfeeding. Many new parents believe that supplementation is just part of the deal. It actually is NOT! Supplementation can be a really critical part of a family’s feeding experience, but it may not be part of the picture at all for many other families.

What is supplementation?

Essentially, supplementation just means offering the baby more food than what they are getting at the breast. It might mean giving some additional nutrition using:

• Formula
• Your hand-expressed breast milk
• Your pumped breast milk
• Donor milk
• A combination of some or all of the above

It might mean giving the baby this additional milk by:

• Bottle
• Spoon
• Cup
• Syringe
• Finger
• An at-breast supplementer

The way you offer milk supplementation depends on the age and needs of your baby and your ultimate goals. If it’s in the first few days of life, or you just need temporary supplementation, and you eventually plan to exclusively breastfeed, then you may consider not using a bottle. Using alternatives like a spoon, cup, syringe, or supplemental nursing system might be better alternatives in this case, because using a bottle can sometimes make it harder to transition to the breast if offered first or primarily.

It’s best to seek help from a lactation professional to determine whether your baby needs supplementation and how to best go about it.

When is supplementation recommended?

There are a lot of reasons a baby might need more milk than you can provide directly from the breast. If your goal is to mostly or exclusively feed your baby directly from the breast, but supplementation is recommended because there is a need for more, know that it’s very possible to just supplement temporarily.

If you do NEED to supplement, it can sometimes be hard to figure out why you’re having problems, so before you do it, you should definitely see a lactation consultant. They can devise a plan for you, and also help you ensure that your baby doesn’t become dependent on the supplementation so you can transition off of the plan.

Some of the more common reasons they will recommend supplementation include:

• Improper latch
• Ineffective sucking
• Low milk supply
• Slow growth or weight gain for baby
• Separation of parent/baby

An improper latch means the baby is not holding on to the breast correctly. There are a lot of different reasons for this, but it can mean that the baby can not get enough milk out of the breast. Or a baby might latch on correctly, but might not be able to draw out enough milk. They might be weak or have an issue with their tongue or mouth that means they can’t suck hard enough to get the milk out effectively.

When the baby can not draw out milk effectively, that can actually lead to low milk supply, which could end up being an additional reason to supplement. Low milk supply can also be caused by other factors.

If there is not enough milk, supplementation is necessary, but it might only be a temporary need. A lactation consultant can prescribe some treatment strategies that might involve a pumping schedule to get your milk supply back up.

If your baby is growing slowly, not gaining enough weight, or even losing weight, supplementation may also be recommended. The cause of the baby’s slow weight gain should be explored. If it’s an issue of improper latch or suction and/or low milk supply, that can usually be fixed.

If you and your baby need to be separated for any amount of time, supplementation may also be needed. Often, you can do some quick hand expression so your baby can be fed your milk from a spoon, cup, syringe, or bottle.

However, pumps and bottles are often not recommended in the first few days when the milk (colostrum) is very thick and there are only very small amounts available. Much of that precious milk can end up in the pump parts or lining the inside of the very big bottle and nipple. That is why hand expression and other methods like spoons, cups and syringes are recommended. If you are separated for longer, pumping will likely be needed, and you may need to bottle feed.

Pumping is important for building and maintaining a good milk supply until you and your baby are reunited and you can do more direct breastfeeding.

It’s important to recognize that most of the time breastfeeding works, and supplementation is not necessary. It happens often though! A lot of times, people supplement on their own because they perceive that their baby needs more. Most of the time, that’s not actually the case.

There are a lot of normal behaviors and phases that babies go through when they are breastfed. For example, sometimes they cluster feed and seem much more hungry than usual. When this happens, a lot of people might want to supplement so the baby can get full. But cluster feeding is actually a normal and important part of maintaining a healthy milk supply. Supplementing in response to cluster feeding can sometimes lead to milk supply problems.

When might you choose to supplement?

Not everyone supplements out of necessity. Some people just want to supplement for reasons of convenience. If you like the flexibility of direct breastfeeding sometimes, and bottle feeding other times, supplementation may be right for you.

In this case, it might not technically be supplementation. It might be called combination feeding or just your feeding style. Or it might actually be both. If you want to be able to feed your baby from the breast AND using formula from a bottle, your milk supply might not be quite as full. If you are combination feeding using formula, and you are not also pumping on a good schedule, your milk supply might suffer and you may not be able to offer breast milk anymore at some point.

Tips for successful combination feeding:

• Consider using breast milk in a bottle if your goal is to get your baby using a bottle. The pumping that you will need to do to provide milk for those bottles will help ensure that your milk supply doesn’t dwindle.
• If you’re using a bottle for the first time, try introducing it when your baby is happy and relaxed. Don’t wait until your baby is SUPER hungry. They may just get very upset and refuse the bottle.
• Try letting someone else feed your baby the first few bottles. They will often be more likely to accept a bottle from someone else who is not associated with breastfeeding.
• Try a different position for bottle feeding than you typically would for breastfeeding. Again, they won’t associate that position with breastfeeding and be more likely to accept something new.
• Pump on a regular schedule that mimics when your baby might be needing to eat. That will be less likely to have an impact on your milk supply. So, if you know your baby will be getting a bottle around 1pm, you could pump at that time. Your body is getting the signal to make milk at that time similar to how it would if your baby was there breastfeeding.
• Add in the bottle feeds gradually. Start with just an occasional bottle, then one per day, etc. You might plan this around when you’ll be going back to work and work backwards from there. For example, if you have four weeks until you’ll be working away from home:
  • Week 1: Give your baby a bottle every other day.
  • Week 2: Give your baby one bottle feed per day.
  • Week 3: Give your baby two bottle feeds per day.
  • Week 4: Give your baby three bottle feeds per day.

That might be all you need! Three bottles a day might be the right number for your baby when you’re not with them. You can continue to feed from the breast when you’re together.

Tips for successful breastfeeding and formula mix:

• Always start with breastfeeding first. If your baby is full and doesn’t need the bottle, you can skip it if you choose. If your goal is to introduce formula as part of the baby’s normal feeding routine, you might just breastfeed for a shorter amount of time, and then finish the feeding with the bottle. Starting with breastfeeding will ensure that you continue to stimulate the breast so your milk supply doesn’t decrease too much.
• Don’t mix breast milk and formula in the same bottle. Some people choose to do this, and it’s not dangerous as long as you properly mix the powdered or concentrated formula using the right amount of water first, but we don’t usually recommend it for a practical reason. If your baby doesn’t finish the bottle, you end up throwing away some breast milk that you spent time pumping! We recommend first giving the bottle of breast milk, and then a separate bottle of formula. If the baby gets full before finishing all the formula, it’s less difficult to have to throw that away.

There is not just one right way to feed your baby. You may come to find that you have your very own way of feeding your baby that works for your family, and that’s great!

However you choose to feed your baby, we always start by ensuring that your milk supply is protected if you want to continue to provide breast milk. As long as you’re taking some basic precautions, it’s very possible to breastfeed and provide milk in other ways.

Reference

https://pmc.ncbi.nlm.nih.gov/articles/PMC8573934/

Let’s face it, it can get VERY hard to wake up in the middle of the night to feed your baby. Many breastfeeding parents figure out how to breastfeed their babies in bed. This may even be the safest option for those who run the risk of falling asleep while doing night time feedings. But even when you get it figured out and can pretty easily feed your baby at night without too much disruption, a lot of parents start to wish for fewer interruptions to their sleep. This is totally normal, and does not make you a bad parent.

You might happily feed your baby in the middle of the night for the first few months before you start to feel too frustrated, and others might be happy to do it for a couple of years! Whatever your threshold, know that you’re not alone, and there are ways to handle this without too much drama or consequence.

What are “night feeds”?

Basically, night feeds are the feeding sessions that happen during our regular sleeping hours. You and your baby have both gone to sleep, and then they wake you up wanting to eat. That may happen just once or twice, or it may be more. It depends on how old your baby is, among other factors. Sometimes babies start to wake to eat more often even after they’ve cut back on night feedings. Some of those reasons include:

• Is the baby going through some developmental milestones?
• Is the baby sick and needing more hydration/nutrition?
• Is there an issue with milk supply?
• Is your milk content a little lower in something the baby needs more of at that time?
• Has the baby developed the habit of using nursing for comfort and to be able to sleep?

Why are night feeds important?

Remember that babies actually need to wake often during the night… at first. It’s actually safer for them, and can secure your healthy milk supply, especially during the newborn period. Even after they are newborns, night time feedings may still be necessary for some babies to maintain their weight gain and ensure that your milk supply doesn’t drop before you’re ready for that.

At what age do babies “outgrow” night feeds?

You can find lots of opinions out there ranging from six months to over one year of age. There is no right answer to this question, although newborns and babies who have trouble maintaining weight shouldn’t be restricted and will likely need to eat every couple of hours. I always hesitate to offer exact numbers for anything related to feeding, and parenting in general. Every baby is different. Every parent is different. It’s more important to pay attention to your baby’s specific needs, and consider what feels right for your family.

If you are comfortable with night feedings the way you’re doing them, there’s no need to worry about it until it stops feeling right. If your baby is past the newborn stage, and you’re very uncomfortable with the night feedings and want to start dropping them, consider a few things, and you may also want to consult with your pediatrician and/or lactation consultant:

• Is your baby at a healthy weight and gaining weight easily?
• Do you want to continue breastfeeding?
• Is your milk supply very stable?
• Will your life circumstances allow you to increase daytime feedings if your milk supply does drop in response to fewer night feedings?
• Patience will pay. You don’t have to do anything drastic. You can gradually shorten the feedings, and/or reduce them by one gradually over a period of time. This will make it easier for your baby and for your milk supply.

Sometimes, even younger babies can go for longer stretches at night without eating. Other babies continue to need night feeds for longer in order to maintain their weight and keep growing. Some people have a very stable milk supply and can cut the number of feedings without seeing any impact, while others will notice a quick drop in supply if they cut back. Formula fed babies may have different needs. Just be sure to consider all of these things before you decide to make a plan for dropping night feeds. You can also seek advice from a lactation consultant if you’re unsure.

What you DON’T have to do

To reduce or eliminate night feeds, you do not have to do any of the following:

• Stop breastfeeding.
• Accept that you and/or your baby will experience emotional trauma.
• Do it quickly and abruptly.

It is absolutely not an “all or nothing” kind of situation. Like so many parenting choices, there is a lot of grey area here. You can reduce night feeds without eliminating them completely. You can also make it a very slow and gradual process that your baby might not even notice!

How to reduce the night feeds

It might be simple for you. If your baby ate just before falling asleep, and they wake a couple of hours later, try helping them back to sleep without feeding. This might work great! If your baby wakes again, you can go ahead and feed them. So, now your baby is feeding less at night. After a week or two of this, you might try doing the same thing with another of the nightly wake ups. So, to clarify:

• Let’s say that when you decided to start your plan to reduce night feedings, your baby was waking up to eat three times; once at 12am, again at 2am, then again at 4am (in reality, this will not be the EXACT same time every night!).
• First, you took away the 12am feeding while continuing the rest.
• Then 2 weeks later, you go through the same process with the 4am feeding.
• Now your baby is only eating once at night, at 2am.
• You can continue with that until it feels like the right time to eliminate the night feedings completely. Many breastfed babies still need at least a little nutrition during the overnight hours even up until one year of age.

Your baby might not have any trouble with this. You can reduce the night feedings at your own pace. It might be you wait a week or two, but you might also wait a month or more before continuing to reduce the number of night feeds. Do what feels right for you and your baby. If your baby is happy, seems to be growing well, and your milk supply stays stable, then you can assure yourself that it’s working.

What if my baby is a boob junkie?

There is definitely a persistent attitude out there that babies get hooked on the breast, use it as a pacifier, and that there is something wrong with this. I just saw a great comment about this on social media. I can’t find the exact source, but it goes something like this, “You are not a human pacifier; a pacifier is actually a plastic you!”. This does not mean that no one should ever use a pacifier. This just means that it’s very normal and natural for a baby to find comfort at the nipple. This has been going on forever, and babies do eventually stop needing it, even if you don’t actively do anything to stop it.

So, if your baby finds comfort at the breast, that’s great, as long as you’re ok with it. Again, what’s best is what works for your family. There is no shame in using nursing for comfort. This is how most babies have been raised since the beginning of time. It does not cause damage. However, if you are having a lot of negative feelings about it, or it’s interfering with your ability to function well, you may need to make some changes.

How to gently break the habit

As long as your baby no longer NEEDS the nutrition as much at night, it can often be a pretty simple process to reduce your baby’s reliance on nursing for sleep purposes. It can be simplified into classical conditioning.

Pavlov’s dogs salivated at the sound of a ringing bell because over and over, that bell was associated with food. Your baby has developed a strong association between sleep and nursing. You can try a number of things to undo this conditioning:

1. Find a new sleep association. Rather than stopping the nursing to sleep, just introduce something else into the routine. Maybe you start playing a particular song as your baby is falling asleep at the breast. Eventually this song might be enough to make your baby sleepy, and you can remove the nipple to watch your baby fall asleep. You can include multiple sensory inputs for this, so there are multiple things that your baby will associate with feeling sleepy. Try adding a blanket or soft toy, a particular smell, a certain kind of soft lighting, some kind of special touch or massage, or even some gentle movement. The important thing is that your routine is consistent. It will be a lot easier to remove the nursing association when there are other things that will be comforting for your baby.
2. You can gradually reduce time at the nipple. Rather than stopping abruptly, you might consider a more gradual process for reducing night feeds. You might allow your baby to start to fall asleep at the breast, and then be sure to ease the nipple out just before your baby is fully asleep. This might not work the first time, or even after many tries, but it might eventually work. The trickiest thing here might be making sure that YOU can stay awake to remove the nipple!
3. If your baby does fall asleep in other ways, use those instead. It might not be very difficult, as long as you have something else that works well. If your baby falls asleep well in a carrier or being walked around or bounced or rocked gently, it might not be too much of a struggle. If your baby needs to be in the car or in the stroller, you may even want to do that for a little while. It might be REALLY hard to get up in the middle of the night to take a car ride or a walk with the stroller, but if you’re working to extinguish your baby’s reliance on nursing for sleep, this might be something you’ll want to do for a short period to minimize the difficulty. Once your baby doesn’t have that strong association, it can be easier to drop the night feeds.

A few more helpful hints

When you are ready to wean from night feedings or minimize them, here are some things you can do to increase your chances for success:

• Make sure your baby is getting plenty to eat during the day. You may even INCREASE the amount of time spent nursing during the day in preparation for cutting back at night.
• If your baby is also starting to eat solid foods at the same time, try to avoid doing that close to bedtime. Some babies have more trouble sleeping when they are starting solids due to digestive system issues. They may even increase how much they want to nurse at night during that transition.
• You might start alternating breasts when nursing during the transition. If you feed a lot leading up to bedtime, use the same breast. That can ensure that the baby is getting all of the more dense and filling milk at the “bottom” before they go to sleep. They may be able to sleep for a little longer. Then use the other breast when they do wake for a feed, and make sure they get a full feed from that side. You’ll try to avoid lots of very short snacks.
• Make sure your baby is not going through any other big changes. If your baby is getting a first tooth, or has been sick, it might not be the best time to start making this change.
• If it doesn’t go well at first, take a break! It might just not be the right time. After a few days or weeks, you can try again and see how it goes.
• Ask your partner for help with the night time parenting. Especially if you are trying to break a strong association with breastfeeding, it might be harder for your baby to find comfort with you WITHOUT the nipple. Your partner may have their own special methods for comforting your baby that will work great. Once the association with breastfeeding is less strong, you can participate in the night time comforting again.

Remember that every family’s needs are different, and the most important thing is not to start dropping night feeds too soon. You may feel a lot of pressure for your baby to “sleep through the night”, but the textbook definition of that is actually just five hours of sleep at a time. Most babies can not go much longer than that without eating without consequence to their health or your milk supply.

It can be so hard to get up in the middle of the night, but try to remind yourself that these can be sweet quiet moments with your child that you will not have forever. Also, as much as you can, try to get in bed early and catch up on sleep whenever you have the opportunity. Let other people help you, so you can be well-rested and manage those night feeds with less difficulty.

You may never hear the term “cluster feeding” before you are breastfeeding a baby of your own, but once you experience it, you never forget it. Cluster feeding is when a baby seems to want to breastfeed ALL THE TIME. It can last a day or several, and it’s usually frustrating or even worrisome, especially if you don’t know to expect it.

What is Cluster Feeding?

It is absolutely normal for infants to cluster feed. It’s actually an essential part of making and maintaining a good milk supply. In the first few days of life, a baby will usually do some cluster feeding. In this case, the goal is to give your body the signal that the baby is here and ready for more milk. The more often the baby feeds at the breast, the more quickly the milk supply will increase. Everyone starts out producing only a very small amount of milk called colostrum. After a few days of good feeding at the breast, a more mature milk supply will begin. For most people it’s very noticeable. The breasts might enlarge, and even get swollen and hard. The baby will actually get mouthfuls of milk, and you’ll likely be able to see them taking bigger swallows. You may even start to leak milk.

At that point you probably have plenty for your baby’s current needs. But then the baby will grow!

Cluster feeding is usually blamed on growth spurts, but you may not be able to see those growth spurts, or predict them. Some common ages for cluster feeding/growth spurts are when babies reach 2-3 weeks, 6 weeks, 3 months, and 6 months of age, but all babies are different and you may see more or less cluster feeding, or at different milestones.

Whenever it happens, cluster feeding is definitely part of ensuring that your baby gets enough milk. Your baby will start to feel hungrier and start asking for more milk. That’s when cluster feeding happens. You just fed your baby for half an hour at which point the baby fell asleep only to wake up 30 minutes later and ask to eat again! Or your baby might normally eat for 15-20 minutes, but now doesn’t seem to want to stop after an hour at the breast! The baby might even seem a little frustrated. At this point, a lot of people worry that they’re not making enough milk. This is true… temporarily, and it’s normal. Now that your baby has a bigger appetite, your body does need to get the signal to make more milk. The most powerful signal is a baby at the breast.

A common mistake

Many people make the mistake of supplementing their feeds with a bottle of expressed breast milk or formula when the baby can’t seem to get enough at the breast. There are some cases where this might be necessary, and it’s best to seek help if you suspect a problem, but supplementing during cluster feeding is most often a mistake, because it can lead to a vicious cycle. If your baby gets full from a bottle, they won’t ask to be at the breast and your body won’t be getting that signal to make more milk. Then your baby will continue to need more than your body is producing, leading to a reliance on supplementation. If your goal is to exclusively breastfeed, supplementation can definitely interfere. It may also mean that you have to rely on pumping so that your milk supply does not decrease.

What to do?

It may not be exactly what people want to hear, but the best thing to do is just go with the flow… no pun intended. Let your baby stay at the breast as long as they want, and feed them whenever they are showing hunger signs. And it might feel like you are breastfeeding constantly and around the clock. You might need to do this for one day, or several days, so it’s a good idea to prepare yourself physically, mentally, and emotionally.

• Tell yourself that this is normal, and that your baby is doing exactly what they should be doing.
• Tell yourself that your body needs this to happen so you can continue to make enough milk for your baby.
• Tell yourself that this might be hard, but it’s very temporary.
• Remind yourself that you’re doing a great job.
• Remind yourself that after a couple of days, things will be back to normal, BUT you will have more milk to feed your growing baby, and your body is amazing for being able to do this.
• Remind yourself that your child will only be this small for a short time, and that you won’t always have the opportunity for this level of closeness and connection.
• Set up some fun stations wherever you tend to breastfeed. Stock them with anything that’s comforting or entertaining for you since you know you’ll be spending more time there while your baby gets milk.
• Get help. You might feel very frustrated about all the things you can’t get around to doing because so much of your time is spent breastfeeding. It’s a great idea to tell people that you need a little extra help during this time.

It’s really important to recognize cluster feeding for what it is, an important part of a normal breastfeeding journey. I definitely struggled with this when I was breastfeeding, but I didn’t know why it was happening at that time so I felt very overwhelmed and frustrated. If I had the opportunity to do it again, I like to think that I would feel differently about it knowing what I do now. Now that my children are teenagers, I might be able to cherish those cluster feeding days as an opportunity to just hold and feed my baby. I also want to recognize the wonder that is the design of the human body. Closeness and bonding with your child is also something that supports healthy physiological processes, and the reverse is also true. You’re doing a great job!

Reference

https://wicbreastfeeding.fns.usda.gov/cluster-feeding-and-growth-spurts

Breast size and nipple size can be factors for successful breastfeeding, but probably not in the ways that most people think. There is a perception that larger breasts make more milk. Some people worry that their nipples might be too small to deliver enough milk, or too large for the baby to comfortably hold on to. These concerns make sense, but actually don’t have very much affect on your ability to breastfeed successfully.

Anatomy of the breast

The actual nipple is the smallest piece right in the center of the breast. It’s the bullseye. Some nipples are large or long, while others are much smaller. Then there’s a bigger ring of darker skin around that which is called the areola. This part might take up more or less space on the breast. Breastfeeding involves more than just the nipple. The baby actually needs to take in a big part of the areola to breastfeed efficiently and with the least amount of discomfort for you. There are also milk making cells and sacs that create and hold milk in the breast tissue. There are ducts that send the milk to the nipple. These parts of the anatomy actually fill up quite a bit of space in the breast even beyond the areola. There is also fat tissue in the breasts.

When you’re feeding a baby, they need to take in the nipple AND much of the areola to be able to squeeze out the milk from where it’s held in the breast. The pressure from the baby’s mouth helps send the milk down, then the suction draws it out.

Big breasts

Larger breasts don’t necessarily have more milk sacs or ducts. In fact, they usually don’t. What larger breasts do have is more fat. Sometimes larger breasts are associated with being overweight, but not always. Some people just have a lot of extra breast tissue. I do like to think of it as extra. A lot of volume is not necessary for the breasts to function properly. In some cases larger breasts can actually be an obstacle to easy breastfeeding. It might be harder to find a position to hold your baby in a way that is comfortable for you and the baby when the breasts are very large.

There ARE ways to make this easier though, so it’s a great idea to see a lactation consultant for some guidance if you have very large breasts and are struggling with breastfeeding. There are also some associations with difficulties breastfeeding related to a very high BMI. Most often, this does not cause a problem, but if you do have a very high BMI, be aware that you may have a delay in getting your full milk supply. If this does happen, it’s important to get some support to help you manage this. Most of the time, this is a temporary problem. You may be able to get on a pumping plan and/or supplement just until your milk supply is maximized.

Small breasts

If you have small breasts, don’t worry! You will most likely have everything you need there to feed your baby. The hardware needed to make milk doesn’t take up all that much space. Having smaller breasts most often means just less fat tissue. In some cases, breasts might be small enough to mean that there is less storage space for milk, although it doesn’t affect your ability to make milk. In this case, the baby just needs to eat more often.

Then there are some more rare cases of a condition called mammary hypoplasia or insufficient glandular tissue. This condition actually means that a person does not have enough milk glands to produce a full supply. In this case, a lot of people will breastfeed as much as they can and then supplement with donor milk or formula.

What about the nipples?

Whether you have large or small breasts, your nipples might be big or small. Larger nipples can sometimes make it easier for the baby to get a grip on the breast, but small nipples can work very well too. There are some special nipples that can make it a little more difficult.

If you have flat or inverted nipples, it can make breastfeeding more challenging, but doesn’t necessarily mean that it’s impossible to feed your baby directly from the breast. Some people don’t have a hard time with it, or it can be managed with some help.

There are some other more extreme nipple shapes and sizes that might make it more difficult to breastfeed directly. If your nipples are very large or long, it might be difficult for your baby to latch on. Their mouths are very small at first, and they might not be able to fit a very large nipple. A very long nipple may cause gagging. A nipple shield may help, or you may need to pump milk and feed your baby from a bottle temporarily until the baby grows enough to manage the size of the nipple.

Resources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819476/

Because of social media and the internet, there is a lot of sharing going on about emotional struggles that many new parents face. You might be one of those people who shares, or you might be one of the many more people out there who keep these thoughts and feelings to themselves.

First, I want to normalize the FACT that there is a very huge range of “normal” emotions that a new parent might have. It’s very normal to feel very happy and excited about having a new baby and all the things that go along with it. It’s also very normal to feel a little bit happy but mostly confused and overwhelmed.

First, are your emotions normal?

If you are having overwhelmingly negative emotions and thoughts, it’s very important to figure out if you might have a perinatal mood disorder like Postpartum Depression or Anxiety. It might really be that you need some intervention before you can get a handle on it and start to feel more normal.

When it’s the normal stuff

The “normal” emotions you might experience related to breastfeeding are also wide-ranging. Some people find breastfeeding effortless and magical. Others really struggle with it and it becomes a source of big frustration and stress.

If you are one of those people who have an easy time with breastfeeding at the beginning, that’s wonderful! Most people don’t. I think it’s important to really enjoy this time, and you might even ask yourself why you enjoy it so much. There are a lot of reasons that it might feel like a positive experience:

• You might enjoy the closeness with your baby.
• You might like that having to stop what you’re doing to feed your baby gives you breaks that you weren’t used to having in your busy prior life. You probably can’t multitask when you’re first learning how to breastfeed, so you’re being mindful and present when you’re feeding your baby. That can feel very positive, and sometimes can even give you some insight into how much you needed that. You might even take this lesson with you as you go back to work or back to a more structured and busy life.
• Some people have a special connection with breastfeeding when conception or pregnancy or birth were especially difficult. When getting pregnant is a struggle, people might start to doubt their body’s ability to function properly. If pregnancy is complicated, you might have some of the same feelings. If birth doesn’t go as planned, you might feel like your body has malfunctioned or that you’re not capable. I don’t believe that any of these things are true, but it can be hard to convince yourself of that sometimes. But then if breastfeeding goes smoothly, it can feel like redemption. Your body worked extremely well this time, and it can feel really good to recognize and celebrate this.
• You might be very excited about this new ability that your body has to make food for someone else!
• Some people like breastfeeding because it gives them a reasonable excuse to check out! Socializing and being around people can be exhausting or stressful for many people. When you are breastfeeding, you have a reasonable excuse to go somewhere quiet to feed your baby and recharge your social battery.
• No matter what kind of birth experience you had, your body needs rest. It can be hard to get rest for a lot of reasons. You, other people in your life, or even just the cultural norms might be telling you that you should be busy and doing lots of stuff. That’s just not true. You should actually be letting your body rest and heal, because pregnancy and birth were a very big deal. Breastfeeding is often forced rest. You have to sit down or lie down to feed your baby, and especially with breastfeeding, you have to do it often and it can take a long time. You might be feeling good because you’re resting!

Breastfeeding Will Change

Whatever the reasons for your positive emotions, it’s a good thing. For most people, breastfeeding is the hardest at the beginning. For those who have a very easy time at the beginning, it’s also important to recognize that things will change. These changes might not be negative, but they can be. As your baby grows, they may develop some new habits or behaviors that make breastfeeding more difficult. The baby might decide that pinching your chest skin is fun to do while they eat. They might start thinking it’s funny to pop off the nipple every few seconds because it makes a sound or because it will spray milk. Some babies suddenly decide that they don’t want to breastfeed anymore, and it’s way before you were planning to stop. These things can usually be managed well and don’t have to mean an end to breastfeeding, but they can be obstacles to pure enjoyment and ease! You might have some feelings of frustration or confusion. It’s always good to seek help, even later in your breastfeeding journey.

When things don’t feel so good

If you’re not having an easy time with breastfeeding, it can be very difficult. There are so many potential obstacles to easy breastfeeding. A lack of education about breastfeeding might be at the top of the list. Other things include birth related medical complications, structural issues with the breast or the baby’s mouth, mother/baby separation, latch issues, positioning issues, and more. When things aren’t going smoothly, it can be very normal to have some negative thoughts and emotions.

• You might feel like your body is failing. Some people have the understanding that breastfeeding is just a basic bodily function, and it is! But just like any other bodily function, there can be problems. Sometimes digestion doesn’t work just like it should, or things interfere with our sleep. When those kinds of dysfunctions happen, we usually don’t beat ourselves up too much. We just change our habits, or get some medicine, and then we’re back to normal. Breastfeeding should be the same way, but unfortunately it usually isn’t. If you’re struggling with breastfeeding and feeling negative about your own body’s ability, please question that! It hasn’t failed, it just might need a little extra support. This is a bodily function that you’ve never used before, and it might take a little time, learning, and effort before it becomes effortless.
• You might feel like a bad parent for not liking it at first. Not everyone does like breastfeeding at first, even if it’s not especially difficult. You might be experiencing some resistance to being the ONLY one who can do this job. You might not like having to stop what you’re doing every time the baby needs to eat. It’s very normal to have some of these negative thoughts and emotions. Before you had a baby, your time and your body were your own. Now you’re having to share in a very time-consuming and intimate way! You are not a bad parent. This is just a big adjustment, and it can take time for it to feel normal.
• If you don’t like breastfeeding because of pain, it’s really important to get that checked out. It should not be painful for long. There might be some discomfort at first, but it should go away pretty quickly as long as the latch is correct and the baby is doing it right. Get some help if you are having persistent pain.
• Sometimes people have negative emotions about breastfeeding because of other people. Social pressures can really affect us, and when it’s negative, should definitely be examined and avoided. Do your friends and family members support your breastfeeding efforts? If you have people telling you it’s wrong or weird or pointless to breastfeed, and you start to believe them, it can be really hard to continue. You might feel shame or embarrassment about your choice to breastfeed and those are very negative feelings. If this is the case, and you want to continue breastfeeding, you have some options:
  • Whenever you can, find privacy for breastfeeding and do it quietly. This might avoid confrontations that are harmful.
  • You might need to minimize visits whenever possible, or avoid asking certain people to take care of your baby. Sometimes, when they are offering help, they might think they have the right to undermine your choices. Supportive family members and friends should offer help AND ask you how you want things done for YOUR baby.
  • Don’t argue. You might want to tell them why they’re wrong, but that doesn’t usually work. If they feel they have to give you their opinions, you can just listen and nod, then you don’t have to do anything else.
  • Instead, lovingly share some good information with the people who are resistant to breastfeeding. We have this great article listing many of the benefits of breastfeeding and this one about the amazing components of breast milk. You could even invite them to your breastfeeding class!
  • You can also just be very clear and direct. Setting boundaries is something that most new parents have to do at some point about something. You might tell them that you are choosing to breastfeed. You understand that they don’t agree with your choice, but it is your choice, and you need them to stop being outwardly negative or trying to undermine you, or they will not be welcome. We know they love us and want the best for us, but sometimes people just don’t know how to do that correctly. It’s a good idea to set those boundaries as soon as possible so they learn. You can do it clearly and respectfully, but it’s important to follow through. It will most likely be difficult at first, but the people who love you usually come around and end up respecting you even more for making your own informed choices. This definitely happened for me. I had some family members who thought some of my parenting choices were very strange. I told them, “I understand that might have been the right choice for you, and thank you for your advice, but I’m choosing to do it this way instead.” Years later, it was so rewarding to hear them tell me that they think I’m a great parent.

Most of the time, problems can be solved, and breastfeeding can continue more easily. Once this happens, most people feel much better about breastfeeding, and more positive overall. However, if problems persist, and breastfeeding becomes something that is causing you severe emotional distress, it’s also really important to do a risk assessment.

• Do the benefits of breastfeeding outweigh the risks to your mental health and your enjoyment of parenting? If not, then sometimes finding another way to feed your baby is the best option for you and ultimately your family.
• Is breastfeeding so important to you that you worry that your mental health will suffer more if you stop? If so, is there anything you can do to improve your situation or better manage the negative emotions? There are professionals out there trained to help you. You do not have to suffer through it.