I recently worked with a 15-year-old mom (Jane) who was ready to quit breastfeeding her four-day-old baby. Jane wanted to stop because it was too difficult to breastfeed and the baby always cried! After I assisted her through a successful breastfeeding session, she told me that her mother breastfed her and that she wanted to do the same for her baby. Jane also said that her friends with babies choose not to breastfeed because they do not know much about it and find it painful and embarrassing. This is a typical scenario and numerous surveys have shown that teen moms are less likely to breastfeed than older mothers. In a 1990 survey, 39% of teen moms having their first baby breastfed in comparison to 86% of mothers over the age of 30. (Ineichen, et al, 1997).

As health care providers, we need to identify our own personal attitudes and feelings towards teen pregnancy. Effective communication with a teen mom starts with putting negative feelings aside, using simple visual aids and handouts, avoiding the use of specialized medical or biological terminology, and by working from a genuine, honest level of communication. Furthermore, understanding certain issues and barriers in this young age group will aid in reaching them. Some barriers include a lack of knowledge about breastfeeding, lack of family/friend support, body image issues, emotional immaturity, and returning to school. "The difficulties of working with this group of mothers, due to their immaturity and frequent social problems should not be underestimated." (Ineichen, et al, 1997). The following strategies can help teen moms to breastfeed:

• Use strong peer role models, videos, and role-playing.
• Mention the benefits of breastfeeding and discuss concerns and myths. Emphasize breastfeeding as an aid to returning to an optimal weight more quickly, and mention that breasts sag due to pregnancy and not from breastfeeding.

• Begin breastfeeding education in early pregnancy. Include the baby's father, maternal grandmother and other family members.
• Praise the mom for her time and effort with breastfeeding.
• Boost the mom's confidence by emphasizing that only SHE can breastfeed her baby.
• Provide tools to continue breastfeeding upon returning to school. Schools with minor programs allow teens to nurse in the school's daycare center.
• Close follow-up is essential with this young population.

Mothering and nurturing may be challenging for teens since they are very focused on their body image and peer approval. As health care providers, we must correct misconceptions, increase positive attitudes and promote and support breastfeeding among teen moms. Weave the quilt while they are young!