 |
|
|
|
|
|
Eyla Boies MD, FAAP
 Eyla Boies joined the UC San Diego Pediatric Faculty Practice in 1992. She devotes her time at UCSD to teaching residents and students, conducting clinical research on clinical breastfeeding related issues, and seeing patients She is a member of the Academy of Breastfeeding Medicine, and the Section on Breastfeeding of the American Academy of Pediatrics, and sits on the board of the San Diego Breastfeeding Coalition.
Question:I have heard the term "tandem nursing" used for breastfeeding more than one infant. What, exactly, is it? Answer:Tandem nursing refers to breastfeeding a new baby while continuing to breastfeed an older child, usually a toddler. Tandem nursing may occur when a lactating mother of a toddler or young child adopts or becomes the primary caregiver (e.g. foster mother) of an infant and elects to breastfeed both children. More commonly, a mother conceives while lactating and continues to breastfeed throughout pregnancy and after delivery breastfeeds the older child in addition to the new infant. Many women around the world who have breastfed during pregnancy and tandem nursed after delivery have done so without informing their health care providers. Their failure to share this information stems partly from the belief that they would be admonished to wean the older child when intuitively she feels she should breastfeed both. I believe providers of health to expectant mothers, mothers of young children, and infants will encounter these question more commonly in the future as the goals of the AAP and WHO to breastfeed for at least one or two years or longer are realized. Many questions come up when considering this situation. Is it safe for the pregnant mother to breastfeed? Will the infant get enough breastmilk after delivery if he/she has to compete with the older child? What effect will the additional demand of breastfeeding a toddler, in addition to a newborn, have on the mother emotionally as well as physically? What if one child is sick, can they both still breastfeed? In response to the question, "Is it safe for pregnant women to breastfeed?" the answer is generally yes if the mother is well nourished and the pregnancy is not at high risk of premature labor. There have been theoretical concerns that stimulation of the breast during suckling could initiate uterine contractions and delivery through the release of oxytocin. Experience has shown that the uterus is not sensitive to oxytocin until term and thus in the uncomplicated pregnancy breastfeeding does not increase the risk of fetal loss. The fetus also appears to do well in a healthy well-nourished breastfeeding mother whose |
|
pregnancy is not high risk as documented in studies from Peru1 and San Diego2. A study from rural India, however, documented lower birth weight in mothers who were poorly nourish and breastfeeding. 3 In response to the second question about the possible limitation of milk supply available to the newborn, the answer is usually this not a problem in the well-nourished mother. Most mothers report ample breastmilk supply and the more common problem is over supply of milk4. One study in India documented faltering growth in the older child in pregnant and malnourished mother3. However, weaning the older child of a pregnant mother when adequate nutrition is in short supply is not without risk as was demonstrated in a study from Bhutan where an abruptly weaned children had a greater risk of developing diarrhea, stunted growth and illness5. After delivery of the new infant a mother will produce colostrum providing the all important immunologic boost to the newborn. The toddler may notice the difference and reject that milk. The answer to the third question regarding the effect of tandem nursing on the mother physically and emotionally is more variable. There is evidence that short birth intervals, that is conceiving within six months of a previous pregnancy, places the subsequent pregnancy at high risk6. Physically most mothers report increased fatigue and many experience nipple pain with nursing during pregnancy. In two studies of women who became pregnant while nursing 57% and 69% weaned during the pregnancy2,7. Half of the weanings were mother led and usually due to nipple/breast pain; the other half were child led weanings. Milk supply frequently diminishes during pregnancy and it may change in flavor. These factors likely promote child led weaning. Some mothers feel tandem nursing is absolutely the right thing to do for both children and others have very negative feelings much to their own surprise. Besides extreme fatigue, some women report resentment toward one of their children or a sensation of being "touched out" by both children and partner. Almost all mothers who successfully tandem nurse recommend protected down time for self-care. Adventures in Tandem Nursing by Hilary Flower is an excellent resource for parents and clinicians. She not only covers the limited literature on the topic, she enlisted the comments of 200 mothers around the world who tandem nursed their children. I highly recommend this book for anyone interested in this subject. The answer to the fourth question, can both children nurse if one is sick, is usually yes. For common colds exposure usually occurs before symptoms are apparent and usually occurs whether breastfeeding or not. However in the case of a toddler with cold sores otherwise known a herpes on the lip (HSV I), the toddler should not breastfeed until the cold sores have completely healed. Herpes infections in the first months | |
