As Baby Grows

"How long should a woman breastfeed her baby?" This is a question I am often asked in class or when I am  doing hospital rounds.  I usually repeat part of latest statement on the subject by the American Academy of Pediatrics  (AAP).  Currently, breastmilk ONLY is recommended for the first six months.  It is the perfect, complete food for the baby.

Around six months of age, a reflex which causes babies to push food out of their mouths (extrusion reflex) disappears.  Now, I wonder why that reflex is even there?  Maybe starting solid food too early is not a good thing?

 Babies will start grabbing for food off mom's plate and putting it in their mouths around the sixth month. This is a good sign they are ready for solid food.  Check with your pediatrician and/or La Leche League and/or other "baby food" source for recommendations of what foods to add and when. 

The AAP also recommends continuing breastfeeding for AT LEAST one year.  It cites benefits for feeding until age two or after.   Don't forget:  studies are indicating that the longer the baby breastfeeds, the bigger his or her brain will grow.  That alone is a great incentive to try to continue breastfeeding if you run into problems early on.

The average age of weaning worldwide is significantly higher than in our culture.  We been a "formula" culture a long time.  We have a long way to go before being comfortable with young children going to mom's breast for a snack, for a bedtime feeding, or for comfort.  If people would think of breastfeeding the older baby as medicine, or brain food, they could appreciate the benefits and be less disapproving. 

But, why would the average person consider these benefits?   When was the last time you heard or read about of these benefits for babies AND for three and four year olds?

There are cultures where attitudes about long term breastfeeding are very relaxed.  People have seen children die from disease after they were weaned, so they realize the protection breastfeeding provides. But the sanitation processes available in a culture is not the sole criteria for determining if it is "safe" to wean a baby around a year, or even to formula feed.

In our culture mothers hear comments like "You're still nursing?  Don't you realize he KNOWS what he is doing?"  (I would hope so -- he is going to his favorite spot in the world -- cuddled close to his mom. He is enjoying the sweetness of her milk).

One of the most precious things I have seen lately is my little 21 month old grandson interacting with his mama.  This little guy loves his mama so much I have seen him flirt with her!  When he wants to breastfeed, he lets her know by special words and looks that he needs mama and her sweet milk.

It was pretty standard in Biblical times (depending on the era and location) for children to breastfeed until they were three to five years of age.  Very likely, there were some cultures where breastfeeding lasted longer.

Nothing better has been developed over the past thousands of years to feed to babies and young children.  The mothers who want to continue breastfeeding for health reasons may be few, but they are not acting foolishly.

 I believe the decision of when to wean is a personal one between mother and child. I have yet to find anywhere in the Bible where the father had any input with regard to breastfeeding.  All passages refer to the mother and her infant or child.

However, family dynamics must be considered. There is a balance between caring for one's child and respecting a husband's desires.  My thoughts are that the principle of "husbands love your wives" applies very strongly in this case.  This will prevent an intense emotional struggle for the wife to "submit" to her husband when she feels she is abandoning the emotional and physical needs of her baby.  In most cases, if the father understands the health benefits to both the child and the mother, he will be supportive of breastfeeding. But, like it is for most women, most men do not know the risks of formula feeding.  They base their feeding preference for their wives on limited, even erroneous, information.

On the other hand, once a woman has received objective, research based information on the risks of formula, if she does not want to breastfeed, I believe she has the final say. 

It will do little good if the mother is resentful of having to breastfeed because of pressure from her spouse.  Most likely breastfeeding "problems" will crop up and she will soon wean anyway.  A wise husband will offer to encourage her in practical ways.  The time he can spend cleaning the kitchen, or doing laundry, etc. if she will breastfeed, may encourage her to try.  A reluctant mother might find she enjoys this new experience when she does not feel the added pressure of having to deal with all the household tasks.

Some women have to cope with the long term effects of emotional, physical, or sexual trauma in their earlier years.  For some of these women, breastfeeding is too emotionally taxing.

Back to weaning.  My opinion is for mama and baby to continue breastfeeding until one or the other indicates, "I'm done."  Most women who understand the importance of breastfeeding will continue as long as it is feasible practically and emotionally.

Employment outside the home is a great challenge to nursing mothers.  In most cases, it can be done,  It takes planning and commitment.  For some women, knowing they can continue to work outside the home and still provide their babies with their milk makes having to leave their babies to return to work easier.  For others, it seems to be too much to manage.  Again, mom knows what she is capable of handling and should be the one who decides.  Still, I would encourage women to try to continue breastfeeding after they return to work. They may find that it does all come together and they can continue.  Providing any amount of breastmilk supports the baby's needs better than formula alone.

Weaning should occur gradually.  Abrupt weaning can be physically or emotionally traumatic for mom or baby, or both.  Check www.llli.org or other good breastfeeding web sites, or in the books I recommended earlier for tips on gradual weaning.  You will find recommendations which make sense to you and work for your situation.

Let's get back to the main purpose of this post -- the time between those first days of breastfeeding and weaning.  There are some things which will be helpful to know.  Below is some practical advice and "food for thought":

1. First, as your baby grows, he or she may not poop everyday.  Breastmilk has very little waste product. The older baby, beginning around three or four months, who is exclusively breastfed, may go several days without a bowel movement.  His or her body is simply using the milk efficiently.

However, when "poop day" arrives, be prepared!  Some mothers recognize that their little one will be "doing his business" soon.  They may see "squirminess", fussiness, a scrunched up, red face, and perhaps some signs unique to her baby.  These moms have learned NOT to leave the house until the "mission is accomplished" OR they have learned to take extra diapers, wipes, and baby clothing if they have to leave with the baby before the big poop! 

My first baby, after reaching about three and a half months, started going longer and longer between poops.  I was so concerned one day I called his doctor.  Dr. Judson Tripp, a wise and compassionate pediatrician, told me to relax and not worry.  "He's just using up all the milk.  He'll go when he's collected enough to fill his diaper". 

Constipation results in hard, dry stools.  It is not diagnosed by the length of time between bowel movements.   Exclusively breastfed, growing babies may go several days between poops. However, when they fill their diapers, the stool is soft, like the consistency of toothpaste.  Constipation (hard dry stools) is more likely to occur in formula fed babies.

2.   Sometimes, especially in warm weather, breastfed babies want a drink of water.  To get this, they nurse just a couple of minutes.  They are drinking foremilk, which is high in water and sugar, and low in fat.  Even in hot climates, bottle feedings of water only are not necessary.

Even during hot weather some mothers insist on feeding exactly on a schedule.  Think about this:  when was the last time you wanted a drink of water an hour or two after your last meal.  When you tried to get it, did someone tell you "Ahh ahh!  It's not time for you to eat.  You have another hour before you can have anything!"?  Give your baby a break and let him or her nurse when thirsty.

3.  Another problem with artificial schedules is the some women have smaller breasts.  They can make enough milk throughout the day for their babies, but storage is limited.  Their babies have to nurse more frequently, usually for a short time, to get the full amount of milk mom produces.  Telling them to feed every three hours just won't work.

4.  Some parenting programs encourage fairly strict feeding schedules for babies. In some of them, the number of breastfeeds per day is lowered as the baby grows.  This is not based on any scientific evidence.  As a result, many mothers starts to loose their milk supply.

Whenever milk stays in the breast longer than about three hours, a chemical marker is reabsorbed back into mom's blood stream.  This marker is sent back to the brain, and in essence says, "No one is taking the milk.  We need to cut back on production or the breasts might explode!"  (well, not really, but I can imagine this!).  The pituitary gland will start reducing the amount of prolactin and before long, mom's milk supply will be reduced.  The more breastfeeds or pumpings are delayed beyond a three hour point, the more the milk production is reduced.

Women who are working need to express milk by around the three hour point, even if all they can do it "pump and dump".  It is better to keep the milk supply up than to try to wait another hour and store the expressed milk.  Learn how to hand express so you can reduce the amount of milk in your breasts if you can't get to your breast pump on schedule.  

5.  Just as a reminder, there is no need to start giving cereal before 6 months to the healthy, breastfed baby.  ANY OTHER FOOD is a LESSER FOOD compared to breastmilk.  Also, when a stomach virus is going around, breastfeeding is the ideal way to feed your baby.  It is easier for baby to digest than anything else.  Electrolyte "formulas" are not as beneficial.  Some older babies will refuse solid food, but will take the breast during times of G.I. upsets.

6.  When it comes time to wean, do so gradually.  In many cases, older nursing babies/toddlers are nursing only once or twice a day anyway.  Drop a feeding for a few days, and and then drop another one for a few days, etc.   There is a saying for the  mother who wants to wean an older baby,  "Don't offer, don't refuse".  This can help babies who are ready to wean do so a little sooner.  If a baby wants to keep breastfeeding, mom has the opportunity to re-evaluate before weaning.  As always, the decision is ultimately the mother's to make -- unless baby decides "I'm done!".

Sometimes babies go on a nursing strike. Some reasons may be obvious.  Some are not.   Le Leche League (www.llli.org) is a great source of what  you can do if your baby suddenly refuses the breast.

7.  Check with your baby's doctor, your OB, or the pharmacist regarding the effects of a prescribed or over the counter medication on your baby and on your milk supply.  Only in a few cases is a medication unsafe for a baby or causes a problem with mom's milk supply.  Often, a substitute med can be safely given instead.   Sometimes the recommendation is based on how much actual breastmilk baby is taking.  A baby who is nursing only twice a day, but eating solid foods, may be able to continue nursing, even if mom is on a medication of concern.  Talk with your care providers and pharmacist.  They will be able to figure out from solid resources, what it safe.

8.  Some mothers like to teach their babies a sign to use when they to nurse while mom is out in public.  Others come up with a code word.  Ours was "nummies".  My grandchildren used it too.  

9.  Don't breastfeed in a bathroom.  If you want a quiet, private place, dressing rooms or your car are much better.  Also, there are many styles of nursing capes for privacy when baby wants to eat at the mall, restaurant, the movies, etc.  These allow you to feed virtually anywhere (except a bathroom!) without exposure.  

An experienced mom can breastfeed discreetly just by lifting her top enough for the latch on, and then covering again down to baby's nose or "nursing interface".  You can try practicing in front of a mirror if you want to use the "top down" technique until you are comfortable that exposure will be minimal.

10.  Modesty is something Christian women are taught in Scripture.  Exposure should be considered in context.  Full breast exposure when nursing at home is different than full breast exposure while nursing in public, or when people are visiting you at home.  Women, including Christians, are all over the board on this issue.   Some will not breastfeed in public at all, but bottle feed pumped milk.  Others on the other end of the continuum have no problem with fully exposing the breast for nursing. (I do not like the phrase "whip it out" -- no one "whips out" a breast!  Women "uncover".)

Men tend to be sexually stimulated by seeing significant exposure.  They have limited experience with seeing the normalcy of women breastfeeding in all aspects of life, and can not compartmentalize what they see as well as men in other cultures. 

We, as Christian women, should be careful not to "defraud".  I Timothy 2:9 states that we should "dress modestly, with decency and propriety".  While that verse has particular meaning for the culture at the time it was written, the basic principle still applies in our culture.

Even though the exact interpretation of modesty is culturally defined, I think it is safe to say that excessive breast exposure in public places will NOT be thought of as as "modest", even in our low cut, tight top, culture.

11. Don't breastfeed in a moving car.  Your baby needs to stay in the car seat.  Find a safe place to park, and then feed the baby.  It isn't worth the risk to try to save the few minutes it takes to feed the baby.  One sudden stop or accident is enough to toss your baby out of your arms and cause injury -- or worse.

12.  Don't become upset when someone says something negative about your nursing, especially nursing an older baby.  You can ignore them.  Or, you can use the opportunity to teach them about the risks of formula feeding and the great benefits of giving your baby human milk for the first year and beyond.

13.  Consider becoming part of a breastfeeding support group.  Most communities have a couple of different types to choose from.  Some hospitals offer them, as well as Le Leche League or groups sponsored by lactation consultants in private practice.  Some churches offer groups for mothers and babies.  Try out different ones until you find one which "fits" you.

Be careful of any group which promotes breastfeeding advice which goes against what solid  research has shown. 

If a group goes beyond breastfeeding information as it's focus, feel free to take the breastfeeding advice and leave the rest.  While learning more about topics like good nutrition can be a part of the discussion from time to time, you do not have to grow and grind your own wheat and make your own bread to be a good mother!  

Your journey through the first year, or more, of breastfeeding will be filled with joy, perhaps an occasional struggle, learning, and amazement.  When it is completed, you will experience a great sense of satisfaction that you gave your baby "God's formula.

This posting completes the planned course of this blog.  However, I have enjoyed writing so much, that if I come across new information or experiences which I think are worth sharing, I will probably continue to add posts.  The nice thing about writing a blog is that the reader does not have to agree that the topic was worth sharing!

I hope the information provided by this project will help more women decide to breastfeed, or to continue breastfeeding a little longer for their own sakes and the sake of their babies.

I also desire that everyone who reads this blog will realize or remember that the loving God who designed human milk for human babies also created the universe.  He continues to control it even though things may seem out of control. He will one day redeem His creation.

In the meantime, each of us who know Him as our Savior and Lord, must continue to do what He has placed on our hearts and in our lives to do. Motherhood is one of the most important of those tasks.  For Christian women, mothering is a ministry to God's precious little ones.  Breastfeeding makes motherhood sweeter.  Soli Deo Gloria.