Breastfeeding / Antropolgy

Beyond Toddlerhood:
The Breastfeeding Relationship Continues
by Priscilla Young Colletto

While mothers who are still nursing children at two, three, four or more years of age are exceptional in Western culture, they are perhaps greater in number than most people realize. Because nursing beyond the first year of life is seen as atypical in Western culture, mothers making this choice may face heavy criticism. They may also feel isolated, for as their children grow older, it often becomes harder and harder to find support and more difficult to find peers who have taken the same path. Source of Support As Leaders we are important sources of information and support for these mothers. We can help them to overcome the feelings of isolation and doubt that come with making a choice that is different. We can help them see the broader picture: there are mothers all over the world who nurse their children for years rather than the few weeks or months that are common in Western culture. We can remind them that many mothers before them, throughout human history, have had nursing relationships with their children throughout the early childhood years. We can make sure these mothers have the information they need to counter the criticism and judgmental attitudes that they may encounter. We can help support their self esteem so they may confidently follow their inner voice and feel comfortable making the choices that are right for them. Since Series Meetings are designed to meet the needs of new mothers, a special forum may be needed to give mothers of older children the opportunity to share their experiences and concerns about nursing through the toddler years and beyond. A special meeting of this type gives a mother the opportunity to build a bridge of support and knowledge that can be helpful in overcoming the isolation that she may feel as a mother of an older child who continues to nurse. At Area Conference workshops on the topic of nursing through toddlerhood and beyond, mothers are clearly grateful to finally have a chance to share their experiences and are eager to ask others the questions that they may have had to face alone. As they recognize the commonality of their experiences and concerns they feel relieved. It is reassuring to hear that others have had similar experiences. Since nursing past infancy is no longer the norm in many cultures and is, in fact, often perceived as abnormal, we as Leaders can benefit by looking beyond our cultures and our time period to gain a more in- depth understanding of what is truly normal and natural human behavior. Katherine Dettwyler, an anthropologist, has drawn attention to this subject through her article, A Time to Wean, (Breastfeeding Abstracts, August 1994). Here is part of her answer to the question of the "natural" age of weaning in humans: According to the research of Smith (1991), many primates wean their offspring when they are erupting their first permanent molars. First permanent molar eruption occurs around 5.5 to 6.0 years in modern humans. It is interesting to note that achievement of adult immune competence in humans also occurs at approximately six years of age, suggesting that throughout our recent evolutionary past, the active immunities provided by breast milk were normally available to the child until about this age (Frederickson). Our evolutionary past has produced an organism that relies on breastfeeding to provide the context for physical, cognitive and emotional development. The non-human primate data suggest that human children are designed to receive all of the benefits of breast milk and breastfeeding for an absolute minimum of two and a half years, and an apparent upper limit of around seven years. Natural selection has favored those infants with a strong, genetically coded blueprint that programs them to expect nursing to continue for a number of years after birth and results in the urge to suckle remaining strong for this entire period. In her book, Breastfeeding: Biocultural Perspectives, Dettwyler theorizes that the six-year nursing practice for humans began to be modified, first by the use of fire for cooking (one-half to one million years ago) and then even more significantly by the domestication and processing of grains via pounding and grinding, both of which provided alternatives to uncooked vegetation and raw animal foods. It is interesting to note that the hunter/gatherer lifestyle represents more than 99.9 percent of human existence on earth and that agricultural societies have existed for only about the last 10,000 years. Ethnographic studies of hunter/gatherer and other pre- industrial societies show that while the duration of lactation varies considerably between cultures and between individual children within a culture, the average duration is between three and five years of age. Here are some examples from Wickes' 1953 survey of various tribes: Australian aborigines, two to three years; Greenlanders, three to four years; Hawaiians, five years; Inuit, around seven years. Lactational duration is just one of many cultural variations in breastfeeding practices. Patricia Stuart-Macadam, writing in Breastfeeding: Biocultural Perspectives, informs us that the !Kung San of the Kalahari desert in Southern Africa breastfeed frequently and intensively, "giving the breast about four times an hour during the day and several times at night for at least the first two years of life." This practice has a significant child-spacing effect with conception occurring on average 35 months postpartum, resulting in a birth interval among the !Kung of almost four years. Nature's Norm Such frequent suckling may indeed be nature's norm, reports Sheila Kippley in her book, Breastfeeding and Natural Child Spacing, as it is true of both chimps and gorillas as well as representative of a number of human cultures living in natural conditions. The Gainj of New Guinea nurse their infants at an average interval of 24 minutes. For their 3-year-olds, the average interval between nursings is 80 minutes. It is interesting to compare these practices to the standard recommendation given to new mothers today of 8 to 12 nursings in a 24-hour period. In a thought provoking article, "The Concept of Weaning: Definitions and Their Implications" (Journal of Human Lactation, June 1996), Ted Greiner points to research in northern Bangladesh where children who were breastfed at 3-4 years of age received the breast 9-10 times a day and those who were still breastfed at 4-5 years of age received it 7-9 times a day. Greiner comments, "Although the quantity of breast milk was not measured, this sucking frequency can be assumed to maintain a relatively high level of breast milk production (as indeed it does in women who relactate), and should hardly be termed 'token breastfeeding."' We seem to know so little about what is normal nursing behavior for the four- to five-year-old that this cross-cultural information can be very reassuring to a mother who is wondering about her child's nursing behavior. In her book, Mothering Your Nursing Toddler, Norma Jane Bumgarner gives us this glimpse into the history of the decline in breastfeeding duration in English-speaking countries. She reports that according to a study of advice given to mothers by doctors from 1550 to 1900: It was not until 1800 that most of the popular English writings on child care recommended weaning as young as 12 months. Even in 1725, writers commented with disapproval on nursing four- year-olds, an indication that a significant number of eighteenth century four-year-olds were still receiving love and comfort at their mother's breast. By 1850 most "experts" were recommending weaning by 11 months. At this time it was the nursing two-year-olds seen by child-care advisors who drew official frowns. It is enlightening how closely these changes in recommended patterns of child care parallel other changes in family life that accompanied the Industrial Revolution in England and the United States. Bumgarner reports these other interesting pieces of history: In ancient India, influenced by the belief that the longer a child nursed the longer he would live, mothers usually nursed their children as long as possible, often seven or even nine years sometimes. In Tsinghai, China, mothers observed in 1956 were still nursing for several years, five years not being unusual, or until another child was born. In Inner Mongolia in 1951, children nursed two or three years, nor was it rare that a six- or seven-year-old would want to nurse for a bit of reassurance. Kathleen Huggins and Linda Ziedrich, in The Nursing Mother's Guide to Weaning, give an interesting glimpse into weaning practices of other cultures. In one account a Sioux mother "came to school at recess to nurse her eight-year-old boy because he had a cold." And they comment "this wasn't a very remarkable occurrence in her culture; the average nursing period among the Sioux, traditionally, was three to five years." Within Western cultures there have been significant regional differences in breastfeeding practices. While "experts" in England were recommending weaning as early as 12 months in 1800, Gabrielle Palmer notes in her book, The Politics of Breastfeeding, that "in East Lincolnshire women were reported to suckle their children until they were seven or eight years old even in the 1820s." Though it is clear that the majority of women worldwide and throughout history have nursed their children into toddlerhood and beyond, women who choose to do so today may face an uninformed and frequently critical audience. Therefore many choose to make sure that they limit who sees and who knows, taking greater care as the child grows older. Given this climate it is a highly select group of mothers who nurse their children beyond toddlerhood. Social Pressures Because of the social criticism and resulting secrecy, it is hard to get an accurate picture of just how many children are continuing to nurse this long. Often the last nursings to be given up occur in bed and so are hidden from all but those who share the bedroom. It must be difficult even for the anthropologist in a native tribal village to get an accurate picture of when nursing has completely ended. Older nursing children as well as mothers feel the social pressures. They are often very aware that other people just don't understand. Privacy may be even more important to the child than it is to the mother. Knowing other children their age who are continuing to nurse is helpful. Reading stories about other nursing children also helps to normalize it. Unfortunately these stories are not widely distributed or well known. My daughter has asked me several times to reread stories of older nursing children from HARVEST, Area Leaders' Letter of LLL New York West, USA. She chose to have a weaning party after being inspired by one of those stories. Given social criticism, people who are unfamiliar with the practice of nursing beyond infancy may wonder why mothers would want to continue to nurse through toddlerhood and beyond. As Leaders we can help mothers answer this question confidently. Mothers find many practical advantages in nursing. As a parenting tool it is useful when easing the exhausted child into sleep or soothing both mother and child after the storm of a tantrum has passed by. During illness, breast milk may be the only food or drink that a child will take or can keep down and digest. It can make the difference between a dehydrated child needing hospitalization and a sick, but well-hydrated, child at home in mother's arms nursing through a potentially serious illness. Health Benefits The adverse health effects of weaning a child before or during toddlerhood are well documented for Third World countries such as Guinea-Bissau, where children who were no longer breastfed at ages 12 to 35 months had a 3.5 times higher mortality than did their peers who continued to breastfeed. There is a lack of this type of comparative research between breastfeeding toddlers and preschoolers and their already weaned peers in economically advanced countries. The negative impact of early weaning on children's health is not as dramatically evident but in time it may prove to be significant. The scientific evidence on extended breastfeeding is just now beginning to accumulate. A number of the health benefits are now being found to be related to the length of nursing with an increasing amount of benefit correlating with increased duration. This is the case, research has indicated, with breastfeeding's protective effect in maternal breast cancer, osteoporosis, childhood ear infections and malocclusion anomalies (misaligned teeth). Katherine Dettwyler reports that "a wealth of scientific evidence exists documenting that the benefits of breastfeeding (and the risks of artificial feeding) continue for as long as the infant nurses. Aside from the health concerns, there is now evidence that the longer a child breastfeeds, the higher that child's IQ score and school grades will be in later years, with a dose effect evident even beyond two years of nursing." The word "benefit" is perhaps misleading here, for these "benefits" are what nature intended to be the human norm. Breastfeeding is normal. It is artificial feeding substitutes and premature weaning that are, in fact, abnormal from a biological viewpoint. It is these abnormal practices that place the child at increased risk of illness and compromised intelligence. For many nursing couples, by the time the child reaches toddlerhood, nursing is a well-established part of their relationship. We can help mothers to feel confident in acknowledging that their breastfeeding relationship is mutually satisfying: highly cherished by the child and often by the mother as well. For mothers it is a mode of giving both nurturance and sustenance. For both mother and child nursing is a momentary retreat from the increasing separateness of their lives, back to the closeness they shared when the two were one. Nursing Through Toddlerhood and Beyond Special meeting discussion questions: While it is clear that nursing a child beyond the first 12 months of life is something we have in common with the majority of mothers throughout history, in many cultures we stand out as different. While we have been able to find support, we also may face criticism. How do you feel about this criticism? How do you deal with it? We want to meet our child's needs and we want to promote the normalcy and healthfulness of nursing without offending others or becoming a target of criticism. It is a tricky balance to achieve and we each need to find our own comfort level. How do you handle the issue of nursing a toddler in public? Sometimes our partners or other close relatives have a different outlook on continued nursing. How do you manage these differences? Children can be demanding. At times it may feel that your child's demands to nurse are excessive or inappropriately interrupting your activities. How do you balance your child's needs and wants with your own? When we choose to limit nursing or decide to wean completely, how can we help our children handle their feelings of loss? The nursing child may be keenly aware that peers or adults disapprove of continued nursing. How can we protect our child from social disapproval and help him/her handle the situation constructively? What do you see as the benefits of nursing through toddlerhood and beyond? An Anthropological Look at Nursing Beyond Toddlerhood Time Period Who and Where Nursing Duration Ancient Times Egypt 3 years Early 1900s China and Japan 4-5 years 1940s Burma 3-4 years 1950s Kenya up to 5 years 1950s Siniono (Bolivia) 3-5 years 1950s Inuit around 7 years N/A Chimps/gorillas 5-6 years Natural Reassurance When reading a children's book about chimpanzees by Jane Goodall to my then five-year-old daughter, I learned that mother's milk remains a chimp's most important food until about three years of age. The book described Goodall's field observation of a chimpanzee mother named Fifi and her four-year-old daughter Flossi. "Flossi starts to suckle. She will not be able to do this for many more months. Fifis milk is drying up and she often prevents Flossi from nursing these days. Then Flossi pouts and utters sad crying sounds until Fifi relents and lets her suckle for just a little while. In about a year Fifi will probably have another infant." Of the hundreds of children's books I have borrowed from the library and read to my daughter, this is the only one that described nursing a four-year-old. As another nursing mother I found myself reassured by both Fifi's and Flossi's behavior. I identified with the mother's ambivalence, at first resistant and irritated at the youngster's demands and yet, in the face of her daughter's grief, relenting and giving in. Perhaps those experts who admonish mothers to be firm and consistent are out of touch with our nature as primates.

Sleep Advice / Night Weaning

Changing The Sleep Pattern In The Family Bed

By Dr Jay Gordon

I can only imagine a mom and dad who are as tired as anyone can be, eager to see this article on sleep, and finding that we had made it unavailable for a little while!

We had to do that because I didn't write the article clearly enough and need to clarify some very important facts.

It would be hard to find as strong a proponent of the family bed as I am. Yet, I have received email commenting that there were sections of this "plan" which were easy to misinterpret as being just another angle on "sleep training" for young babies. It is not meant to be that. Not even close to an endorsement of the benefits of getting your baby to "soothe herself to sleep" during the first year.

Here's what I really want to do: I want to offer an alternative to Ferber and Weisbluth and the Whisperer. I never want to see my ideas applied to a four month old or even a seven month old baby. As a matter of fact, I am not too excited about pushing any baby around at night but I know that sometimes it will be done and I'd like to offer a gentle, supported plan for after the first year.

Before I go any further, let me express my overriding concern. Babies do better when we answer all their questions as best we can and meet their needs as best we can.

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Most of the families I have taken care of in my pediatric practice sleep in a family bed.

Their babies tend to breastfeed for more than one year and they don't sleep through the night any better than most of us would if we napped and cuddled within inches of the best restaurant in town and knew it was open 24 hours a day.

This arrangement is not just adequate and tolerable, but actually feels easier to moms who can just roll over, nurse a while and fall back to sleep with their babies rather having to get out of bed to nurse or, alternatively, refuse to nurse and get their babies back to sleep some other way.

Lots of parents continue this pattern through the first year and well into the second and beyond, but some get tired of it -- or just plain tired -- after a while and are looking for a way to change things. Saddest of all, some moms and dads think that total weaning from breastfeeding is the best way to get more sleep. They choose not to look into nighttime weaning as a good option instead.

There are dozens of confusing books and magazine articles implying that there can be some quick and easy way to get your baby to sleep or to not nurse through the night. I have yet to read one which told parents the complete truth: It's not easy, it's rarely quick and it's usually a little loud and heartbreaking for a few nights . . . or more. I have seen too many families needing help and getting offered choices they didn't like at all.

I have a better alternative to completely weaning or to letting the baby cry it out. Babies wake up for the optimal interaction with their moms, breastfeeding back to sleep. If we offer them a little less than that for a few nights and then a little less and still less in the ensuing nights, gentle behavior modification will lead them to realize that it might not be "worth it" to knock on the door of a closed restaurant, so to speak.

I don't recommend any forced sleep changes during the first year of life. Probably the only exception to this would be an emergency involving a nursing mom's health. There are many suggestions in books and magazines for pushing "sleeping through the night" during a baby's early months or during the first year. I don't think this is the best thing to do and I am quite sure that the earlier a baby gets "non-response" from parents, the more likely he is to close down at least a little.

Don't get me wrong. I love the family bed, child-led weaning and cuddling all through the first, second, third year or more if it's working well and if the family is doing well. Don't let anyone convince you that this is a harmful choice or that there will be "no way" to get him out of your bed if you don't do it now. Don't believe anyone who says that babies who cuddle and nurse all night long "never" learn to self soothe or become independent. This is simply not true but it sells books and the myths stay in our culture.

Some moms just don't want to do this after some months or years and there should be a third choice to the dichotomy of crying it out or giving in to all-night nursing. Again, I support the family bed and frequent night nursing for a long time and even attempt to pull some parents along "just a little farther," but I often have to switch tacks and support and help families with difficult choices.

Here's what I recommend for older babies:

Choose the most valuable seven hours of sleep for yourselves. I personally prefer 11p.m. through 6 a.m. but you might have a slightly different idea.

Change the rules during those hours and be comfortable that a "well-built" family bed baby's personality can withstand this rule changing and the mild inconsistency of getting everything he wants all the time . . .oops, almost all the time. That's the word we want to show this baby. The word "almost." If only we could explain to him that "tired moms and dads take their children to the park a little less and that children of well-rested parents get to go the zoo and for hikes a lot more than children of exhausted parents." If that explanation only made sense to kids somewhere before the third birthday (and it doesn't!) they would simply roll over, say, "See you in the morning," and let us get the sleep we want.

I try to do this in three- and four-night intervals.

I'm assuming that you have a wonderfully healthy 12-, 15-, 20- or 30-month old baby who still loves to wake up every 2 to 4 hours to cuddle, eat or . . . whatever. I'm assuming that you have thought this through, decided you want to make changes and alerted the neighbors that it might be a little noisy for a week or so.

I'm assuming that both parents agree -- or almost agree -- that this is the best thing to do. And, most important assumption of all, you are willing to go "in a straight line" to the goal of seven straight hours of sleep.

The reason for that last statement: If your baby learns that crying, squirming and fussing (euphemisms, let's just say "crying" . . . sorry) for an hour will get him fed you will set yourself back quite a bit. This is the best program I have seen but it's far from easy. And now, to say it again, I really like what you've been doing. Cuddling, nursing, hugging through the night. Don't change this with my program or any other if you're happy doing what you're doing. But . . .

The First Three Nights

At any time before 11 p.m. (including 10:58) nurse to sleep, cuddle and nurse when he wakes up and nurse him back to sleep, but stop offering nursing to sleep as the solution to waking after 11 p.m.. Instead…..

When your baby awakens at midnight or any other time after 11 p.m., hug him, nurse him for a short time but make sure he does not fall asleep on the breast and put him down awake. Rub and pat and cuddle a little until he falls asleep but don't put him back on the breast (or give him a bottle if that's what you've been doing). He must fall asleep with your comfort beside him, but not having to nurse to feel comforted enough to drift off.

Now, he will tell you that he is angry and intensely dislikes this new routine. I believe him. He will also try to tell you that he's scared. I believe he's angry, but a baby who's had hundreds of nights in a row of cuddling is not scared of falling asleep with your hand on his back and your voice in his ear. Angry, yes. Scared, no, not really.

During these first three nights, repeat this pattern only after he has slept. He might sleep for fifteen minutes or he might sleep for four hours, but he has to go to sleep and reawaken to get cuddled and fed again.

These will be hard nights.

You may have decided you're really not ready to do this. That's OK. Stop and start over again in a few months if you like. Choosing the right time is crucial and many people choose a time suggested or pushed by friends, doctors or in-laws. This doesn't work as well.

Is it better to do this in the family bed, a crib in the same room or using a crib in another room? I prefer to continue the family bed even though it might seem harder at first, but it has always seemed harder to me to be putting a baby in and out of a crib. However, a crib or toddler bed in your room may be what works best for you. Another option is to expand your bed's limits by placing another mattress against your mattress. A bit more space for each family member may help to solve some of the sleep issues. My least favorite choice is a crib or bed in a separate bedroom.

Again, during these first three nights, between 11 p.m. and 6 a.m., cuddle and feed short, put him down awake, rub, pat, talk until he falls asleep and repeat this cycle only after he's slept and reawakened. At 6:01 a.m., do whatever you have been doing as a morning routine ignoring the previous seven hours' patterns. Many babies will roll over, nurse and cuddle back to sleep and give you an extra hour or so. Some won't.

For me, one of the most reassuring parts of this "sleep plan" is seeing that babies wake up fine, happy and grudge-free about the change in the rules. You'll see what I mean, even if the first few minutes of the morning are not exactly as they've always been.

The Second Three Nights

Again, the nursing to sleep stops at 11 p.m. When he wakes up, hug him and cuddle him for a few minutes, but do not feed him, put him down awake. Putting him down awake is a crucial part of this whole endeavor because it really does teach him to fall asleep with a little less contact and then a little less. Not feeding is the big change during these three nights. One-year-old babies can easily go for those seven hours (or more) with no calories. They like to get fed a little through the night, but physiologically and nutritionally, this is not a long time to go without food.

If I could wake my wife a few times each night, ask her to squeeze me a little fresh orange juice (my favorite drink) and rub my back while I drank it, I wouldn't choose to voluntarily give up this routine. My wife might have some different ideas and get tired of the pattern quickly. Babies rarely give up their favorite patterns and things -- day or night-- without balking and crying.

I really don't like listening to babies cry. I actually hate listening to babies cry. Unlike them, though, we adults can truly understand the implications of lack of sleep for a family of three, four or more people. Sleep patterns sometimes have to be changed. The incredible safety and reassurance the family bed has provided, and continues to provide, supplies the best context and location for these changes.

During these second three nights, some babies will cry and protest for ten minutes at a time and some will go for an hour or more. Your toddler is aware that you are right beside him, offering comfort and soothing. It just isn't the mode of comfort he wants at the moment. It is hard to listen to him fuss, but it will work. I believe that a well-loved baby, after a year or more in the family bed, will be the ultimate beneficiary of his parents getting more sleep. Not coincidentally, the parents benefit "big time," too.

"Yes, for the past many months we have enjoyed voting "1 to 2" -- non-democratically -- in favor of . . . the baby. 'Anyone want to get up all night, feed and walk the baby and be really tired all day and the next day too?' Well, the vote is 1 to 2 in favor of the baby."

Now, what we're saying is, we will sometimes be voting two to one in favor of the baby's family. This "baby's family" concept may be abhorrent to he who considers himself the King of England, or Emperor of the Whole World, but our knowing he has that feeling of power allows us to confidently demote the dictator to a majority-respecting member of the family. His family.

By the end of the sixth night, your baby is going back to sleep without being nursed or fed. He's going back to sleep after a nice hug, a cuddle and with your hand on his back and your words in his ear.

If, at any point this is feeling "wrong" to you, stop, wait some months and start over. Don't go against your "gut instincts" which tell you that this is the wrong time to get longer sleep intervals from your baby. Your instincts are better than any sleep-modification program ever written.

The Next Four Nights

Nights seven, eight, nine and ten. Don't pick him up, don't hug him. When he awakens after 11 p.m., talk to him, touch him, talk some more, but don't pick him up. Rub and pat only. No feeding either, obviously. He will fall back to sleep. Repeat the rubbing and talking when he reawakens. By the end of the ninth night, he will be falling back to sleep, albeit reluctantly for some babies and toddlers, with only a rub and a soothing voice.

After

After these first ten nights, continue to cuddle and feed to sleep if you like and he wants to, but do nothing when he wakes up except to touch a little and talk to him briefly. This may continue for another three or four nights but occasionally keeps going for another week or more. Then . . . it stops. He has learned that he is just as well-loved, gets virtually everything he needs and wants all day, but must give seven hours per night back to his parents and family.

What happens if you travel, he gets sick or some other circumstance demands a return to more nighttime interaction? Nothing. You do what you need to do (cuddle, nurse, walk, in the middle of the night, as many times as you need to) and then spend a night or two or three getting back to the new pattern the family has established.

By the way, pay the baby. Make sure that he really does get a lot of the benefit of your getting a good night's sleep. Go to the park more often. Do all those things with him you said you'd do if he ever let you sleep longer. Explain it to him as you're doing it. He'll understand in an ever increasing way and will be OK with all this.