Baby

Most of what you hear or read about breastfeeding concentrates on getting started and the first few weeks - which makes sense, because getting started can be challenging. But nursing a four-month-old, a six-month-old or a toddler is not the same as nursing a newborn. Here are some of the signposts on the roadmap through the first year of breastfeeding.

Birth to Three Months: Total Concentration

A newborn baby tends to be completely absorbed by breastfeeding. Maybe it's because he's still trying to master all the skills and coordinate sucking, breathing, swallowing and keeping the nipple in the right position. Mothers often feel that a marching band could go past two feet away and the baby at the breast wouldn't even blink. Miranda Hughes, the mother of four children, says her daughter Sophie, now a year old, was like "a little feeding automaton" as a newborn.

Of course, new mothers are often very absorbed by breastfeeding, too, in those first few weeks. They're struggling to remember all the advice they've been given about positioning, getting the latch right, watching to see if the baby is swallowing. And just when things seem to be working, and you think you have the baby's feeding pattern figured out, it all changes again.

Leslie White, the mother of two breastfed daughters and two adopted sons, says that the first change she noticed was a sudden increase in nursing frequency that lasted for a couple of days. "Babies seem to go through these somewhat predictable growth spurts, perhaps around three weeks and six weeks, and then at three months and six months. It's that six-week one that is so problematic. You think you've got her feeding pattern figured out, and then she seems to nurse all the time. It can be a crisis of confidence."

But these bouts of frequent feedings serve an important purpose. This is the baby's way of increasing the milk supply as he grows. Usually, after two or three days of extra nursing, the milk production will have caught up to the baby's needs. Babies who have picked up a virus or other infection will often nurse frequently for a few days as well. This gets more antibodies into their system to help them fight off the illness.

Joan MacNeil, a mother, labour and delivery nurse, and IBCLC (International Board Certified Lactation Consultant) in Halifax, says: "As the baby matures, and the mother gains experience, it becomes easier to understand the cues the baby is sending about needing food or comfort. Sometimes the frequency of the feedings lessens, and the length of the feedings increase. At other times it may mean that the baby will have frequent short feedings." By adjusting the feedings this way, the baby can change the composition and amount of the milk to meet his needs as he grows.

Even when babies aren't in the midst of a growth spurt, they may have certain times of day when they want to nurse more than others. White says: "Many babies, even those who are not colicky, are fussy and unsettled during the late afternoon and evening. Maybe this is an immature digestive system, or maybe they are just tired and overwhelmed after a busy day. But it seems to improve after the baby is three or four months old."

Three To Six Months: Distraction and Exploration

Jane Hedges, the mother of a nursing toddler, Alannah, and four-year-old Evan, says she found the time between three and six months to be very rewarding. "By this point I felt relaxed and confident in breastfeeding, and it was easier to interpret the baby's needs. I loved the special smiles I got that were reserved only for me while breastfeeding. I was really glad I had persevered through my earlier problems."

By the time he was about four months, though, Hedges says Evan "would become easily distracted while nursing. Any interesting sound or movement, and he would pull away to check it out."

White adds: "For babies, the universe seems to expand at four months. They become very distractible nursers, and they constantly pop off to have a look around - or, worse, they try to take the breast with them!" She found that moving to a quieter place helped, but when that wasn't possible, the baby usually made up for any missed nursing with a marathon feeding later in the evening or at night.

This is also a time when many babies begin to use their free hand to "explore" Mom's body while nursing. Some babies give free dental exams, poking a tiny finger into Mom's mouth, or reach up to stroke her hair. It's less charming when you get a finger in the eye or your glasses are yanked off. Sometimes these explorations turn into patterns or rituals that the baby wants to repeat every time he's at the breast. Hughes, for example, says that Sophie "has given me a rash by scratching my stomach with her nails as she breastfeeds. She's gentle, so it isn't uncomfortable, but she's so persistent about it that I always have these red scratch marks. I'm a marked woman."

If your baby starts to do something (like scratching, or pulling at your hair) that bothers you, it's better to gently redirect him early on, before it becomes an expected part of every nursing session. The baby who wants to pull your hair, for example, might be persuaded to stroke a piece of soft fabric instead.

Six to Nine Months: Teething and Separation

By the time they are six months old, many babies are acquiring teeth. That's a moment the breastfeeeding mother may dread. MacNeil notes that "teething is commonly talked about as a reason for weaning, as many women are afraid of being bitten. I try to reassure mothers that a baby who is properly latched and drinking can't bite, and to show them the cues that indicate the baby is finished eating and thus more likely to bite."

Hedges recalls: "One of the first things I heard as a new mother was, 'Wait until he gets teeth!' My family and friends all seemed to believe that once your baby has teeth, he will bite you and it is time to wean. I know they meant well, but my babies never bit me, and I found out that many babies don't."

Of course, some babies do. White found that, "Biting my nipple was always my first sign that a new tooth was coming! Each time, I'd teach my baby not to bite, and we'd nurse happily until the next tooth."

How do you teach a baby not to bite? Hughes says: "My children were all very sensitive to my reaction - I would spontaneously yelp or cry out. Usually they would cry immediately themselves, quite taken aback, and then try not to bite again. The biting was only transient and very infrequent."

The natural reaction to having your nipple bitten, of course, is to remove the baby from the breast, and this alone often gets the message across to the baby. If the baby clamps down on the nipple when you try to pull her away, try pulling her in very close instead, so that she has to open her mouth to breathe. Or slip your finger quickly between her gums to prevent clamping down.

If you are alert, you can often feel the baby preparing to bite. The nursing baby has her tongue forward over her bottom lip and gums, and she must pull her tongue back before she bites down. It's a subtle movement, but noticeable if you are paying attention.

When biting does become a problem, it's often because the baby is having a lot of pain with teething. Giving him lots of suitable items to chew on between feedings - like nicely chilled teething rings - can help.

Another milepost that many mothers and babies experience at around six months is the end of maternity leave.

MacNeil observes: "Both mother and baby have to adjust to the separation." White discovered that going back to work changed Meghan's nursing pattern quite dramatically: "Previously, she had been quite alert in the mornings, slept in the afternoon, and slept through the night. Once I began working half-days, Meghan refused any nourishment offered by the sitter and slept away most of every morning until I returned at noon. She quit napping in the afternoons and made up for her missed nursings by waking again to nurse at night."

Mothers need to look at the options for how they will provide milk for their infants in the hours they are away. Expressing milk at work, to be stored and given to your baby while you're away, is one option. Other moms rely on solid foods or other breastmilk subsitutes during the day and nurse before and after work.

Babies often adapt to being separated from She Who Has Breasts by nursing more at night when Mom is available. It keeps up the milk supply, but is admittedly tiring for mothers who are, themselves, adjusting to their return to work.

"Although reverting back to a sleep-deprived state is difficult for the mother, it's actually a coping mechanism for the baby. An increase in nightwaking is the baby's way of ensuring he gets the breastmilk and the contact with mom that he's missing during the day," explains MacNeil. She suggests that bringing the baby into bed can be a helpful strategy "because the mother can latch the baby on and return to sleep."

Nine to Twelve Months: The Yo-Yo Nurser

Many babies begin nursing less often during the day once they become mobile, even if Mom is still home with them and available. White theorizes: "I think they have so much to explore that they haven't enough time to nurse." Usually these babies want to nurse more at night - when the house is dark and quiet and kind of boring anyway - to make up for the feedings they miss during the day.

This situation can sometimes be helped if mothers plan on a nice, long, quiet bedtime nurse. If the baby feeds well during the evening, he may wake less at night.

Breastfeeding begins to take on new meaning in your baby's life now. With solid foods and juice added to her diet, your baby no longer relies on your milk as his only source of nutrition. But Hedges says that once her son began to crawl "nursing became even more important to him as a source of comfort. As he went through his day exploring, I was his 'base.' He'd come back to me to nurse and 'refuel.' A few minutes of nursing and all was well again, and off he would go to explore some more." It can feel like the older baby is nursing as frequently as a newborn, but these "touch base" nursings may be very brief.

White, too, has experienced this: "Breastfeeding becomes a safe haven, a calm and secure place to return to. My children were both deeply attached to their 'nummies' and needed them any time they were upset, hurt or over-excited."

Hughes has noticed that Sophie seems to see breastfeeding as a way to re-connect after a separation from her mother. "When I come home after being away from her for a while, whether she's hungry or not she toddles over and wants to nurse. Just checking that it's still there, still hers, still working. Then she's okay, but for the next few hours she'll be back frequently, just for little check-ins."

At this stage, MacNeil points out "it is a wonderful feeling to have a 'magic bullet' to help calm a scared or hurt child or to settle a child who is getting out of hand."

One Year and Beyond: The Breastfeeding Relationship

Your newborn baby will have grown into a very different person by the time she is a year old, and your breastfeeding relationship will change, too. At this age, MacNeil notes, "The need for breastmilk as nutrition lessens somewhat, but the need for nurturing and comfort at the breast remains fairly constant." Hedges says, "Whenever Alannah hurts herself, she will come running to me crying, 'I need a dee!' and after a quick pick-me-up she is off again, chasing after her brother."

Alannah's use of the word "dee" makes a discrete code word for nursing. Because it can be embarrassing to have your child announce to everyone within earshot that he wants "boobies," many parents teach nursing toddlers a less obvious (or at least more polite!) word. It's helpful to start this before your child begins to speak.

Toddlers may adopt their own, very individual, nursing rituals. MacNeil's two-year-old twins each have their own way of ending a nursing session: "When Erin is finished, she'll pat my breast, wave bye-bye and then pull my T-shirt down to cover my breast. Aidan will simply pop off with a loud "aaahhh" and run off. This concerns Erin, so she'll come over, pat the breast, wave goodbye, and cover it up. When Aidan sees that, he decides he wasn't finished after all, so back he comes. That reminds Erin that perhaps another sip wouldn't hurt her either, so she comes to nurse, too. Eventually I just have to stand up and shoo them both away!"

Nursing a toddler has special benefits when illness strikes. "As the baby's second year begins, breastmilk contains more antibodies and immune-boosting properties," explains MacNeil.Not only does the baby benefit from the antibodies and other health-boosters in the milk, but breastmilk is often better tolerated than any other food when the child's digestive system is upset. That may be why most toddlers who are ill refuse anything but the breast. And the toddler who is feeling miserable because he is sick may be comforted by nursing when nothing else seems to help.

Keeping these benefits in mind can help when family or friends who are not used to seeing toddlers at the breast voice their disapproval. Sometimes, with a verbal child, you can avoid potential conflicts by negotiating nursing times: "We won't nurse at Grandma's house, but we can nurse as soon as we come home." Many parents also develop a list of responses to negative comments: "My doctor recommended nursing until he's three because he's allergic to milk," "Yes, we've started weaning but we're doing it gradually," or "I expect she'll quit before she starts high school."

Breastfeeding, Miranda Hughes reflects, "begins as a way to feed the baby and grows into a relationship."She says, "The bonding, the sort of deep-down gut feeling, happened right away. The more personal, getting-to-know-each-other thing takes much longer. It happened slowly, as my babies grew and developed, and I see it all so clearly in the context of our breastfeeding. Breastfeeding really is a fundamental way of giving to someone you love. It's a little oasis of time six, eight, a dozen or more times a day when my baby and I are wrapped up in each other. Our touches and smells and sounds and feelings all mingle. That intimacy and attachment is a wonderful foundation for my child's future relationship with me, and with others."

From her own experience - she is currently nursing her two-year-old twins - MacNeil has discovered another reward of breastfeeding into toddlerhood. She smiles as she recounts, "I have so many funny and heart-warming stories. One of my twins told me, 'Your milk is better than ice cream!'"

Spring 2000