By Kathleen Mitchell-Askar, senior contributing editor to Attached Family magazine
When my friend, a mother of one, found out her nine-year-old daughter wanted to become a vegetarian, she didn’t know what to do. She and her husband had never considered a meal complete without chicken, beef or fish, so her initial worry was whether her daughter would be healthy. The worry was quickly replaced with wonderment at the person her daughter was becoming.
Parents of adolescents and teens may find that their child’s growing awareness of the world and their part in it may lead them to choose vegetarianism. Some parents may worry that their child’s choice is a reflection of some mistake they have made, but parents should instead be proud that they have raised an empathetic child.
For my friend’s daughter, the shift occurred on a family trip to Mexico, while walking through an open market. When her daughter saw the meat hanging in the butcher’s stall, she decided then and there she would never eat meat again. She has been a vegetarian for two years and remains committed.
For parents who were raised on the idea that meat is essential to health for its vitamins, nutrients and protein, vegetarianism may seem like a nutritionally inferior way to eat. On the contrary, a vegetarian diet is often lower in fat, cholesterol and calories, and higher in fiber than a diet that includes meat. Eliminating meat, however, is not a sure path to health. A vegetarian who eats large amounts of potato chips, cookies and cheese will, of course, not reap the same benefits as one who focuses on wholesome, plant-based foods. Dr. William Sears encourages parents to ensure their vegetarian child does receive proper amounts of calcium, iron, zinc and vitamin B-12, nutrients found in high concentrations in the meat and dairy the child may choose not to eat. Continue reading Feeding a Vegetarian with Love and Respect→
Dad’s job is to take over the job of the lactation consultant when the family goes home from the hospital. The father is who will be available to answer questions at 3 a.m.
Many mothers struggle with confidence when breastfeeding: They doubt the baby’s desire to breastfeed, they doubt their family’s support for breastfeeding, and most of all, they doubt themselves and their ability to breastfeed. A new mother struggles with confidence almost every day, and her shaky confidence is easily destroyed by a doubting father. When you say something foolish like, “I don’t know, Honey, maybe we need to give him a bottle,” you have just damaged your family’s chances at breastfeeding success.
Just like us, each baby is unique and needs a different amount of sleep. Even within the same family, we can have “high energy” children and those requiring more sleep. While most babies fit somewhere along a spectrum of “normal” sleep requirements, it can help to realize that most infant sleep charts were compiled many years ago when breastfeeding rates were at their lowest, so these observations were based on mostly formula-fed babies sleeping in rooms by themselves under laboratory study conditions.
Settling the Cosleeping Controversy: Get the Facts About Cosleeping, SIDS, Bedsharing and Breastfeeding with special guest Dr. James McKenna
Click here to register for this API Live! Teleseminar to hear hosts Lu Hanessian and Lysa Parker talk with Dr. McKenna about:
Why the cosleeping debate?
What if the baby won’t transition out of our bed?
Can we put the baby in the middle?
Can’t there be siblings near the baby?
Until what age are the guidelines relevant?
Can I nurse lying down? How?
More recently, studies have shown that babies who are fed formula do generally sleep longer at an earlier age than breastfed babies because formula is more difficult to digest. However, if you are thinking that a bottle of formula and banishment to the nursery may be the answer to your baby’s — and your own — sleepless nights, please consider the accompanying risks of premature weaning: You could find the trade-off being hours pacing the floor with an unwell baby. Also, young babies are much safer sleeping near their parents. Since no parents would knowingly trade their baby’s well-being for an uninterrupted night’s sleep, it is better to measure normal by what is safe and healthy.
It may help – or not, if you are suffering from sleep deprivation — to realize that in most infant sleep studies, “all night” is defined as five hours. If you are thinking that even five hours of uninterrupted sleep would be a dream come true, there are some gentle strategies you can try to help your baby, and you, to get more sleep:
Learn your baby’s language — None of us like being kept awake when we are craving sleep, so rather than waiting until your baby is “past it,” help her to calm and get ready for sleep as soon as she shows sleepy signs such as becoming quiet, yawning, making jerky movements, losing interest in people and toys, and fussing. If you miss this window of opportunity, your baby is likely to become grumpy and difficult to settle.
Offer womb service — Ease the transition from womb to room by snuggling your newborn against your bare skin and heartbeat. Carrying your baby in a sling next to your body is another perfect way to help him feel secure and snug, just as he was in your womb. As well as reducing your baby’s stress levels and relieving symptoms of colic and reflux, which can cause wakefulness, carrying your baby may also help him adapt more quickly to a day/night sleep cycle.
Feed your baby — Tiny tummies don’t hold enough food to go long between feedings, day or night. Babies also have appetite increases to match growth spurts. If you are breastfeeding, remember, the more your baby sucks, the more milk you will produce. He needs to suck long enough to get the more satisfying hindmilk, which is higher in calories and will help him sleep more soundly. The best way to do this is to watch your baby, not the clock, and allow him to decide when he is finished with the first breast before you switch sides.
Respond quickly — You can’t spoil a little baby, but if you leave her to cry, she will become more upset as her crying picks up momentum. Soon she won’t even know why she was crying in the first place – she will just be crying because she can’t stop and will be much harder to settle. If you are breastfeeding, it is particularly important to respond quickly to hunger cues: A baby left to work up to a full-blown cry will have a more disorganized suck and may have difficulty latching on correctly (when babies cry, their tongues are pointed towards the roof of their mouths), or she may only suck for a short time before she falls asleep with exhaustion. Then she will wake sooner because she is still hungry.
Introduce bedtime rituals — Bedtime routines can become cues that help even tiny babies wind down and become conditioned to fall asleep. From the earliest days, give her a deep, warm relaxation bath (sharing a candle-lit bath with your baby will relax you both) just before bedtime and sing her a song (she won’t mind if you don’t have perfect pitch) or use some gentle sleepy words.
A magic touch — Silent nights could be at your fingertips: Research from Miami University showed that infants and toddlers who were massaged daily for one month, for 15 minutes prior to bedtime, fell asleep more easily by the end of the study. Gently introduce massage a few strokes at a time when baby is calm so he associates your touch with feeling relaxed. A massage and a bath will be too much for a newborn to handle at once, but when your baby can manage it, try massaging before a bath, then snuggling your baby in a warm towel so he doesn’t become cold and distressed.
Soothing sounds — The calming, repetitive sounds of traditional lullabies recall the “womb music” your baby heard before birth: your heartbeat, and fluids whooshing through the placenta. Humming to your baby will calm you both, and baby music that incorporates elements such as the rhythm of the maternal heartbeat and womb sounds can have remarkable soothing effects, especially if played continuously on a low volume through the night.
Rock-a-bye baby — The motion of a rocking chair, being carried in a sling, or gently bouncing on a fit-ball (try humming a lullaby as you rock) will lull baby to sleep. So will a special-purpose baby hammock — and as baby moves and arouses during lighter sleep cycles, her movements will start the hammock rocking.
All snuggled up — The startle reflex, a primitive survival reflex that produces spontaneous, jerky movements even in sleep, can be disturbing (literally). If your baby isn’t sleeping in a sling or with you, provide a sense of security by swaddling your newborn — wrapping him in a gauze or muslin sheet in summer, or a soft shawl in winter. Gradually swaddle more loosely and discard the wrap as this reflex disappears, at around three months.
Cut caffeine — If you are breastfeeding, caffeine can create a vicious circle: You drink coffee (or tea or cola) to give you a hit, baby gets a boost of stimulant through your milk and becomes restless. Newborns are particularly vulnerable to caffeine: A newborn may take up to 97 hours to get rid of caffeine, so the effects will be accumulative.
Food intolerance — If your baby’s wakeful, crying spells seem to be related to your diet, keep a food diary. If there appears to be a link, eliminate the suspect food for at least a week. Common culprits include dairy products (milk, cheese, yogurt), citrus, chocolate, and peanuts. Some babies may also react to food additives in soft drinks or processed foods, or chemicals such as salicylates present in a range of otherwise healthy foods such as grapes, citrus, berries, and tomatoes.
Do not disturb — Avoid waking baby fully during nighttime feedings by keeping lights dim and talking quietly. If you need to change a diaper, do this either before or half way through a feed, not when baby is all groggy and full. If baby is falling asleep during feedings and only having a short feed, try changing the diaper half way through, then offering the breast again.
Let your baby suck up to the boss — Falling asleep on the breast is one of the easiest ways for most babies to settle. This is due to hormones released while your baby feeds, but if you are concerned about it becoming a habit, alternate feeding with other sleep cues.
Share sleep — Research shows that mothers and babies who cosleep share the same sleep cycles, so these mothers get more sleep overall.
Stop the clock — Simply knowing how long you are awake can be enough to make you too tense to get back to sleep, or it may encourage you to rush your baby and make him feel anxious. If you see your baby’s waking as a genuine need, it could help you to enjoy this precious cuddle time: feel the softness of his skin, breathe in his delicious smell, and snuggle!
My son woke up that summer morning and came to me. His light blue-green eyes were clear, and he looked healthier than I had seen him in a long time. Something was different with my three-year old.
“I want to paint today.”
I paused in shock at his request. It was a bright morning, just one of many beautiful days we’d had that summer in 2000. But a feeling of unreality washed over me. With those simple words, I had entered the twilight zone.
For almost two years before that day, my son hadn’t spoken much at all, hadn’t searched out my eyes, hadn’t really done anything that a normally developing child would do. He had lived in a separate universe, a never-never land of lost boys and lost parental dreams. My little cabbage boy.
Suddenly, as spectacularly as my son had disappeared, he was back with me. I didn’t react. There were no big moments of hugging or kissing him. In general, he didn’t care for demonstrations of affection. So I didn’t fuss. Frankly, I didn’t quite believe what was happening. My husband was getting ready for work, and so I just went through the usual motions of making breakfast, while wondering if this would last. Wondering if I was dreaming.
I got out his paints and his easel. What had happened? What had brought my son home to me?
A Leap of Faith
The day before we had taken a train trip upstate to Brewster, New York to a DAN! (Defeat Autism Now!) protocol doctor – the very same doctor who had been mentioned in Karyn Seroussi’s book, Unraveling the Mysteries of Autism and PDD.
Defeat Autism Now!™ (DAN!) is a project of the Autism Research Institute, a group of physicians, researchers, and scientists committed to finding effective treatments for autism. DAN! does not regard psychotropic drugs as the best or only means of treating autistic patients. More information can be found at www.autism.com/dan/index.htm.
My son had acted up on the train, screaming and yelling, hurling his body back against the stroller I’d confined him in. Being on the autistic spectrum this was standard operating procedure. I was glad that the train compartment was almost empty because it cut down on the amount of dirty looks I would receive for having a tantruming preschooler. Finally, after our taxi ride, he settled down in the doctor’s office while we waited. He had found a basket of fast food restaurant toys and he was content.
It never failed to amaze me that a child so nonresponsive to his mother and father, never hearing us and never searching us out, could spot a favorite toy from yards away and make a bee line to it. Yet I found that reassuring somehow – that even though he didn’t care for us, there was something in his universe that he loved: Blue from Blue’s Clues, Thomas the Tank Engine, Elmo and his other friends from Sesame Street. As long as he loved them, he wasn’t alone. They reached him where we could not.
The doctor recommended that we use twilight sleep so that my son wouldn’t struggle during the prolonged blood draw necessary for all the testing we needed to have done. And it would help because after taking the blood we’d be doing an IV push of Secretin and vitamins, which would also take more than a few minutes.
It took me and two nurses to hold down my son’s small yet very strong, three-year-old body. He screamed and struggled until the sedative took effect. It broke my heart, but I had had two years of getting used to being heart-broken. I was so used to it, and yet it still hurt.
My mother, 68 years of age, a vivacious woman who talked a lot but rarely gave any thought into what she was saying, lived only a few miles away and was there to pick up my very groggy son and me after the appointment. My son was very much under the effects of the drug we’d used to calm him and I had to be careful that he didn’t hurt himself as he flopped around. Thank goodness for my mother driving us back to the city because I’m not sure I would have been able to handle the train trip back. My boy went to sleep as soon as we got home.
And then it was the next day, and a child I hadn’t seen for two years was back with me. I didn’t think miracles happened just like that. Hadn’t the government and various studies debunked the use of Secretin? Maybe it had been the vitamins?
In the next few weeks, we spent all of our savings and maxed out our credit cards with this doctor, on the basis that the two years we had stuck with mainstream doctors and therapies had done little to nothing for our child. Time was passing. Our son’s childhood and potential were speeding by us.
Our leap of faith had paid off. Eye contact, and speech, but more – much more: someone was home again in there. Someone who knew us, knew that we loved him and cared for him.
The Food Connection
In Attachment Parenting (AP), very often a family will be confronted with a professional’s opinion that goes against what is in their hearts. Doctors will tell moms to quit breastfeeding and introduce solids. They will tell families not to share sleep, because it will permanently hurt the child. They are told to let their child cry-it-out.
Our doctors had ignored our son’s constipation and diarrhea for two years. Earlier that year his bowel movements had been so acidic that they had left welts on his upper thighs and testicles. We’d had to change him in the bath tub while he screamed in pain. And once, after having popcorn, our son’s constipation had reached the point where he couldn’t stand up straight or walk. It had taken two baby enemas to clean him out.
Our mainstream doctors hadn’t seen a connection between our son’s bowel problems and his Autistic Spectrum Disorder (ASD). Everything I had been told about it being solely genetic and irreversible, except through behavioral modification and heavy-duty drugs, was a lie. Here I had proof that ASD is reversible: Our boy was back, at least as long as he avoided gluten, casein, soy, and corn.
And so we took our first steps on a trip through a world where doctors, public health administrators, and even some politicians lie to protect themselves from the truth: Genetics is the gun, but environment is the trigger.
Our son’s dramatic response to Secretin had shown us that symptoms of autism are reversible. Eventually we found Secretin to have diminishing results, and it was his diet which kept him from drifting away from us.
The Vaccine Connection
Two years later, he had his first biopsy and colonoscopy and was found to have Lymphonodular Hyperplasia of the colon – a condition associated with chronic measles activity from the MMR vaccine.
Our Son Returned
This journey has been a long one, filled with twists and turns and even a few dead ends. I didn’t know, couldn’t know, if after losing two years of his development whether he would ever be fully normal. But he was talking, making eye contact and the stimming was gone, and that was good enough for my husband and me to see that our son was still there and had never been completely lost.
What is Stimming?
“Stimming” refers to repetitive, self-stimulating movement, such as through flapping, tapping, scratching, or rocking.
Where would we be now if we hadn’t listened to our hearts and tried alternate therapy for our son? I was grateful that I had a support community of parents who were of a like mind about AP. They stood by and encouraged me to believe that something more was going on with our son than genetics alone. They were there for me to help me parent my child gently even when he was screaming and tantruming every day. They helped me through the pain and anguish of my own son not knowing his mom anymore. Thank goodness for those parents who wouldn’t let me give up hope.
Changing the Course of Autism by Dr. Brian Jepson Healing the New Childhood Epidemics: Autism, ADD, Asthma and Allergies by Dr. Kenneth Bock Children with Starving Brains by Dr. Jaqueline Candless Unraveling the Mysteries of Autism and Pervasive Developmental Disorder by Karyn Seroussi Special Diets for Special Kids by Lisa Lewis Evidence of Harm by David Kirby The Child with Special Needs by Stanley Greenspan Is This Your Child? by Dr. Doris Rapp
As each new talent emerges, toddlers get busy and forget to do lots of things: watch in front of them when moving, pick up toys before stepping on them, and eat. They fight the fork, the spoon, and even self-feeding in an effort to get back to their most important work: play.
Some toddlers make up by nursing even more at night. Sometimes this continues to work for both mother and toddler. Sometimes, however, Mother chooses to night wean.
In this case, night weaning led to day weaning, and soon, my toddler was completely off the breast long before I ever considered the idea.
When Ryan was 15 months old, we decided to move. (May I just point out, this is total chaos and I never recommend it!) We packed up everything we owned and drove four hours north. This move from the familiar into the unknown turned my toddler’s world upside-down. He didn’t know where he was, where any of his toys were, where his dogs were, and most importantly, he didn’t understand why Mommy had been less than 100% attentive in the weeks leading up to the move. Since he was mobile, self-feeding, and easily entertained, my attention had been focused on working and packing.
So, slowly but surely, one feeding would slip through the cracks, then another and another.
At the same time, we gave up night nursing. As a family, we decided that Ryan’s continued and constant night nursing wasn’t working. As he became a busy toddler, he became what I like to call a “full-body” nurser. What I mean by this is that he no longer just nursed with his mouth, he rubbed my belly with his hand, kicked with his feet, and screamed every time I even considered taking him off the breast so I could roll over and sleep myself. When he was an infant, night nursing was a joy. But as he grew more adept with his body, it became a challenge.
One thing led to another, and the next thing I knew, my toddler had not asked to nurse and I had not offered in several days. He did take a few weeks to wean completely; it was a gradual and gentle weaning.
But I found myself missing the time we spent together. My baby was gone, and a cranky toddler had replaced him. And though I love the new skills and fun this age provides, I missed my little boy.
I felt rejected — that I was less than the mother I used to be. How can I possibly be an attached parent if I didn’t breastfeed past the 16th month? And the guilt — oh, the guilt! I’ve selectively vaccinated my son — is he now set to get polio since he’s weaned? Do I have to skip ahead and vaccinate like crazy to catch up now that he won’t be getting breastmilk anymore? These are just a few of the questions bouncing around in my mind.
Nursing had always been my go-to fix for anything Ryan needed. Fell down and bumped your knee? Nurse. Bored and cranky because we’ve had to wait too long for an appointment? Nurse. Tired and distracted and just need some time to get centered? Nurse.
With weaning, like all transitions, I had to learn how to interact and care for this new person in my life. This independent, yet fragile, little boy still needed my love and support, and I had to figure out some other way to be there for him without offering the breast.
Easing the Transition
Here are a few tips that have worked for us:
Make up for the missed breastfeeding time by having extra cuddle time — Sleep with your toddler even after the nursing is gone.
Have special before-bed and wake-up time — that involves singing, cuddling, and the same undivided attention you would have given had you been nursing.
Consider bottle nursing — If you are comfortable with it, cow’s milk or water in a bottle can be tempting enough for some toddlers to allow lap time, even if it is only once a day.
Pick a special song or two just for boo-boos — When Ryan gets hurt, I pull him onto my lap and sing very softly and close to his ear the same song every time. He seems to get a sense of comfort from this. He knows that he has been upset or hurt before, and by the end of the song everything seems a little bit easier to handle.
Acknowledge and mourn the passing of one stage, but celebrate and rejoice in this new one — It is okay to feel sad and miss that small bundle who depended on you for everything. It is also normal to feel happy and relieved that you are no longer the only one who can provide this comfort for your child. Allow yourself some time to just stop and feel.
I know that Ryan still loves me, needs me, and can’t imagine a day without me. And I know that like all things in life, this too shall pass. Sometimes, though, I wish some things — like breastfeeding — wouldn’t pass so quickly!
By Rita Brhel,managing editor and attachment parenting resource leader (API)
When we think of the Attachment Parenting International Principle of Feeding with Love and Respect, what first pops into our minds is a woman enjoying a close breastfeeding or bottle-nursing relationship with her baby or perhaps a family sitting around the dinner table engaged in a lively conversation about the day’s happenings. What many of us don’t picture are the myriad challenges many parents must encounter in order to do what seems to be such a basic part of child-rearing: feed their child.
Unless we’re experiencing a challenge at the time, we don’t think of the working mother pumping her breast milk, the parents feeding breakfast to their son via a stomach tube, or even the parents struggling with emotions toward their picky preschooler. And we certainly don’t think what it must be like for the HIV-positive mother who wants to breastfeed but is opposed by the medical community. But there remains debate about breastfeeding by HIV-positive mothers and whether the mother, particularly in developing countries where there are additional serious risks to not breastfeeding, should breastfeed or formula-feed her newborn.
Even for breastfeeding advocates, breastfeeding by HIV-positive mothers is a gray area. We want all mothers to feel welcomed to nurse their babies, but no one wants to pass HIV to their child through this naturally loving act. When going against what seems natural to us, we have to look at the research — and many of us probably do not fully understand what the studies have found.
It is because of this gap in knowledge and application of that knowledge that Marian Tompson founded AnotherLook as a 501(c)3 nonprofit organization in 2001, separate and unaffiliated with the La Leche League (LLL) International she co-founded more than 50 years ago. The opening statement on the homepage of AnotherLook’s website, AnotherLook.org, says it all: “The issue of HIV and human milk has been clouded by possibly questionable science, lack of precision concerning the definition of breastfeeding, and premature public policy statements.”
Editor’s Note: Attachment Parenting International finds the mission of AnotherLook to be incredibly important to the HIV-positive community. However, API wants to make it clear that this contents of this article do not constitute medical advice and that all HIV-positive women should consult their health practitioners regarding breastfeeding and their child’s risk of transmission. API cannot be held liable for any personal decisions made by readers based on the contents of this article.
I first heard about the monumental hurdles HIV-positive women face in breastfeeding while attending a LLL conference in Nebraska last summer. The speaker was Tompson, and her topic that morning was the nonprofit organization called AnotherLook (at Breastfeeding and HIV/AIDS), which helps to educate both parents and professionals as to the issue of breastfeeding by HIV-positive mothers.
About AnotherLook Based in Evanston, Illinois, AnotherLook is dedicated to further its mission to gather information, raise critical questions, and stimulate needed research about breastfeeding in the context of HIV/AIDS. AnotherLook questions feeding strategies based solely on the possibility of virus transmission instead of on maximizing the probabilities for good mother-infant health. The organization calls for clear, published scientific evidence as to the type and manner of feeding that will minimize infant morbidity and mortality and seeks out scientific proof that infectious HIV virus is present in breast milk and is transmitted from mother to baby through breastfeeding.
AnotherLook provides presentations, position papers, and recommendations, which can be found at its website.
Tompson spoke about the variety of information related to HIV/AIDS and breastfeeding, such as that the medical community in industrialized countries like the United States advises HIV-positive women not to breastfeed their babies. The guidance is out of fear of transmitting the virus to their child. One story told was of a woman in only the last couple years whose baby was removed from her care until she promised not to breastfeed, because the authorities called the choice to breastfeed over using formula as dangerous mothering.
It is for this reason that AnotherLook exists — to give HIV-positive mothers and health professionals factual information on what we know and don’t know about breastfeeding when a mother is HIV positive, to ask critical questions, and to stimulate needed research. Knowing the importance breastfeeding has in establishing a strong mother-child attachment relationship, you can understand what this organization means to those women with HIV/AIDS for whom AnotherLook provides a voice in exclusively breastfeeding concerns.
A Call to Action
AnotherLook has issued a Call to Action to assure the best maternal-infant health outcomes in relation to infant feeding in the context of HIV/AIDS. This call is needed because current research, policy, and practice, often based on fear, are focused on the reduction of transmission while neglecting the impact on morbidity and mortality. This not only may be misleading but may inadvertently set back critical gains already achieved in public health as a result of the protection and promotion of breastfeeding.
AnotherLook acknowledges the possibility that HIV may be transmitted through breastfeeding and that there is an urgent need for feeding guidelines.
In light of the above, AnotherLook calls for immediate action to provide:
Clear, peer reviewed research, with careful ongoing follow-up, which will provide sound scientific evidence of optimal infant feeding practices that lead to the lowest morbidity and mortality.
Concise, consistent definitions of feeding methods, testing methods, HIV infection and AIDS.
Development of research based infant feeding policies which are feasible to implement in light of prevailing social, cultural and economic environments; which address breastfeeding (particularly exclusive breastfeeding) as a critical component of optimal infant health; and which fully consider the impact of spillover mortality/morbidity associated with infant formulas.
Epidemic management from a public health perspective, with the focus on primary prevention, careful, unbiased surveillance, and the achievement of overall population health with the lowest rates of morbidity and mortality.
Evidence-based practices which protect the rights of both mothers and infants including education, true informed consent, support of a mother’s choice, and avoidance of coercion.
Funding to support the above actions and those programs which improve maternal/child health in general such as prenatal and postnatal care, nutrition, basic sanitation, clean water, and education, as well as exclusive breastfeeding until clear scientific evidence supporting the abandonment of breastfeeding is available.
Continued commitment by local and global researchers, policy makers, health workers, and funding bodies to basic scientific, medical, public health, and fiduciary principles in responding to this critical issue.
In summary, AnotherLook calls for answers to critical questions not currently being addressed that will foster the development of policies and practices leading to the best possible outcomes for mothers and babies in relation to breastfeeding and HIV/AIDS.
With the background laid out, let’s turn to Tompson for more information on the past, present, and future of AnotherLook.
RITA: Hi Marian. I recall hearing you say at the LLL conference that, knowing the time and energy and sheer work that goes into building up a successful nonprofit organization as LLL International is, founding another organization was a task that you never thought you would do. What made you decide to pursue the organization of AnotherLook?
MARIAN: It has always been important to me (and La Leche League) that mothers get correct information. In 1997, when WHO [World Health Organization] changed its infant feeding recommendations when a mother was HIV-positive from one where the decision would be made on a case-by-case basis as to whether or not she should breastfeed to one where all HIV-positive women were encouraged to formula-feed if at all possible, I set out to find the studies that backed up this change.
I was looking for the evidence proving that babies who are breastfed by HIV-positive mothers are more likely or less likely to get sick and die than those fed formula mixed with possibly contaminated water, which is common in developing nations with HIV/AIDS epidemics such as parts of Africa.
RITA: What did you find?
MARIAN: We question infant feeding strategies based solely on the possibility of virus transmission instead of on maximizing the probabilities for good mother-infant health. We still don’t know if HIV virus in breastmilk is actually live (infectious), and if it is infectious, if there is enough to infect the baby. We have a team ready to research this and have been looking for a grant to cover the cost.
The challenge is that most people in this field think we already have the answers to these questions.
RITA: How has AnotherLook reached out to professionals and the HIV-positive community?
MARIAN: We have had an international focus since the beginning, calling attention to the difference in recommendations depending on where the HIV-positive mother resides.
We have a private chat list that includes researchers, health professionals, speakers on this topic, health workers working with mothers in Africa, and LLL leaders and others interested in this issue.
We were invited to do roundtable sessions at an American Public Health Association annual meeting, did a poster session at the International AIDS Conference in Toronto [Canada], and our abstract was included in the syllabus of last year’s International AIDS Conference in Mexico City [Mexico]. We have given presentations at LLL conferences, both in the United States and abroad.
We’ve had letters printed in major medical journals criticizing published research.
RITA: Do you have any success stories that stand out of how AnotherLook is able to educate mothers or professionals in a way that changed the course of establishing a breastfeeding relationship when HIV/AIDS is a factor?
MARIAN: We have helped to change recommendations on infant feeding in developing countries from one in which mothers were told to formula-feed if at all possible to one where now all mothers are encouraged to breastfeed exclusively for six months.
Our poster sessions have pointed out the lack of evidence in the citations used to back feeding recommendations. The research hasn’t been done that would give us the answers needed about breastfeeding when a mother is HIV-positive.
We have become a resource for women in the United States who have no support group, like drug users and gay people have if they are diagnosed with HIV virus.
We also educate professionals about the assumptions that have long been accepted as facts.
RITA: Where do you see AnotherLook heading in the future?
MARIAN: Continuing to provide information through presentations and our website, while responding to inquiries. Even school children have contacted us. Working to get the research still needing to be done accomplished. Raising funds to enable us to participate in discussions of this issue.
When a director from UNICEF, who initially questioned the need for AnotherLook, attended one of our presentations at an LLL International Conference, she said that AnotherLook should participate in all international discussions because we were including elements that others had overlooked.
RITA: Thank you for your time, Marian. Do you have any closing thoughts?
MARIAN: New online at www.anotherlook.org/updates is Rodney Richard’s letter questioning the wisdom of mandatory testing of newborns for HIV. Richards is a bio/organic chemist who worked many years for Amgen, the world’s largest biotechnology company, specifically in the area of HIV test development.
His letter is in light of legislation passed in Connecticut, Illinois, and New York that require mandatory testing for HIV in newborns. Many states, such as Arkansas, Michigan, New Jersey, Tennessee, and Texas, have laws requiring HIV testing of pregnant women as part of routine prenatal care and then testing of newborns if the HIV status of the mother is unknown. We will probably see this legislation being considered in other states.
Also in the works are:
A detailed paper on WHO’s changing recommendations on infant feeding when a mother is HIV-positive
A report from the session we put on at the LLL International 50th Anniversary Conference, “Breastfeeding and HIV: What Works, What Doesn’t, What Has to be Changed,” with Cathy Liles, BBA, CPA, MPH, IBCLC, a member of the LLL International Board of Directors, and Ted Greiner, PhD, coordinator for the World Alliance for Breastfeeding Action Research Task Force.
About Marian Tompson Marian was one of seven women who co-founded La Leche League as a way for women to seek out support and education in breastfeeding as the best way to feed infants. LLL’s beginnings came at a time in history, 1956, when women were advised to forgo breastfeeding as an infant-feeding option. At this time, the U.S. breastfeeding rates dropped to only 20%.
Marian had an instrumental role in the nonprofit organization of LLL, serving as president for 25 years. In 1958, she started the newsletter that eventually became the magazine we know today, New Beginnings, and in 1973, she began the annually held Breastfeeding Seminar for Physicians.
Today, besides her work with AnotherLook, Marian is involved in the LLL Founders’ Advisory Council and the International Advisory Council for the World Alliance for Breastfeeding Action, and is vice chair of the United States Breastfeeding Committee. She and her late husband Tom raised seven children. Marian also has 16 grandchildren and five great-grandchildren.
API’s Connection >> Reedy Hickey, IBCLC AnotherLook and API share a member of their respective Boards of Directors. Hickey not only provides leadership to both organizations but also advocates breastfeeding as a local La Leche League leader and Georgia’s LLL professional liaison. She is the mother of two grown children and 32 foster babies, and practiced AP with each.
By Rita Brhel, managing editor and attachment parenting resource leader (API)
Attachment Parenting International’s seventh of the Eight Principles of Parenting, Providing Consistent and Loving Care, explains how babies and young children have an intense need for the physical presence of a consistent, loving, responsive caregiver who is interested and involved in building strong bonds through daily care and playful, loving interactions. Ideally, yes, this caregiver would be a parent. But, especially in the tough economic climate our world has experienced the past couple years, many families are finding themselves in a situation where both parents must work outside the home.
While a dual-income family may require more creativity in making the time and finding the energy to fulfill API’s Principles, it is certainly very possible to foster a secure attachment.
How does this relate to the second of API’s Eight Principles, Feeding with Love and Respect? According to Kirsten Berggren, PhD, CLC, author of Working without Weaning: A Working Mother’s Guide to Breastfeeding, going back to work is the hardest obstacle an exclusively breastfeeding mother will encounter. A neurobiologist, Berggren shares her own experiences and those of others to create this handbook for mothers who want to continue breastfeeding once they return to work after maternity leave. It’s a tough balancing act — maintaining the breastfeeding relationship despite day-after-day separations — but, as Berggren reiterates in her book, one that is completely worth the effort. Continue reading Working without Weaning: An Interview with author Kirsten Berggren→
By Sonya Fehér, leader for South Austin API (Texas, USA) and blogger at MamaTrue.com
If we’re staying at home to be with our babies full-time, we don’t have to pump milk or offer bottles. We can delay extended separations until our children are older, take our babies with us to run errands, go to appointments, or when we meet friends. And most of the time, we do. We spread out activities, so we can avoid taking Baby in and out of the car for multiple stops. We keep the volume low on the car stereo. We prioritize what we need to get at the grocery and find ways to entertain or distract Baby, so that we can get everything on the list. And we likely plan it all around when Baby may take a nap. That’s what stay-at-home moms do.
What differs for attached moms is that we are likely also sleeping with or near our babies during the night, wearing them during the day, and nursing them every hour or so. Being an Attachment Parenting (AP) stay-at-home mom is an intense 24-hours-a-day/365-days-a-year job.
By Amber Lewis, staff writer for The Attached Family
The first painful hurdle I was to face as a mother was the need to return to work. After a three-month crash course in Attachment Parenting (AP), my daughter and I were well bonded, so going back to work broke my heart. I have to admit it still does — every day that I spend more time working for a paycheck than I do building a relationship with my daughter, I cry a little privately.
I have tried to make the best of this hurdle called work, and in spite of day after day away from my daughter, we are still very much an attached family. When I am home, we use attachment skills that help us best keep and build a good relationship with our daughter, including:
Breastfeeding — Even though my daughter is more than two years old, I still pump twice a day at work. We will practice self-weaning, because I know she needs to nurse. It’s no longer as much of a nutritional need as a psychological need that allows us to reconnect after work and to say good bye without words in the morning.
Cosleeping — We have a family bed. Even though we have experimented with moving our daughter into her own room, we know she’s not ready for that yet and so we allow her to lead the way, at least for the mean time.
Prioritizing — Our daughter is our number-one priority. While we like to have a clean and organized house, this is not always the case. Things frequently get left out or put away in a rush to maximize our time together. I am a stay-at-home mom when I’m home. We take however long we need for library story time, trips to the park in the summer, family walks, crafts, learning, religious study, and anything else I would do if I were a stay-at-home mom.
Tips for Successful Pumping at Work:
Start early and pump often — My breasts are fullest in the morning, so I usually pump twice in the morning. I began pumping even before I returned to work, at night for the last six weeks I was on maternity leave, my daughter would nurse on one side while I pumped on the other, it was the best thing I did to build up my supply. By the time I returned to work, I was a pumping pro and had a freezer full of milk.
Put pumping on your to-do list — I was the only pumping mother in my department, so if I didn’t decide to pump, no one noticed or cared. I added it to my to-do list and set an alarm with the exact time I would pump every day. My breasts got used to the schedule, and if I missed a pumping session, I could feel it. Once I set it as a priority, people knew it was important to me and they respected that.
Be honest and open — If your boss wants to know why you are leaving and what you are doing, be honest. Using the word “breast” in a sentence at work makes people uncomfortable and I used that to my advantage. If my boss needed to know where I had been, I told him I was pumping breastmilk. If I was using a bathroom instead of a nursing room and a busybody needed to know what that funny noise was coming from the stall, I told them it was a breast pump. Anyone who wants to make a big deal about it will usually be too embarrassed at hearing the “b” word, they will immediately back down and none of those people ever mentioned it again to me.
What Fathers Can Do:
Provide support — Remind your wife that she can do continue nursing and working at the same time, because you believe in her.
Help out — Your wife is helping to take care of financial obligations, so you should help take care of home obligations. A little cleaning goes a long way in the heart of a working mom.
Be patient — Your wife feels the stress of working and still wants to be a wonderful mother. Those two things tend to compete for her time, so she can and probably will lose it every once and a while. Be quick to forgive and forget those frazzled moments.
Encourage weekend relaxation — When your wife has a free moment, encourage her to rest or help her so she can catch up on her favorite hobby. A little rest and relaxation can go a long way to preventing those frazzled moments in the point above.
Breastfeeding and Extended Separations
The most challenging time of me was around the time my daughter turned 18 months. I am a Navy reservist and was required to serve my two-week training across the country. We didn’t have the money to fly my husband and daughter back with me, so we set about finding other ways to stay attached.
I began researching everything I could find about nursing while apart. The best information was from a few moms whose travel for work kept them apart from their babies two or three days. I was left with one question as my departure date loomed ever closer: Would my daughter want to continue our nursing relationship when I returned?
Everything I knew about breastfeeding led me to believe it was beneficial for as long as possible, so I made two decisions:
We would nurse up until the moment before I left for the airport. During our last nursing session, I would try to explain to her about my leaving and where I was going and that we would nurse again when I got home.
I would pump throughout the two weeks. So, if she did want to nurse again once I returned, she could.
These decisions I made concerning breastfeeding were just a couple of ways we stayed attached. Here is what I found key to keeping attached with my daughter over the distance:
Video conferencing and lots of phone calls.
Help from Grandma and aunts. This was especially important, not only for giving my husband breaks, but in a pinch, their extra love and attention filled in a bit for my absence. Every time my mother-in-law came over, my daughter was ecstatic. It was as if she needs a woman’s love, and Grandma filled that need for the two weeks.
The decision to pump, with the hope we could continue our breastfeeding relationship, was not one without consequence. Pumps are great and they can do a good job in a pinch, but without a baby to fully empty my breasts, I developed a short bout of mastitis halfway through the two weeks.
My supply did drop, mostly because I was sleeping through the night, so I had to adjust that schedule. Instead of ignoring when my full breasts woke me up during the night, I took the cue and got the pump out. Showers became another tool to help me keep up my supply and fight further infection; using warm water and massaging the milk ducts became a twice-daily routine.
While it was a very stressful and exhausting two weeks, it was well worth all the effort. My daughter immediately nursed after we were reunited at the airport.
It doesn’t matter if you are across town for the day or across the globe for the week, you can successfully continue breastfeeding and AP with a little extra work and dedication. The best part of my time apart was seeing my husband and daughter at the airport when I returned — my daughter squealed with such delight and held on to me so tight, and then that first nursing session after my return was like heaven.
Tips for Successful Pumping during Work-Related Travel:
Bring your best pump — I asked for a second breast pump for my birthday and now I have a pump used only for travel. It stays cleaner and pumps a little more efficiently than the one I use every workday.
Bring lots of photos — This will help you pump more milk and stay connected to your baby. If you have a video phone, take pictures with it to play back while you pump.
Bring lots of batteries — Don’t expect to find a nursing room everywhere you go, especially on a plane. I bring enough batteries to last to whole trip just in case.
Bring a nursing wrap — If you can’t find a bathroom suitable to pump, you can sit in your car or find a secluded chair, cover up, and get to pumping.
Keep your lactation consulant’s number handy — I actually made an appointment just to discuss my plans with my OB/GYN before I left. When I got mastitis, I called her office and got some tips to get over it without medicine and a sympathetic ear, which helps when you are on the verge of tears with two very full and painful breasts.
Keep at it — The first two or three days will be the most difficult. Your body is adjusting to a new type of nursing and it can be hard to get a rhythm going, but once you get a schedule of pumping that works for you, things get easier. Mental attitude will go along way here. If you believe you can keep at this, you can and you’ll overcome any obstacle that gets in your way.
Stay hydrated — Drink lots of water to keep your supply up. I usually don’t drink anything but soy milk as far as dairy goes, but I found that whole milk actually helped increase my supply dramatically. So, the days I was gone, I drank two glasses each morning.
Bring lanolin cream — Invest in a couple tubes of lanolin cream, and don’t be shy when administering it. Pumps can be hard on nipples.
I’m making breakfast for my two-year-old son who stands on a stool next to me. Oatmeal simmers on the stove. “Lid!” Reuben says, pointing to the rattling pan and signing that he hears something. I turn off the flame, then slice an avocado, which I slide into the Vitamix blender. I add half a cup of oatmeal, an ounce of last night’s Parmesan pan-fried pork, applesauce, carrots, and milk. “Mix!” Reuben says, smiling up at me happily as I start the machine.
“Okay, buddy, let’s have breakfast,” I say, strapping Reuben into his high chair. I open the tab of his Mic-Key button, which looks like a beach ball valve on his abdomen, screw in the extension tube, and insert the tip of a syringe filled with the food I’ve just made. I sit down next to Reuben and push ten milliliters, about the volume of an oral bite, directly into his stomach through the tube. Meanwhile, I offer him banana slices and cereal, but he leaves them on his tray.
Reuben’s unusual relationship to food wasn’t always such a comfortable part of our routine.
“Oh, I know,” Other parents say, “my Jimmy is a picky eater, too.” I don’t want to be obnoxious, so I don’t say what I’m thinking: Reuben isn’t picky — it’s that he’s not an eater.
In the Beginning
Reuben’s feeding issues stem from medical complications that arose during birth. He spent 11 weeks in the neonatal intensive care unit, undergoing increasingly invasive treatments to save his life. I could not feed him, talk to him, or touch him. (Unlike some critically ill infants who thrive when touched, Reuben’s blood oxygen levels dropped with any stimulation). But I could pump breastmilk for him. Even though he was so ill that he received only a few milliliters of it each day through a tube into his stomach, pumping became my way of connecting with him and embodying my faith that he would recover.
The doctors warned us that feeding difficulties were often a side-effect of the treatment, but my husband and I assumed that once Reuben was allowed to eat, he would.
He did not.
Common Feeding Difficulties
Oral Aversion Oral aversion occurs when a child is reluctant or refuses to be breastfed, bottle-fed, or eat. The child may have negative associations with food or other objects near or in his mouth, or, in some cases, a child develops oral aversion when she strongly dislikes the texture of certain foods. This often happens when a child has been tube-fed for a long time due to illness or prematurity.
Dysphagia Dysphagia is when the swallowing of food causes it to not pass easily from the mouth to the stomach, which may cause food to get stuck in the lungs and throat. Children with this disorder may also begin to refuse food. This disorder often occurs as the result of another condition, such as prematurity, cleft lip or palate, and large tongue or tonsils.
Comfort in Breastfeeding
We started by offering to nurse him several times each day. Although he never ate enough to allow us to decrease his tube feedings, breastfeeding did give him some practice at sucking and swallowing, and provided him with positive oral experiences. Each time, he would shake his head excitedly, say “ah-ah-ah,” and dive toward me. Then, he would close his eyes and raise his eyebrows in an expression of deep contentment as he settled in. Now, at nearly three, he still asks for nummies as a way to reconnect when I return from work, or when he is particularly tired or upset. He barely latches on, but finds comfort in snuggling.
Through the time that I pumped breast milk for Reuben and he recreationally nursed, I sometimes felt criticized by people on both ends of the spectrum of parenting philosophy. Some people couldn’t understand why I would make the monumental effort to pump milk for 19 months. At other times, I felt pressure from exclusively breastfeeding mothers because Reuben used a nipple shield, didn’t get his nutrition “from the breast,” and received breastmilk calorie-enriched with formula. I had to learn to trust my own instincts, knowing that I was providing the best mix of experiences and nutrition for his unique needs.
Reality Sets In
The doctors reassured us that Reuben would learn to eat when we introduced a bottle or solids. But he did not. Months went by, and the tube remained in his nose; then, the day after his first birthday, it was replaced by one in his stomach. Some family and friends couldn’t understand why Reuben did not eat by mouth, suggesting that the problem would be solved if we simply held his tube feedings and offered only the bottle. They shared stories of breastfed babies who were forced into taking the bottle at day care. We knew this wouldn’t work, even if we had been willing to try it. Babies like Reuben have been traumatized by their oral experiences. They are so out of touch with their bodies’ signals of hunger and fullness, and so lacking in the basic motor skills needed to suck and swallow, that they will starve to death without tube feedings.
But I also understood their discomfort. Eating is central to daily life, social interaction, and celebration. Reuben’s refusal to eat felt deeply strange. More than once, even though we knew all of the medical reasons for Reuben’s behavior, Eric and I asked each other in frustration, “Why won’t he just eat?”
At each meal, I prepared a bottle and a bit of food, knowing in advance that the food would ultimately go in the garbage, and the contents of the bottle would be poured into his feeding tube. “Try to relax,” my husband advised. “Sometimes you focus on the negative, and I’m sure Reuben picks up on that.” He was right, but I wasn’t sure how to remain consistently cheerful when I prepared three meals a day for a child who refused to put them in his mouth.
Easy to Love, Difficult to Discipline by Becky Bailey helped me realize that we can’t ever force another person to do anything; all we can do is set up the situation so it’s easier for them to choose what is safe, healthy, or polite. Or, in the words of one specialized feeding program we researched, “We teach our families the proper division of eating responsibility; it is the child’s responsibility to eat, and it is the family’s responsibility to provide the right environment, foods, and opportunities to eat.”
Easy to Love, Difficult to Discipline By Becky Bailey
Easy to Love, Difficult to Discipline provides parents with seven basic skills to turn conflict into cooperation through development of self-control and self-confidence on the part of both the parent and child. The focus of the book is to teach parents to learn to understand both their and their child’s motivations for certain behaviors and then how to help their child and themselves to improve.
As our knowledge of feeding issues and confidence as parents increased, we became evermore frustrated with the hospital feeding specialist’s behavioral approach, which didn’t seem to work for Reuben or our family. He suggested we strive to “increase Reuben’s compliance with the spoon” and instructed us to set a timer for a three-minute “meal,” then touch the spoon to Reuben’s lips and say “bite” every 30 seconds. To our surprise, this worked well — for three meals. After that, Reuben screamed and sobbed, turning his head away from the spoon. Although we didn’t know the phrase “feeding with love and respect” at that time, we instinctively felt that seeking “compliance” was not compatible with our parenting philosophy.
When we consulted a different specialist, I immediately felt more comfortable. She approached Reuben and greeted him gently, getting to know him first as a person. She watched me feed him, then sat down to offer carrot sticks and Gerber Puffs and observe his reactions. She explained that she saw eating as a complex skill with sensory, psychological, behavioral, and biological components.
With her help, we discovered that Reuben was not comfortable with the preliminary sensory processing required for eating: He hated to have food on his face. She showed us how to work with carrot sticks and dip, as well as vibrating tools, to help him learn to tolerate sensations in and around his mouth.
She also suggested that Reuben requires strong flavors in order to locate food in his mouth. Refried beans and roasted carrot puree loaded with garlic and tahini became early favorite foods. Still, he only ate a bite or two of these foods at each meal.
Tips to Feeding with Love and Respect in Special Circumstances:
Let goof your sense of how things should be, and accept your child for who she is.
Approach your child’s doctors and other care providers as members of the team. They are experts on particular medical procedures, treatments, and diseases; you are an expert on your child. You should expect that medical professionals will listen to your experience and opinions. It is okay to ask questions like, “What other options are there for treatment?” or “What therapies are offered at other facilities?”
Seek out other parents and families in similar situations for support, advice, and alternative options.
Accept whatever is possible in your interactions with your child around food, whether it is making that food from your body or opening a can of formula with love.
Forgive yourself. Whatever decisions you made were based on the best available knowledge you had.
Trust your own intuition and your knowledge about your child. Be cautious of being influenced by those who see your decisions as either too child-focused or insufficiently pure from an ideological perspective.
Abandon any expectation that you will follow some perfect or pure set of principles.
Focus on the social, psychological, and behavioral aspects of mealtime and the possibilities for bonding they provide.
Relying on Other AP Practices, Too
Because feedings were complicated and sometimes tense, we found that other aspects of Attachment Parenting helped us maintain a secure bond with Reuben. I don’t own as many different wraps or know as many different ways to tie one as some people, but I consider myself a babywearing expert because I can get a baby into and out of a sling without dislodging a feeding tube from his nose — and have, on occasion, administered feedings while wearing the baby.
Cosleeping allowed us to ensure that Reuben didn’t become tangled in his tubes during the overnight portion of his feedings. Through soggy experiences, we learned all the ways the feeding tube could leak — once all in one night. First, I was awakened by cold wetness on my backside when the tube connected to Reuben disconnected from the bag containing his food. Two hours and a sheet change later, the medical port on the tube slipped open. This time we put a towel over the wet spot and went back to sleep, only to be awakened again when Reuben squirmed the tube extension off the button on his stomach.
People who say eating in bed is messy have no idea.
Feeding with Love and Respect in Special Circumstances
Over time, we have found ways to make Reuben’s tube feedings a nurturing and respectful experience for all of us. I choose the content of Reuben’s diet when I make his homemade blended formula (though we also use canned formula). Context is also an important part of eating, and we have learned to integrate Reuben’s tube feedings into our family meal time. We put whatever we are eating on Reuben’s plate, and he usually chews at least some of it. Eric pushes Reuben’s tube feeding while we all talk about our day. Before we start, we hold hands and say something for which we’re grateful. Then I smile at Reuben and ask, “Now what?” and he grins broadly as he says, “Blessings on our meal.”
Someday, the doctors assure us, Reuben will move to eating all of his calories by mouth and I will complain with the mothers of other teenage boys about the difficulty of keeping food in the refrigerator. Until then, we have learned that every kind of meal, whether intravenous or tube-fed, hung or pushed or pumped, eaten by mouth from the breast or the hand or the spoon – all of these are a blessing.
MealtimeConnections.com provides feeding therapy and consultation focused on developing a positive partnership between therapists and families, as well feeding in the context of a positive parent-child relationship. I especially recommend their “Mealtime Notions,” which are feeding aids based on the Mealtime Connections philosophy that “feeding is first and foremost a special relationship between the child and the feeder”; and the Homemade Blended Formula Handbook, an indispensable philosophical and practical reference for families of tube-fed children.
The Pediatric Encouragement Feeding Program at Kluge Children’s Rehabilitation Center is an intensive, interdisciplinary program focused on weaning children from tube feedings in a supportive environment.
Connecting with our children for a more compassionate world.