Judy Arnall, BA, is a discipline expert, parent educator, and speaker as well as the mother of five children. Learn more at www.professionalparenting.ca or www.attachmentparenting.ca.
Even though the economy is recovering, many families will still have to put the brakes on Christmas spending. How does one cut down? How do we break it to the kids? What will the relatives think if we don’t participate in the gift frenzy?
Families can do all three if they communicate the changes early, with loving intent and with assurances that the holidays will be about presence and not presents.
To limit children’s demands at Christmas:
Remember that children remember good times and not toys. Create rituals around the tree decorating, baking, other activities, and family and friend visits. Children will remember a special time with Grandma baking cookies much more then the hottest gift that is tossed aside in favor of more gifts.
Try to get the most wanted gift on their list, if possible. It only has to be one special, coveted gift.
If you can’t get or can’t afford the “hot” gift, use your judgment to decide what toys and games have the best play value. Keep in mind that children are often disappointed with the advertising hype when they eventually get the “it” gift. Don’t dismiss the second-hand stores for huge bargains on consignment and gently used toys. Children do not care if the toy doesn’t come in mounds of wire and clear plastic and cardboard packaging; the toys don’t have to be new, just new to them. Make sure the toys are clean and working, though. Keep in mind that as a parent, you know which toys offer more play value than others. Many children like simple, unstructured toys that can be played with in many different ways. Continue reading How to Downsize the Holidays→
Sonya Fehér is a co-leader for the API of South Austin, Texas, USA. She is also a contributing editor for API Speaks.
Bedtime is one of the most challenging times of day for me as a parent. I am tired from having taking care of a little person all day, ready to cuddle with my husband on the couch and watch a show, or check Facebook, or have any kind of leisure or work time that’s my own.
My son was two before we had a solid bedtime routine. We would read a pile of stories, then he’d crawl out of bed for more. He would nurse, then want to play or read and then nurse again. It didn’t bother me much at first because he was napping, and I got breaks during the day. Also, I listened to mamas all around me talk about their kids waking up at 6:00 a.m. and since my son didn’t go to sleep until 10:30 p.m., he slept until 9:00 or so in the morning. Much better for me since I’m a night owl.
Then we night-weaned and he started waking earlier. The long uninterrupted blocks of sleep meant he was more rested, too. He woke anywhere from 6:00 to 8:00 a.m. When the time changed, my son rose with the sun. I’ve never been so aware of dawn. I bought new curtains at IKEA and sewed black-out material into them. Still the early mornings. I couldn’t start my day at 6:30 a.m. and still be present, attached, and nice by 10:30 p.m. I needed a break.
Even though Cavanaugh was exhausted, bedtime took a couple of hours every night. My husband and I thought we were providing a routine because we’d go upstairs an hour before we intended for Cavanaugh to be asleep so he could have quiet winding down time. We’d change him into a nighttime diaper and pajamas, read stories, and then nurse. But our routine didn’t have specific limits and Cavanaugh had no idea when it was supposed to end. It finally occurred to me that Cavanaugh loved “bed” time because he was getting undivided attention from both me and my husband. He wasn’t looking at a clock and counting the hours until morning. He was lying in between us as we cuddled him and read him story after story. So we changed our routine.
We do the playing downstairs now so that just going up to the bedroom signals that it’s time for pajamas, tooth brushing, three stories, and sleep. Before the first book, his dad or I say, “Three more books and then what?” If Cavanaugh says something other than “milk” or “sleep,” we’ll remind him where we are in the routine. And most of the time, this works amazingly well. Knowing what the parameters are means that Cavanaugh can relax and enjoy the time with us. If he wants me to read the last book, he knows when there’s only one more.
But late afternoon and evening need to occur on a timetable that allows the nighttime routine to flow smoothly. We need to eat dinner between 6:00 and 6:30 p.m. We need to be upstairs by 6:45 p.m. This kind of predictability and scheduling didn’t exist in my pre-parent life. I never wore a watch. I ate cereal for dinner and went to sleep at 2:00 a.m. Some nights, I made four-course meals and was asleep by 11:00 p.m. I could do what the day called for. Those times are no more. Sure, we can make an occasional exception to the routine, but two or three nights in a row of odd circumstances mean my boy wants a little wiggle room himself. If we’re not following the schedule, why should he?
As he’s playing around, pretending to go to sleep and trying to negotiate more time with me, I’m looking at the clock thinking that for every minute he stays up later, we are in some convoluted formula that means he wakes up that much earlier the next morning. The voices in my head say it’s my fault because we weren’t home on time or I didn’t remember to start making dinner before 5:30 p.m. or…. None of this is conducive to responding to him sensitively.
Or, say, we’ve followed the routine to the letter but he isn’t going to sleep. I think back to our day full of play dates, errands, and a lot of time together though he hasn’t had much mama focus on just him. Or his dad’s working that night. Bedtime has a way of dragging out on the days when Cavanaugh most needs me and I most need a break.
On the nights when we’ve gone through the whole routine but Cavanaugh is still rolling around and bargaining for another story, index finger in the air, “Just one more,” I usually don’t want to read one more, or the one he will ask for after that. I manage to be sympathetic to his need for attention up to the point that my impatience wins out over my parenting philosophy and I end up snapping, “Cavanaugh, it’s sleeping time.” Then I give him the five-minute transition notice in an angry tone, “I will stay with you for five more minutes and then I need to go downstairs. What do you need from me to help you go to sleep?” Some nights it’s cuddle, a back rub, one more story, icy cold water. But some nights it is “five more minutes” until it’s an hour or more past his bedtime.
This week, though, I’ve been rereading Playful Parenting by Lawrence Cohen. So last night when Cavanaugh was rolling around, being silly, asking for more of me than I had, I tried something — to playfully set the boundary. I told him, in a funny tone, that it was time to go to bed and wagged my index finger at him. My anger gave in to silliness, he was laughting, and the impending power struggle dissipated. After a couple more minutes of playing, he turned over to go to sleep. I got to tell him the limit was firm without having to use firm tones. And he got exactly what he needed, a reconnection as I looked into his eyes and acted a clown.
Judy Arnall, BA, is a discipline expert, parent educator, and speaker as well as the mother of five children. She lives in Calgary, Alberta, Canada.
Last Christmas, I had enough of shopping. With five children in the family, even with buying only one present to each other, there would have been 49 gifts to shop, pay for, and eventually add to the inevitable mound in the landfill. I announced to my family that we were going to make gifts to give to each other, rather then buy them. They all agreed (with twisted arms) and by the 20th of December, I was beginning to worry as there was absolutely no action occurring in this endeavor of mine.
I had to get Dad’s buy-in to help the smaller children with my presents and after a quick reminder to the older children, the house turned into a flurry of creative activity going on everywhere: planning, giggles, secrets, and shhhhing was taking place behind closed doors.
By Rita Brhel,managing editor and attachment parenting resource leader (API)
Marian Tompson, founder of AnotherLook and co-founder of LLLI
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.
Seeking Treatment
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.
Family Resources
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.
By Judy Sanders, member of API’s Board of Directors and API’s Editorial Review Board
It’s dinnertime somewhere. Families sit around a dining table, or gather around a short-legged table, or settle on a rug in a circle. A baby may be in a high chair or on his mother’s back, having food handed to him. He may be in a hammock, gently pushed every so often, dozing, not eating, and absorbing the sounds of his family enjoying their evening meal.
Why regularly share the evening meal as a family? How does this routine activity serve us beyond nourishment? Continue reading The Family Table→
By Kathleen Kendall-Tackett, PhD, IBCLC, member of API’s Resource Advisory Council and API’s Editorial Review Board, adapted from Breastfeeding Made Simple by Nancy Mohrbacher and Kathleen Kendall-Tackett
For survivors of childhood sexual abuse or sexual assault, breastfeeding can pose challenges. Unfortunately, sexual abuse and assault are relatively common experiences, affecting 20% to 25% of women. The reactions of abuse survivors to breastfeeding run the whole range of responses – from really disliking it to finding it tremendously healing.
Surprisingly, research has shown us that abuse survivors are more likely to breastfeed. The two published studies on this topic showed that abuse survivors had a higher intention to breastfeed and a higher rate of breastfeeding initiation. Our research has also shown that a higher percentage of mothers who were abuse or assault survivors were breastfeeding compared with mothers without a trauma history. We have also found higher rates of Attachment Parenting behaviors, such as bed-sharing, among the abuse and assault survivors.
If you are an abuse survivor who wants to breastfeed, I congratulate you for making a positive life choice to overcome your past and parent well. However, there still may be some difficulties you face as you breastfeed your baby or child. If you are having a difficult time, here are some suggestions that might help:
Figure out what makes you uncomfortable – Is it nighttime feeding? Is it your baby touching other parts of your body while nursing? Is it when the baby attaches to your breast? Or all of the above? The intense physical contact of breastfeeding may be very uncomfortable for you. You might find breastfeeding painful, because your abuse experience lowered your pain threshold. The act of breastfeeding may also trigger flashbacks.
Can you address the problem? – If skin-to-skin contact is bothering you, can you put a towel or cloth between you and the baby? Can you avoid the feedings that make you uncomfortable? Nighttime feedings are often good candidates. Would you be more comfortable if you pumped and fed your baby with a bottle? Can you hold your baby’s other hand while breastfeeding to keep her from touching your body? Can you distract yourself while breastfeeding with TV or a book? Several mothers have shared with me that works well for them. Experiment, be flexible, and find out what helps.
Remember that some breastfeeding is better than none – You may not be able to fully breastfeed, but every little bit helps, even if you must pump milk and use a bottle or if you are only breastfeeding once a day. Some abuse survivors find that they never love breastfeeding, but they learn to tolerate it. And that may be a more realistic goal for you.
Past abuse does not have to influence the rest of your life. I know many abuse survivors who have become wonderful mothers. I’m confident that you can, too. Nurturing your baby through breastfeeding is a great place to start.
Connecting with our children for a more compassionate world.
This week, though, I’ve been rereading Playful Parenting by Lawrence Cohen. So last night when Cavanaugh was rolling around, being silly, asking for more of me than I had, I tried something — to playfully set the boundary. I told him, in a funny tone, that it was time to go to bed and wagged my index finger at him. My anger gave in to silliness, he was laughting, and the impending power struggle dissipated. After a couple more minutes of playing, he turned over to go to sleep. I got to tell him the limit was firm without having to use firm tones. And he got exactly what he needed, a reconnection as I looked into his eyes and acted a clown.
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.
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.
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.
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.
It’s dinnertime somewhere. Families sit around a dining table, or gather around a short-legged table, or settle on a rug in a circle. A baby may be in a high chair or on his mother’s back, having food handed to him. He may be in a hammock, gently pushed every so often, dozing, not eating, and absorbing the sounds of his family enjoying their evening meal.
For survivors of childhood sexual abuse or sexual assault, breastfeeding can pose challenges. Unfortunately, sexual abuse and assault are relatively common experiences, affecting 20% to 25% of women. The reactions of abuse survivors to breastfeeding run the whole range of responses – from really disliking it to finding it tremendously healing.