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An infant breastfeeding International Breastfeeding Symbol

Sucking and nursing are synonyms. For other uses, see Nursing (disambiguation)

Breastfeeding (or nursing^[1]) is the feeding of an infant or young child with breast milk directly from human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. Most mothers can breastfeed for six months or more, without the addition of infant formula or solid food.

Human breast milk is the most healthful form of milk for human babies.^[2] There are few exceptions, such as when the mother is taking certain drugs or is infected with tuberculosis or HIV. Breastfeeding promotes health, helps to prevent disease and reduces health care and feeding costs.^[3] In both developing and developed countries, artificial feeding is associated with more deaths from diarrhoea in infants.^[4]Experts agree that breastfeeding is beneficial, but may disagree about the length of breastfeeding that is most beneficial, and about the risks of using artificial formulas.^[5][6][7]

Both the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for the first six months of life and then breastfeeding up to two years or more (WHO) or at least one year of breastfeeding in total (AAP). Exclusive breastfeeding for the first six months of life "provides continuing protection against diarrhea and respiratory tract infection" that is more common in babies fed formula. ^[8] The WHO^[9] and AAP^[10] both stress the value of breastfeeding for mothers and children. While recognizing the superiority of breastfeeding, regulating authorities also work to minimize the risks of artificial feeding.^[6]

According to a WHO 2001 report,^[11] alternatives to breastfeeding include:

• expressed breast milk from an infant’s own mother
• breast milk from a healthy wet-nurse or a human-milk bank
• a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat.

The acceptability of Breastfeeding in public varies by culture and country. In Western culture, though most approve of breastfeeding, some mothers may be reluctant to do so out of fear of public opinion.

Contents 1 Lactation 2 Breast milk 3 Benefits for the infant 3.1 Superior nutrition 3.2 Greater immune health 3.3 Higher intelligence 3.4 Long term health effects 3.5 Fewer urinary tract, diarrheal and middle ear infections 3.6 Less tendency to develop allergic diseases (atopy) 3.7 Less necrotizing enterocolitis in premature infants 3.88 More easily aroused from sleep 4 Benefits for mothers 4.1 Long-term health effects 4.2 Bonding 4.3 Hormone release 4.4 Weight loss 4.5 Natural postpartum infertility 5 Organisational endorsements 5.11 World Health Organization 5.2 American Academy of Pediatrics 6 Breastfeeding difficulties 7 Infant weight gain 8 Methods and considerations 8.1 Early breastfeeding 8.2 Time and place for breastfeeding 8.3 Latching on, feeding and positioning 8.4 Exclusive breastfeeding 8.5 Expressing breast milk 8.6 Mixed feeding 8.7 Tandem breastfeeding 8.8 Extended breastfeeding 8.9 Shared breastfeeding 8.10 Weaning 9 History of breastfeeding 10 Sociological factors with breastfeeding 10.1 Breastfeeding in public 11 See also 12 Footnotes 13 References 14 External links

Lactation

The production, secretion and ejection of milk is called lactation. It is one of the defining features of being a mammal.

Breast milk

Not all the properties of breast milk are understood, but its nutrient content is relatively stable. Breast milk is made from nutrients in the mother's bloodstream and bodily stores. Because breastfeeding uses an average of 500 calories a day it helps the mother lose weight after giving birth.^[12] The composition of breast milk changes depending on how long the baby nurses at each session, as well as on the age of the child.

Research shows that the milk and energy content of breastmilk actually decreases after the first year.^[9] Breastmilk adapts to a toddler's developing system, providing exactly the right amount of nutrition at exactly the right time.^[10]] In fact, research shows that between the ages of 12 and 24 months, 448 milliliters of human milk provide these percentages of the following minimum daily requirements:^[13]

Energy:	29%
Folate:	76%%
Protein:	43%
Vitamin B12:	94%
Calcium:	36%
Vitamin C:	60%
Vitamin A:	75%

The quality of a mother's breast milk may be compromised by stress, bad food habits, chronic illnesses, smoking, and drinking.^{[14][unreliable source?][15]}

Benefits for the infant

Himba woman and child. A woman with her child in Kabala, Sierra Leone in the 1960's.

During breastfeeding nutrients and antibodies pass to the baby^[16] while it helps to strengthen the maternal bond.^[17] Research has found many benefits to breastfeeding. ^[18] These include:

Superior nutrition

Breast milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development.^[17]

Greater immune health

Breast milk contains several anti-infective factors such as bile salt stimulated lipase (protecting against amoebic infections), lactoferrin (which binds to iron and inhibits the growth of intestinal bacteria)^[19][20] and immunoglobulin A protecting against microorganisms.^[21]

As breastfeeding can transmit HIV from mother to child, UNAIDS recommends avoidance of all breastfeeding where formula feeding is acceptable, feasible, affordable and safe.^[22] The qualifications are important. Some constituents of breast milk may protect from infection. High levels of certain polyunsaturated fatty acids in breast milk (including eicosadienoic, arachidonic and gamma-Linolenic acids) are associated with a reduced risk of child infection when nursed by HIV-positive mothers. Arachidonic acid and gamma-linolenic acid may also reduce viral shedding of the HIV virus in Breast milk.^[23] Due to this, in underdeveloped nations infant mortality rates are lower when HIV-positive mothers breastfeed their newborns than when they use infant formula. However, differences in infant mortality rates have not been reported in better resourced areas.^[24] Treating infants prophylactically with Lamivudine can help to decrease the transmission of HIV through mother to child. ^[25]

Higher intelligence

Two initial studies suggest babies with a specific version of the FADS2 gene demonstrated an IQ averaging 7 points higher if breastfed, compared with babies with a less common version of the gene who showed no improvement when breastfed. FADS2 affects the metabolism of fatty acids, such as DHA and AA, which are known to be linked to early brain development. Manufacturers of infant formula have been adding DHA and AA fatty acids to their products since this discovery over a decade ago. The researchers state, "further investigation to replicate and explain this specific gene–environment interaction is warranted," and have concluded, "Our findings support the idea that the nutritional content of breast milk accounts for the differences seen in human IQ. But it's not a simple all-or-none connection: it depends to some extent on the genetic makeup of each infant."^[26]

Horwood, Darlow and Mogridge tested the intelligence quotient scores of low birthweight children at seven or eight years of age. Those who were breastfed for more than eight months had significantly higher intelligence quotient scores than comparable children breastfed for less time. They concluded, "These findings add to a growing body of evidence to suggest that breast milk feeding may have small long term benefits for child cognitive development." ^[27]

Long term health effects

Infants exclusively breastfed have less chance of developing diabetes mellitus type 1 than peers with a shorter duration of breastfeeding and an earlier exposure to cow milk and solid foods.^[28] Breastfeeding also appears to protect against diabetes mellitus type 2,^[29][30] at least in part due to its effects on the child's weight.^[30]

Breastfeeding appears to reduce the risk of extreme obesity in children aged 39 to 42 months.^[31] The protective effect of breastfeeding against obesity is consistent, though small, across many studies, and appears to increase with the duration of breastfeeding.^[32]

In one study, breastfeeding did not appear to offer protection against allergies.^{[dubious – discuss][33]} However, another study showed breastfeeding to have lowered the risk of asthma, protect against allergies^{[dubious – discuss]}, and provide improved protection for babies against respiratory and intestinal infections.^[34]

A review of the association between breastfeeding and celiac disease (CD) concluded that breast feeding while introducing gluten to the diet reduced the risk of CD. The study was unable to determine if breastfeeding merely delayed symptoms or offered life-long protection.^[35]

A study at the University of Wisconsin found that women who were breast fed in infancy may have a lower risk of developing breast cancer than those who were not breast fed. ^{[36][unreliable source?]}

Fewer urinary tract, diarrheal and middle ear infections

Breastfeeding reduced the risk of acquiring urinary tract infections in infants up to seven months of age. The protection was strongest immediately after birth, but was ineffective past seven months^[37] Breastfeeding appears to reduce symptoms of upper respiratory tract infections in premature infants up to seven months after release from hospital.^[38] A longer period of breastfeeding is associated with a shorter duration of some middle ear infections (otitis media with effusion, OME) in the first two years of life. The researches concluded, "For a decrease in the amount of time with OME during the first 2 years of life, prolonged breast-feeding and upright feeding position should be encouraged, and cigarette smoke exposure should be minimized. Limiting early child care in large groups might also be advisable.".^[39] Another study found that breastfed babies had half the incidence of diarrheal illness, 19% fewer cases of any otitis media infection and 80% fewer prolonged cases of otitis media than formula fed babies in the first twelve months of life.^[40]

Less tendency to develop allergic diseases (atopy)

In children who are at risk for developing allergic diseases (defined as at least one parent or sibling having atopy), atopic syndrome can be prevented or delayed through exclusive breastfeeding for four months, though these benefits may not be present after four months of age. ^[41] However, the key factor may be the age at which non-breastmilk is introduced rather than duration of breastfeeding.^[42] Atopic dermatitis, the most common form of eczema, can be reduced through exclusive breastfeeding beyond 12 weeks in individuals with a family history of atopy, but when breastfeeding beyond 12 weeks is combined with other foods incidents of eczema rise irrespective of family history.^[43]

Less necrotizing enterocolitis in premature infants

Necrotizing enterocolitis (NEC), is an acute inflammatory disease in the intestines of infants. Necrosis or death of intestinal tissue may follow. It is mainly found in premature births. In one study of 926 preterm infants, NEC developed in 51 infants (5.5%). The death rate from necrotizing enterocolitis was 26%. NEC was found to be six to ten times more common in infants fed formula exclusively, and three times more common in infants fed a mixture of breast milk and formula, compared with exclusive breastfeeding. In infants born at more than 30 weeks, NC was twenty times more common in infants fed exclusively on formula.^[44]

More easily aroused from sleep

Breastfed babies have better arousal from sleep at 2–3 months. This coincides with the peak incidence of sudden infant death syndrome.^[45]

Benefits for mothers

Breastfeeding is a cost effective way of feeding an infant, and provides the best nourishment for a child at a small nutrient cost to the mother. Frequent and exclusive breastfeeding can delay the return of fertility through lactational amenorrhea, though breastfeeding is an imperfect means of birth control. During breastfeeding beneficial hormones are released into the mother's body.^[16] and the maternal bond can be strengthened.^[17] Breastfeeding is possible throughout pregnancy, but generally milk production will be reduced at some point.^[46]

Long-term health effects

A recent study indicates long duration of lactation (at least 24 months) is associated with a reduced risk of heart disease in women.^[47] Breastfeeding mothers also have less risk of endometrial,^[48][49] and ovarian cancer,^[17][10] and osteoporosis,^[17][10] and breast cancer.

Mothers who breastfeed longer than eight months also benefit from bone re-mineralisation^[50] and breastfeeding diabetic mothers require less insulin.^[51] Breastfeeding helps stabilize maternal endometriosis,^[10] reduces the risk of post-partum bleeding^[52] and benefits the insulin levels for mothers with polycystic ovary syndrome.^[53]

Women who breast feed for longer have less chance of getting rheumatoid arthritis, a Malmo University study published online ahead of print in the Annals of the Rheumatic Diseases suggested (See Women Who Breast Feed for More than a Year Halve Their Risk of Rheumatoid Arthritis). The study also found that taking oral contraceptives, which are suspected to protect against the disease because they contain hormones that are raised in pregnancy, did not have the same effect. Simply having children but not breast feeding also did not seem to be protective.

Bonding

The hormones released during breastfeeding strengthen the maternal bond. Teaching partners how to manage common difficulties is associated with higher breastfeeding rates.^[54] Support for a mother while breastfeeding can assist in familial bonds and help build a paternal bond between father and child.^[55]

If the mother is away, an alternative caregiver may be able to feed the baby with expressed breast milk. The various breast pumps available for sale and rent help working mothers to feed their babies breast milk for as long as they want. To be successful, the mother must produce and store enough milk to feed the child for the time she is away, and the feeding caregiver must be comfortable in handling breast milk.

Hormone release

Breastfeeding releases oxytocin and prolactin, hormones that relax the mother and make her feel more nurturing toward her baby.^[56] Breastfeeding soon after giving birth increases the mother's oxytocin levels, making her uterus contract more quickly and reducing bleeding. Oxytocin is similar to pitocin, a synthetic hormone used to make the uterus contract.^[52]

Weight loss

As the fat accumulated during pregnancy is used to produce milk, extended breastfeeding—at least 6 months—can help mothers lose weight.^[57] However, weight loss is highly variable among lactating women, and diet and exercise are more reliable ways of losing weight.^[58]

Natural postpartum infertility

A breastfeeding woman may not ovulate, or have regular periods, during the entire lactation period. The period in which ovulation is absent differs for each woman. This Lactational amenorrhea has been used as an imperfect form of natural contraception, with a greater than 98% effectiveness during the first six months after birth if specific nursing behaviors are followed.^[59] It is possible for some women to ovulate within two months after birth while fully breastfeeding.

Organisational endorsements

World Health Organization

“

[the] vast majority of mothers can and should breastfeed, just as vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother's milk be considered as unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative - expressed milk from the infant's own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast milk substitute fed with a cup, which is a safer method than a feeding bottle or a teat - depends on individual circumstances. [60]

”

The WHO recommends at least two years of breastfeeding and exclusive breastfeeding for the first six months of life. Breastfeeding should continue after two years of life as long as mutually desired by mother and child.

American Academy of Pediatrics

“

Extensive research, especially in recent years, documents diverse and compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits.[10]

”

AAP recommends at least one year of breastfeeding and exclusive breastfeeding for the first six months of life. Breastfeeding should continue after two years of life as long as mutually desired by mother and child.

Breastfeeding difficulties

While breastfeeding is a natural human activity, difficulties are not uncommon. Putting the baby to the breast as soon as possible after the birth helps to avoid many problems. The AAP breastfeeding policy says: Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed.^[10] Many breastfeeding difficulties can be resolved with proper hospital procedures, properly trained midwives, doctors and hospital staff, and lactation consultants.^[61] There are some situations in which breastfeeding may be harmful to the infant, including infection with HIV and acute poisoning by environmental contaminants such as lead.^[34] Rarely, a mother may not be able to produce breastmilk because of a prolactin deficiency. This may be caused by Sheehan's syndrome, an uncommon result of a sudden drop in blood pressure during childbirth typically due to hemorrhaging. In developed countries, many working mothers do not breast feed their children due to work pressures. For example, a mother may need to schedule for frequent pumping breaks, and find a clean, private and quiet place at work for pumping. These inconveniences may cause mothers to give up on breast feeding and use infant formula instead.

Infant weight gain

Breastfed infants generally gain weight according to the following guidelines:

0–4 months: 170 grams per week^†

4–6 months: 113–142 grams per week

6–12 months: 57–113 grams per week

^† It is acceptable for some babies to gain 113–142 grams (4–5 ounces) per week. This average is taken from the lowest weight, not the birth weight.

The average breastfed baby doubles its birth weight in 5–6 months. By one year, a typical breastfed baby will weigh about 2½ times its birth weight. At one year, breastfed babies tend to be leaner than bottle fed babies.^[62] By two years, differences in weight gain and growth between breastfed and formula-fed babies are no longer evident.^[63];

Methods and considerations

There are many books and videos to advise mothers about breastfeeding. Lactation consultants in hospitals or private practice, and volunteer organisations of breastfeeding mothers such as La Leche League also provide advice and support.

Early breastfeeding

In the half hour after birth, the baby's suckling reflex is strongest, and the baby is more alert, so it is the ideal time to start breastfeeding^[64]. Early breast-feeding is associated with fewer nighttime feeding problems ^[65]

Time and place for breastfeeding

Breastfeeding at least every two to three hours helps to maintain milk production. For most women, eight breastfeeding or pumping sessions every 24 hours keeps their milk production high.^[10] Newborn babies may feed more often than this: 10 to 12 breastfeeding sessions every 24 hours is common, and some may even feed 18 times a day.^[66] Feeding a baby "on demand" (sometimes referred to as "on cue"), means feeding when the baby shows signs of hunger; feeding this way rather than by the clock helps to maintain milk production and ensure the baby's needs for milk and comfort are being met.^[9] However, it may be important to recognize whether a baby is truly hungry, as breastfeeding too frequently may mean the child receives a disproportionately high amount of foremilk, and not enough hindmilk.^[67].

"Experienced breastfeeding mothers learn that the sucking patterns and needs of babies vary. While some infants' sucking needs are met primarily during feedings, other babies may need additional sucking at the breast soon after a feeding even though they are not really hungry. Babies may also nurse when they are lonely, frightened or in pain.[3]"

"Comforting and meeting sucking needs at the breast is nature's original design. Pacifiers (dummies, soothers) are a substitute for the mother when she can't be available. Other reasons to pacify a baby primarily at the breast include superior oral-facial development, prolonged lactational amenorrhea, avoidance of nipple confusion and stimulation of an adequate milk supply to ensure higher rates of breastfeeding success.[4]"

Most US states now have laws that allow a mother to breastfeed her baby anywhere she is allowed to be. In hospitals, rooming-in care permits the baby to stay with the mother and improves the ease of breastfeeding. Some commercial establishments provide breastfeeding rooms, although laws generally specify that mothers may breastfeed anywhere, without requiring them to go to a special area.

Latching on, feeding and positioning

This article contains instructions, advice, or how-to content. The purpose of Wikipedia is to present facts, not to train. Please help improve this article either by rewriting the how-to content or by moving it to Wikiversity or Wikibooks. (September 2008)

Correct positioning and technique for latching on can prevent nipple soreness and allow the baby to obtain enough milk. ^[68] The "rooting reflex" is the baby's natural tendency to turn towards the breast with the mouth open wide; mothers sometimes make use of this by gently stroking the baby's cheek or lips with their nipple in order to induce the baby to move into position for a breastfeeding session, then quickly moving baby onto the breast while baby's mouth is wide open. ^[69] In order to prevent nipple soreness and allow the baby to get enough milk, a large part of the breast and areola need to enter the baby's mouth.^[68][70] To help the baby latch on well, tickle the baby's top lip with the nipple, wait until the baby's mouth opens wide, then bring the baby up towards the nipple quickly, so that the baby has a mouthful of nipple and areola. The nipple should be at the back of the baby's throat, with the baby's tongue lying flat in its mouth. Inverted or flat nipples can be massaged so that the baby will have more to latch onto. Resist the temptation to move towards the baby, as this can lead to poor attachment.

Pain in the nipple or breast is linked to incorrect breastfeeding techniques. Failure to latch on is one of the main reasons for ineffective feeding and can lead to infant health concerns. A 2006 study found that inadequate parental education, incorrect breastfeeding techniques, or both were associated with higher rates of preventable hospital admissions in newborns.^[71]

The baby may pull away from the nipple after a few minutes or after a much longer period of time. Normal feeds at the breast can last a few sucks (newborns), from 10 to 20 minutes or even longer (on demand). Sometimes, after the finishing of a breast, the mother may offer the other breast.

While most women breastfeed their child in the cradling position, there are many ways to hold the feeding baby. It depends on the mother and child's comfort and the feeding preference of the baby. Some babies prefer one breast to the other, but the mother should offer both breasts at every nursing with her newborn.

When tandem breastfeeding, the mother is unable to move the baby from one breast to another and comfort can be more of an issue. As tandem breastfeeding brings extra strain to the arms, especially as the babies grow, many mothers of twins recommend the use of more supporting pillows.

Exclusive breastfeeding

Exclusive breastfeeding is when an infant receives no other food or drink besides breast milk.^[9] National and international guidelines recommend that all infants be breastfed exclusively for the first six months of life. Breastfeeding may continue with the addition of appropriate foods, for two years or more. Exclusive breastfeeding has dramatically reduced infant deaths in developing countries by reducing diarrhea and infectious diseases. It has also been shown to reduce HIV transmission from mother to child, compared to mixed feeding.

Exclusively breastfed infants feed anywhere from 6 to 14 times a day. Newborns consume from 30 to 90 ml (1 to 3 US fluid ounces). After the age of four weeks, babies consume about 120ml (4 US fluid ounces) per feed. Each baby is different, but as it grows the amount will increase. It is important to recognize the baby's hunger signs. It is assumed that the baby knows how much milk it needs and it is therefore advised that the baby should dictate the number, frequency, and length of each feed. The supply of milk from the breast is determined by the number and length of these feeds or the amount of milk expressed. The birth weight of the baby may affect its feeding habits, and mothers may be influenced by what they perceive its requirements to be. For example, a baby born small for gestational age may lead a mother to believe that her child needs to feed more than if it larger; they should, however, go by the demands of the baby rather than what they feel is necessary.

While it can be hard to measure how much food a breastfed baby consumes, babies normally feed to meet their own requirements.^[73] Babies that fail to eat enough may exhibit symptoms of failure to thrive. If necessary, it is possible to estimate feeding from wet and soiled nappies (diapers): 8 wet cloth or 5–6 wet disposable, and 2–5 soiled per 24 hours suggests an acceptable amount of input for newborns older than 5–6 days old. After 2–3 months, stool frequency is a less accurate measure of adequate input as some normal infants may go up to 10 days between stools. Babies can also be weighed before and after feeds.

Expressing breast milk

When direct breastfeeding is not possible, a mother can express (artificially remove and store) her milk. With manual massage or using a breast pump, a woman can express her milk and keep it in freezer storage bags, a supplemental nursing system, or a bottle ready for use. Breast milk may be kept at room temperature for up to ten hours, refrigerated for up to eight days or frozen for up to four to six months. Research suggests that the antioxidant activity in expressed breast milk decreases over time but it still remains at higher levels than in infant formula.^[74]

Expressing breast milk can maintain a mother's milk supply when she and her child are apart. If a sick baby is unable to feed, expressed milk can be fed through a nasogastric tube.

Expressed milk can also be used when a mother is having trouble breastfeeding, such as when a newborn causes grazing and bruising. If an older baby bites the nipple, the mother's reaction - a jump and a cry of pain - is usually enough to discourage the child from biting again.

"Exclusively Expressing", "Exclusively pumping" and "EPing" are terms for a mother who feeds her baby exclusively on her breastmilk while not physically breastfeeding. This may arise because her baby is unable or unwilling to latch on to the breast. With good pumping habits, particularly in the first 12 weeks when the milk supply is being established, it is possible to produce enough milk to feed the baby for as long as the mother wishes. Kellymom [5] has a page of links relating to exclusive pumping.

It is generally advised to delay using a bottle to feed expressed breast milk until the baby is 4–6 weeks old and is good at sucking directly from the breast.^[75] As sucking from a bottle takes less effort, babies can lose their desire to suck from the breast. This is called nursing strike or nipple confusion. To avoid this when feeding expressed breast milk (EBM) before 4–6 weeks of age, it is recommended that breast milk be given by other means such as feeding spoons or feeding cups. Also, EBM should be given by someone other than the breastfeeding mother (or wet nurse), so that the baby can learn to associate direct feeding with the mother (or wet nurse) and associate bottle feeding with other people.^{[citation needed]}

Some women donate their expressed breast milk (EBM) to others, either directly or through a milk bank. Though historically the use of wet nurses was common, some women dislike the idea of feeding their own child with another woman's milk; others appreciate being able to give their baby the benefits of breast milk. Feeding expressed breast milk—either from donors or the baby's own mother—is the feeding method of choice for premature babies.^[76] The transmission of some viral diseases through breastfeeding can be prevented by expressing breast milk and subjecting it to Holder pasteurisation.^[77]

Mixed feeding

Predominant or mixed breastfeeding means feeding breast milk along with infant formula, baby food and even water, depending on the age of the child. Babies feed differently with artificial teats than from a breast. With the breast, the infant's tongue massages the milk out rather than sucking, and the nipple does not go as far into the mouth; with an artificial teat, an infant will suck harder and the milk may come in more rapidly. Therefore, mixing breastfeeding and bottle-feeding (or using a pacifier) before the baby is used to feeding from its mother can result in the infant preferring the bottle to the breast. Orthodontic teats, which are generally slightly longer, are closer to the nipple. Some mothers supplement feed with a small syringe or flexible cup to reduce the risk of artificial nipple preference.

Tandem breastfeeding

Feeding two children at the same time is called tandem breastfeeding The most common reason for tandem breastfeeding is the birth of twins, although women with closely spaced children can and do continue to nurse the older as well as the younger. As the appetite and feeding habits of each baby may not be the same, this could mean feeding each according to their own individual needs, and can also include breastfeeding them together, one on each breast.

In cases of triplets or more, it is a challenge for a mother to organize feeding around the appetites of all the babies. While breasts can respond to the demand and produce large quantities of milk, it is common for women to use alternatives. However, some mothers have been able to breastfeed triplets successfully ^{[78][79] [80]}.

Tandem breastfeeding may also occur when a woman has a baby while breastfeeding an older child. During the late stages of pregnancy the milk will change to colostrum, and some older nurslings will continue to feed even with this change, while others may wean due to the change in taste or drop in supply. Feeding a child while being pregnant with another can also be considered a form of tandem feeding for the nursing mother, as she also provides the nutrition for two.^[81]

Extended breastfeeding

Breastfeeding past two years is called extended breastfeeding or "sustained breastfeeding" by supporters and those outside the U.S.^[82] Supporters of extended breastfeeding believe that all the benefits of human milk, nutritional, immunological and emotional, continue for as long as a child nurses. Often the older child will nurse infrequently or sporadically as a way of bonding with the mother.^{[citation needed]}

Shared breastfeeding

It used to be common worldwide, and still is in developing nations such as those in Africa, for more than one woman to breastfeed a child. Shared breastfeeding is a risk factor for HIV infection in infants.^[83] A woman who is engaged to breastfeed another's baby is known as a wet nurse. Islam has codified the relationship between this woman and the infants she nurses, and also between the infants when they grow up, so that milk siblings are considered as blood siblings and cannot marry. Shared breastfeeding can incur strong negative reactions in the Anglosphere^[84]; American feminist activist Jennifer Baumgardner has written about her experiences in New York with this issue^[85].

Weaning

Weaning is the process of introducing the infant to other food and reducing the supply of breast milk. The infant is fully weaned when it no longer receives any breast milk. Most mammals stop producing the enzyme lactase at the end of weaning, and become lactose intolerant. Many humans have a mutation that allows the production of lactase throughout life and so can drink milk - usually cow or goat milk - well beyond infancy.^[86]

In the past, bromocriptine was sometimes used to reduce the engorgement experienced by many women during weaning. However, it was discovered that when used for this purpose, this medication posed serious health risks to women, such as stroke, and the U.S. Food and Drug Administration withdrew this indication for the drug in 1994.^[87]

History of breastfeeding

For hundreds of thousands of years, humans, like all other mammals, fed their young milk. Before the twentieth century, alternatives to breastfeeding were rare. Attempts in 15th century Europe to use cow or goat milk were not very positive. In the 18th century, flour or cereal mixed with broth were introduced as substitutes for breastfeeding, but this did not have a favorable outcome, either. True commercial infant formulas appeared on the market in the mid 19th Century but their use did not become widespread until after WWII. As the superior qualities of breast milk became better-established in medical literature, breastfeeding rates have increased and countries have enacted measures to protect the rights of infants and mothers to breastfeed.

Sociological factors with breastfeeding

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Researchers have found several social factors that correlate with differences in initiation, frequency, and duration of breastfeeding practices of mothers. Race, ethnic differences and socioeconomic status and other factors have been shown to affect a mother’s choice whether or not to breastfeed and how long she breastfeeds her child.

• Race and culture Singh et al. also found that African American women are less likely than white women of similar socioeconomic status to breastfeed and Hispanic women are more likely to breastfeed. The Center of Disease Control used information from the National Immunization Survey to determine the proportion of Caucasian and African American children that were ever breast fed. They found that 71.5% of Caucasians had breastfed their child while only 50.1% of African Americans had. At six months of age this fell to 53.9% of Caucasian mothers and 43.2% of African American mothers who were still breastfeeding.^{[citation needed}
  
• Income Deborah L. Dee's research found that women and children who qualify for WIC, Special Supplemental Nutrition Program for Women, Infants, and Children were among those who were least likely to initiate breastfeeding. Income level can also contribute to women discontinuing breastfeeding early. More highly educated women are more likely to have access to information regarding difficulties with breastfeeding, allowing them to continue breastfeeding through difficulty rather than weaning early. Women in higher status jobs are more likely to have access to a lactation room and suffer less social stigma from having to breastfeed or express breastmilk at work. In addition, women who are unable to take an extended leave from work following the birth of their child are less likely to continue breastfeeding when they return to work.^{[citation needed]}
  
• Other factors Other factors they found to have an effect on breastfeeding are “household composition, metropolitan/non-metropolitan residence, parental education, household income or poverty status, neighborhood safety, familial support, maternal physical activity, and household smoking status.”^{[citation needed]}

Breastfeeding in public

See also

• Baby-friendly hospital
• Baby-led weaning
• Breast shell
• Dairy allergy
• Erotic lactation
• Human milk banking in North America
• Male lactation
• Milk line
• Nursing chair

Footnotes

References

• Hausman, Bernice (2003). Mother's Milk: Breastfeeding Controversies in American Culture. New York: Routledge. ISBN 0-415-96656-6.
• Huggins, Kathleen (1999). The Nursing Mother's Companion (4th ed.). Harvard Common Press. ISBN 1-55832-152-7.
• Mohrbacher N, Stock J (2003). The Breastfeeding Answer Book. La Leche League International, Schaumburg, Illinois. ISBN 0-912500-92-1.
• Stuart-Macadam P, Dettwyler K (1995). Breastfeeding: Biocultural Perspectives (Foundations of Human Behavior). Aldine de Gruyter. ISBN 0-202-01192-5.
• Leeson C, Kattenhorn M, Deanfield J, Lucas A (2001). "Duration of breast feeding and arterial distensibility in early adult life: population based study". BMJ 322 (7287): 643–7. doi:10.1136/bmj.322.7287.643. PMID 11250848.
• Health risks of not breastfeeding US Department of Health & Human Service
• Kilewo C., Karlsson, K., Massawe, A., Lyamuya, E., Swai,A., Mhalu, F., et al. (2008). "Prevention of mother-to-child transmission of HIV-1 through breast-feeding by treating infants prophylactically with lamivudine in Dar es Salaam, Tanzania.". Epidemiology and Social Sceience 48: 315–323.
• Coutsoudis, A., Goga, AE, Rollins, N., Coovadia, HM. (2002). "Free formula milk for infants of HIV positive women: blessing or curse?". Health Policy and Planning 17: 154–160.. doi:10.1093/heapol/17.2.154. PMID 12000775.

External links

Wikimedia Commons has media related to: Breastfeeding

Look up breastfeeding in Wiktionary, the free dictionary.

• Breastfeeding at the Open Directory Project
• Human Milk Secretion: An Overview US National Institute of Health
• Breastfeeding Resources La Leche League International
• Breastfeeding Information
• Breast-Feeding Past Infancy ABC News