Breastfeeding the High Risk Infant [For Healthcare Professionals]

By, 

Lindsay Sims, BSN, RN, RNC-OB

The mother of a high risk infant is confronted with numerous parenting challenges, not the least of which is the decision about how to nourish her vulnerable newborn. Successful breastfeeding depends on overcoming obstacles posed by infant condition, maternal health, and the neonatal intensive care (NICU) environment. These obstacles include preterm, very preterm infants, and even late preterm infants, hypoglycemia, hyperbilirubinemia (jaundice), multiples (twins/triplets), drug addiction, size issues (SGA or LGA), infections, womb position and birth trauma (torticollis, facial asymmetry), congenital problems and defects (heart conditions, cleft lip/palate, ankyloglossia/tong tie).

We will specifically be discussing the challenges and support of breastfeeding the high risk infant during this blog today. But know that there are many other issues related to breastfeeding the high risk infant, such as maternal health, the NICU environment, and infant contraindications (Galactosemia and amino acidurias such as Phenylketonuria/PKU) that will not be discussed today. These are great topics of research and knowledge if you wish to further educate yourself.

Support and interventions may vary slightly depending on the situation at hand. After a careful assessment is completed and the infant diagnosis is reviewed the healthcare worker can assist the mother and baby to try to achieve a successful breastfeeding relationship.  Things to take into consideration are upmost the wishes of the mother in regards to breastfeeding, her physical and mental condition, the infant’s physical and mental condition and

any contraindications. This will help you form a nursing care plan for the precious dyad you are working with.  You as the healthcare team can protect the mother and baby, provide anticipatory guidance, provide education and believe in miracles!

 In recent years so much information and research has surfaced regarding skin to skin directly after birth and the Golden Hour.  We have all seen it and know the multiple benefits to not only to mother, but baby too. Now think of your high risk baby and the array of things skin to skin could potentially help during the first few hours, days, weeks or months of its life.  Skin to skin supports the natural habitat for the infant and draws many benefits to both mom and baby.  Some important benefits to the high risk infant is bonding, promoting milk production/breastfeeding (increased antibodies in mothers milk), reduces stress hormones, regulates respirations, reduces risk of hypothermia, reduces risk pf hypoglycemia, and helps the infant function optimally/physiologically.  Skin to skin and breastfeeding go hand and hand and help each other per se in aiding a successful first feed. Remember, they also work as preventative medication for the high risk infant.

Breastfeeding promotes many benefits to high risk infants including improved feeding tolerances, better growth and development, improved cognitive outcome (higher IQ), reduced risk of NE, sepsis or any infection, and allergies.  During this difficult time the mother may not be able to provide skin to skin nor breastfeeding directly due to their infant’s condition, but we must support that with an alternative. Two of the ten steps listed in Baby Friendly are to help mothers initiate breastfeeding within one hour of birth and also show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants (this includes hand expression or pumping if needed).   These steps are endorsed and promoted by the major maternal and child health authorities in the United States, including AWHONN, AAP, AAN, and WIC.

The most important thing to consider when caring for the high risk infant is knowing that the baby must be able to suck-swallow-breathe in a coordinated way to take food by mouth. Some of the signs that a baby is getting ready to do this include:

Physical stability. A baby's condition should be stable so the baby can physically handle being held and fed.

Non-nutritive sucking. A baby first displays rhythmic sucking on a pacifier, feeding tube, etc., in brief bursts of more than one suck per second.

Gestational age. At about 32 weeks gestation, a baby will begin to display bursts of sucking and around 34 weeks a rhythmic suck-swallow-breathe pattern develops.

Wakeful state. A baby must remain awake – from drowsy to quiet alert to active – for brief periods in order to feed by mouth.

Oral reflexes. A baby must be able to tolerate touch to the mouth area and demonstrate the reflexes needed for oral feeding. This includes rooting, sucking, cough and gag reflexes.

Breastfeeding is usually less stressful for a high-risk infant because the baby sets the pace.  A baby's heart and respiratory rates, oxygen saturation level and body temperature tend to remain more stable and often improve during breastfeeding. This stability of physical systems means breastfeeding takes less energy and is less work for the high-risk baby.  Of course, a baby must actually latch-on and effectively suck to get milk during breastfeeding. This may take time for a baby to learn. When bottle-feeding, milk drips in the baby's mouth and a baby must swallow it, ready or not.

The stages listed below describe a baby's progression to direct breastfeeding. They are meant only as a guideline, as progress varies among high-risk babies.  A baby might move quickly from one stage to another or skip a stage altogether.  On the other hand, a baby may sometimes seem to get stuck at one stage for a few days or weeks, this is all normal progression for a high risk infant.  Encourage the mother to practice feedings during the early stages of learning to breastfeed. The high-risk baby may not take in much milk during each feeding as it is quite normal for baby to only be practicing the motions.  Neither mom nor baby should ever feel any pressure to perform. As we talked before, during skin-to-skin contact a baby is likely to begin rooting or nuzzling at the breast and may latch-on when held directly near mom. "Empty breast" feeding is when a mother may want to pump before skin-to-skin holding sessions once rooting and nuzzling are noted. Then, the baby can latch-on and practice without being overwhelmed by the let-down of lots of milk at once. Being overwhelmed can affect a baby's physical state, and mom’s mental state. Progressive non-nutritive sucking sessions are when a baby will advance at the breast from latching-on, to sucking in bursts, to occasionally coordinating suck-swallow-breathe.  As the baby shows more ability, you will want to see what he or she can do with more milk in the breast.  Encourage pumping until the let-down flow slows and then offer the breast. This prevents large amounts of milk that often come with let-down from overwhelming the baby, yet leaves plenty of milk in the breast for a feeding.

© Lucidwaters | Dreamstime.com - Mother Breastfeeding Her Newborn Photo

If these milestones or stages are not met or if baby or mother are unable to do skin to skin and breastfeeding in the first hour (as recommended) then the healthcare team must support her with education. This will include hand expression and pumping.  Hand Expression is simple to explain. First wake up the breasts (shake, massage, move them), the use fingers on opposite sides of your areola. Press back toward chest.  Compress fingers toward each other, drawing slightly toward nipple but not sliding skin. Release pressure, relax hand, and repeat several times. Don’t expect anything immediately, this process takes time.  Shift hand to a different position to move milk from other ducts. Collect colostrum on a plastic spoon, then tip into baby’s mouth or collect with dropper. Collect expressed milk into pump funnel or large bowl. These can be labeled and taken to NICU for the baby.  If pumping is a better option or used as alternative, encourage the mother to pump on a scheduled, making sure she gets at minimum of eight pumping’s in a 24-hour period (possibly allowing one 4-5 interval of rest during this 24-hour period).

There is no "one size fits all" method for achieving effective breastfeeding with a high-risk baby. Every baby and situation is unique. Reinforce with the mother to give extra time to learn to breastfeed and let the infant set the pace for learning. Learning to breastfeed effectively is a process that may take days or weeks for premature and many other high-risk babies. However, mom and baby can become a breastfeeding team if they are patient, persistent and maintain a healthy perspective. Every baby and mom deserves the best possible start even if they have special circumstances. 

A Better Approach for the Professional Lactation Consultant

By, Erin Wells, BA, IBCLC, RLC (Owner of Lily Lactation)

As a Lactation Consultant, I have the opportunity to work with many pregnant women and new parents. I have noticed that we, the Lactation Community, are often viewed as extremists who use shame, force, and intellectualism to bully families into breastfeeding their babies’. This is troubling for such an important profession as ours. Have we lost our focus as we promote breastfeeding and, if so, how do we get back?

With a quick internet search using some of the derogatory names, “lactivists” and “lacto-nazis,” I found two stories written by two very different moms both making the same point about their experiences with their lactation consultant. The first was a new mom who thought she had been doing a great job with breastfeeding her newborn and the second was a breast cancer survivor who had a double mastectomy. Blogger Michelle Golberg, a new mom, from slate.com writes, “One of the worst moments of my first year with my first child was a visit from a well-regarded lactation consultant. Until she showed up, I’d been thinking that the whole having-a-newborn thing wasn’t quite as bad as I’d feared. Afterward, I was ashamed, overwhelmed, and unsure I could handle parenthood.” In Goldberg’s blog she explains how the lactation consultant told her that her son’s sucking skills and her milk production were inadequate and that she needed to pump 20 minutes between each feed. She states that because she was vulnerable she obeyed and was left feeling ashamed and overwhelmed. Emily Wax-Thibodeaux, breast cancer survivor, writes in the Chicago Tribune, “As the two of them cuddled afterward, I was in a mood that I can describe only as postpartum elation. That is, until those I jokingly call the ‘breast-feeding Nazis’ came marching in to my room. ’You really should breast-feed,’ the hospital's lactation consultants, aka ‘lactivists’ said. ‘I can't. I had breast cancer,’ I said.”  Further in Wax-Thibodeaux’s article she says that even with being told she didn’t have breasts the lactation consultant still encouraged her to breastfeed stating, “Let’s hope you get some milk.” A patronizing approach, shaming and guilt tripping moms to breastfeed and even sometimes forcing breastfeeding upon an unwilling recipient should never be a part of our support.

© Lucidwaters | Dreamstime.com - Mother Breastfeeding Her Newborn Photo

The Lactation Community should be empowering families to make a well-educated decision about how they will feed their babies. Liz Brooks, a lawyer and IBCLC states on her website lizbrooksibclc.com, “IBCLCs have the essential credential for lactation support! They empower mothers and save babies’ lives.” We encourage breastfeeding but shaming and guilt tripping will only repulse families from breastfeeding      

Additionally, “The Surgeon General’s Call to Action to Support Breastfeeding” should be taken seriously for all Lactation Professionals since it is a “Call to Action to Support Breastfeeding” not to force breastfeeding. The document states, “Women who choose to breastfeed face numerous barriers. Only through the support of family members, communities, clinicians, health care systems, and employers will we be able to make breastfeeding become the easy choice, the default choice.”  Every parent gets to choose how they will feed their baby. We should never force any parent to breastfeed.

How do we support those who choose not to breastfeed? In the Ten Steps to Successful Breastfeeding  FAQs, the question is posed:

“Q. If a mother states her preference to formula-feed her infant, how should the hospital respond?

A. Counseling the infant feeding decision should be both patient-centered and family-centered. If a mother chooses not to breastfeed, we would expect the hospital to explore the mother’s concerns about breastfeeding and offer ways to address them. However, if after being informed of the negative consequences the mother still chooses to formula-feed her infant, a level of respect must be maintained regarding her choice. Once she has given birth, she should be taught how to safely prepare formula, provided the best formula options for her infant and shown how to properly feed her infant. Remember, mom’s often make last minute decisions to breastfeed. Hospital processes should be flexible to allow the mother this option.”

The number one principle for the IBCLC in the IBLCE Code of Professional Conduct Principles is to, “provide services that protect, promote, and support breastfeeding”. Shaming, forcing, and guilt-tripping families to breastfeed is unacceptable as a Lactation Consultant. We are to be professional in our support. Let’s make this time in a family’s life a happy time, full of good memories and nonjudgmental support empowering their decisions.

References:

Goldberg, Michelle. Breast-Feeding Extremists Are Even Worse Than You Thought

Courtney Jung’s Lactivism shows just how dangerous their cause can be. slate.com. Dec. 4, 2015 11:07AM

Wax-Thibodeaux, Emily. “Why I Don’t Breastfeed, If You Must Know.” Chicago Tribune. chicagotribune.com. April 8, 2016

Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women’s Health (US). The Surgeon General’s Call to Action to Support Breastfeeding. ncbinlmnih.gov. Rockville (MD): Office of the Surgeon General (US); 2011.

Ten Steps to Successful Breastfeeding Q&A. 2012 Baby-Friendly USA, Inc. UNICEF. World Health Organization. babyfriendlyusa.org. 1989

IBLCE. Code of Professional Conduct for IBCLCs. iblce.org. November 1, 2011 updated September 2015.

But I should be happy....

By,

Stacie Bingham, CD(DONA), LCCE 

www.staciebingham.com

These are my sad stones. I found them at the beach one day, when I felt the need to venture away from my home and my problems and spend time collecting my thoughts and just feeling free for a while. I had been crying daily, hit by a sadness I couldn’t even explain. It was a terrible time for me, and while I knew I should reach out to a professional for help, everything just felt too overwhelming. With a family of busy children, a nursing baby, and all that was expected of me, I couldn’t fathom finding someone to call from a random list of names, figuring out if my insurance would cover expenses, and taking the time to travel and sit with a therapist, pouring out my sadness…which I already didn’t have the energy to engage. There was just too much I already had to do, and I didn’t have the resources within me to do this for myself.

When I trained as a doula, many years before I ever experienced a perinatal mood disorder, I learned depression in pregnancy is more common than postpartum depression. This surprised me, and it took many years before I heard Birdie Gunyon Meyer, RN, MA, CLC, give the exact numbers: one in five women experience depression while pregnant, and one in seven experience postpartum depression. Dads can be affected as well – one in ten will experience depression before or after their child is born.

In my childbirth classes I often share we have ideas about how life will be after our baby is born. I liken it to a wall of decorative boxes where we have our existing activities and priorities. We expect to contain our new baby in the space we have carved out for him or her. The reality sets in, though, and suddenly we see that “baby space” has exploded, baby puke all over the other boxes – everything smells faintly of sour milk, and we wonder, “Could this be right?”

Up to 80% of women experience Baby Blues. This is a week of very strong emotions, tears, frustration, as we move into the role of being mothers. It is not supposed to last longer than two weeks – at that point, it is possible we have moved into a postpartum mood disorder. What can be confusing, though, is we often tell women to watch out for “depression,” for crying all the time, sadness, not getting out of bed, etc. We don’t often warn women there are other signs of something going on inside, and it may not look anything like depression.

Pregnancy and birth is a time when hormones affect almost everything related to growing, having, and feeding a baby. Hormones affect our bodies, and they can also affect our minds. It makes sense to have emotional changes related to becoming a parent – as our bodies are prepared to grow, birth, and feed our new ones, emotional changes can help us prepare in other ways. There is a saying – worry is the work of pregnancy. Indeed, worrying can move us to action. If we are worried about birth, we can take a childbirth class or hire a doula. If we worry about how our babies will stay warm, we can gather clothes, blankets, a safe place for sleep, etc. Worry can help us be ready.

Many mood disorders are normal feelings that are working overtime. This is where anxiety, panic, or obsessive-compulsive thoughts and actions can appear. That doesn’t always come with crying all day or feeling sad. This can look like worrying something is wrong with your baby; needing to check on your baby while he or she is sleeping, counting baby’s breaths or heartrate, taking baby’s temperature; feeling overwhelmed about all the baby gear you must bring with you to leave the house and choosing, instead, to stay home. When these habits or behaviors interfere with the pastimes you used to enjoy, activities with friends and family, or needed tasks such as grocery shopping, it may be time to let your doctor know and ask for support.

Recently, because this is such a tender topic for me, I have set up a Postpartum Support International chapter for Kern County. PSI is an organization that provides resources for families dealing with mood disorders related to pregnancy and having a baby. Families can call for resources – therapists and groups that can help. They can call for information about mood disorders. They can also call just to talk to someone when they are feeling they need immediate support. If you are a professional who works with mothers and families dealing with perinatal mood disorders, please connect with me so you can be listed within the resource network of PSI of Kern County.

On PSI’s website it says this: “You are not alone. You are not to blame. With help, you will be well.” Reading this statement continues to bring tears to my eyes. It is valuable! We aren’t alone in this. We are not to be blamed. And we can, with help, be well.

I keep my sad stones in my kitchen window, to remember that time. As I picked each one up off the sand, they felt like heavy weights adding to my emotional burden. I held them, wet and cold, and wondered, how will I ever get past the thick fog of confusion that has settled around my brain? I did, though, with help and with patience, to emerge feeling healthy and well on the other side.

I can look at them now for what they are – rocks. They are smooth to the touch, with tiny holes bored in them by sea creatures. Just rocks – nothing more, nothing less. But I remember, also, I was dealing with a real illness, and I don’t want to face that again. They remind me that if I end up there again, there is hope and there is help. And I don’t have to suffer alone.

PSI FAQ: http://www.postpartum.net/learn-more/frequently-asked-questions/

Postpartum Fitness

By, Janelle Webb, MBA, CLE

Getting back to pre-pregnancy weight does not happen right after birth, but it does not need to take the same nine months that the baby was in the womb.  The American Council on Exercise advises the first few weeks after birth should be focused on bonding with the baby and getting the necessary rest that allows mom’s body to heal properly.  As mom chooses to begin exercising during the postpartum period, she should speak with her doctor regarding any medical precautions that she should consider.  The goal of the exercise program should be relaxation and stress management, focusing on adding exercise into the daily routine for physical and mental health benefits other than weight loss. Breastfeeding moms are already burning calories due to the nature of breastfeeding and may need to keep track of their rate of weight loss to ensure they do not lose faster than a pound a week.  Postpartum exercise, like any new exercise program, should be started slowly and with realistic expectations.  Special attention needs to be given to warming up, cooling down, and avoiding pain and excessive fatigue.      

While high-intensity exercise may produce a sour tasting breastmilk because of the lactic acid your body produces, moderate exercise that results in a slightly increased pulse rate and faster breathing but still leaves mom able to talk in short sentences does not affect the quality or taste of the breastmilk.  Breastfeeding before working out will relieve the fullness of the breasts and lessen any soreness that may be felt by mom as she moves. A supportive sports bra will reduce “bounce”, and nursing pads will absorb any leaking breastmilk.  The breasts may taste saltier after exercise which can be reduced by washing with a warm washcloth before the next nursing session or taking a shower.  As with any exercise program, it is important to drink water, especially for nursing moms; drink enough water to avoid feeling thirsty. 

Since babies’ schedules are unpredictable, use “stolen moments” to exercise.  This can include marching in place while holding the baby, taking stroller walks around the block, or walking up and down a flight of stairs for ten minutes at a time.  Even small spurts of exercise can kick start your metabolism, burn calories, and relieve stress.  Get moving with your baby and have fun!

When do you need a breast pump?

By, Sara Steelman, MPH, CLEC

In accordance with the Women’s Health Preventive Guidelines in the Affordable Care Act, non-grandfathered health plans are required to provide breastfeeding support and supplies when needed.   There seems to be mass confusion of when a breast pump is “needed”. Breast pumps, when necessary, serve many purposes! They are especially useful when mother and baby need to be separated for an extended period of time. However, it seems there is a misconception that when you plan to breastfeed, you need a breast pump, end of story. That is simply not the case. Here are some reasons why a mother would need a breast pump:

• Mother and baby will be separated for more than a couple of hours. An example is when a mother goes back to work or school.
• A baby who isn’t nursing well (or at all). Examples include babies who are premature and unable to suck efficiently, babies with cleft palate, and babies with Down syndrome or other medical diagnosis which prevents them from nursing effectively – these infants may be able to nurse, and feeding at the breast should be attempted first.
• A mother who needs to increase her milk supply, or induce lactation for an adopted baby. Feeding frequently at the breast is always the best way to increase milk supply, but occasionally a pump will be needed in between feedings.
• A mother who makes an informed decision to feed her baby expressed milk. If this is the case, it is important to frequently hold your baby skin to skin (the unclothed baby lies on your bare chest). This will increase the mother/baby bond, and aid in the production of milk.

Please keep in mind, you should always consult with your healthcare provider or lactation consultant before deciding to pump your breast milk.

An alternative to a breast pump is hand expression. This method is good for the mother that will be with her baby the majority of the time, and may need to express milk for the occasional separation. This method also works great those first few days of life when small amounts of nutrient-rich colostrum need to be expressed to feed the baby, and for relief from engorgement.

© 2010 La Leche League International, The Womanly Art of Breastfeeding, Chapter 20.

Things to keep in mind while pumping:

1.  Proper storage is important. Follow these guidelines to store your milk: 

   

   Breastfeeding and Returning to Work or School. California Department of Public Health, California WIC Program

2. Nurse often when you are with your baby. This will prevent a drop in milk supply.
3. Talk to a lactation consultant to see if you need a pump, and how to use the pump. The lactation consultant can show you how to fit the flange for the pump, and set up a care plan for pumping and nursing. The hospitals will have lactation consultants to help you while you are in the hospital, and there are many community groups and organizations that can provide support once you leave the hospital. La Leche League and Baby Café Bakersfield are great community resources open to everyone. The Women, Infants, & Children (WIC) program also has lactation consultants, breastfeeding peer counselors, and trained nutrition counselors on staff to provide breastfeeding support.

For a detailed list of all the breastfeeding support available in Kern County, please refer to our resource directory: 

Reviewed and edited by Priya Khullar, RD, IBCLC 1/5/2016

Weaning is not something you do, weaning is something that happens!

By, Julie Huisjen, BS, IBCLC, RLC

How many times have we heard it?  “If you don’t wean your baby, he will never get off the breast!”  “He will be in kindergarten and STILL breastfeeding if you don’t wean him!”  Or maybe you’ve heard even worse: “you’re STILL breastfeeding?!”  “When they are old enough to ask for it, they are too old!”  Or worse still: “Ew!  Gross!”  These negative comments imply that a child is not capable of stopping breastfeeding on his own, it is something we must do to him.

We live in such a confusing culture.  There is so much pressure for new mothers to breastfeed, yet there is not enough support.  Mothers are criticized for not breastfeeding at all, yet if you do breastfeed, you are criticized for breastfeeding too long!  It can seem like you are never doing it right.

Having successfully breastfed and weaned all four of my children, I can assure you that they all do eventually wean.  They may not do it on your timetable or in the way you thought, but they all do outgrow the need and desire to breastfeed on their own. 

Humans are biologically programmed to breastfeed and do so for a time measured in years.  This can be surprising information in our culture, but it is supported by evidence-based information as well as thousands of years of human existence.  Rest assured, you are not doing anything wrong by continuing to meet your child’s needs at your breast into the toddler and preschool+ years.  So what does natural weaning look like?  Or better, what does normal/ biological breastfeeding look like?

Ask any mother who has breastfed past infancy why she does it, and she will likely tell you that it is a great way to calm a fussy toddler, fix a “boo boo,” reconnect at the end of the day, provide superior nutrition and antibodies, get some sleep.  The needs of the child change and breastfeeding remains a constant lighthouse in the stormy sea of life.  Study after study shows that children who have their needs met and have a strong connection to a primary caregiver are more independent later.  Breastfeeding is our primal way to connect with our children.  When allowed, our children are capable of deciding for themselves when their needs have been met, or not.  Learning to trust our children to make these decisions for themselves is one of the greatest gifts breastfeeding can give to us, as mothers. 

A natural weaning will typically occur after two years of age.  The child will gradually reduce breastfeeding, sometimes holding onto the last breastfeeding of the day, or the first one in the morning for quite some time.  Children can continue to nurse once or twice a day, sometimes skipping a day or two, for many weeks or months.  “Don’t offer, don’t refuse” is wonderful advice from La Leche League and allows the child to take the lead.  This is a great time to communicate your desires to your child.  An older child can understand that “we don’t nurse at the park anymore” or “I am busy right now, but we can nurse in five minutes.”  A toddler’s need to breastfeed is not usually as urgent as an infant’s. 

There are two books that I often recommend to mother’s seeking information on weaning.  One is “How Weaning  Happens” by Diane Bengson and the other is “Mothering Your Nursing Toddler” by Norma Jane Bumgarner.  There are great support groups online, and La Leche League meetings are wonderful places to get support in person (and sometimes the only place a mother can feel supported for breastfeeding past our cultural “norm.”)  I have talked to thousands of mothers over the years, including grandmothers.  I have never heard from a grandmother who wishes she wouldn’t have breastfed, but most of them say that they wish they would have breastfed longer.  I tell new mothers, “you can’t breastfeed too much” and this applies to all children, whether they are newborns or toddlers.  If you are a mother who is breastfeeding your child and are conflicted about weaning, seek out support, follow your heart, and trust your child.  It will happen!

Why Exclusively Breastfeed for 6 Months?

By, 
Rochelle Lukehart RNC, IBCLC (San Joaquin Community Hospital)

There has been a resurgence of public awareness in the past 15 years of the benefits of exclusive breastfeeding for 6 months.  The American Academy of Pediatrics recommends it in their policy statement from 2012. They state in the policy that exclusive breastfeeding is the normal standard of infant feeding and nutrition.  They state that there is documentation of the long and short term health and development benefits for the infant.  It is also stated that breastfeeding should be considered a public health issue and recommend exclusive breastfeeding for 6 months and continuing breastfeeding with complementary foods for 1 year and beyond.

A recent La Leche League publication on the “Gold Standard” of infant feeding restates the AAP recommendation,

Babies grow and develop best when exclusively breastfed for six months. Continued breastfeeding with complementary feeding after six months is also important to infant and toddler health. The American Academy of Pediatrics encourages breastfeeding until at least a year with complementary foods after six months, and thereafter, as long as mutually desired. The World Health Organization and UNICEF recommend that breastfeeding should continue after six months with appropriate complementary foods up to two years or beyond.

Interestingly the awareness of benefits of breastfeeding has a long history. In the eighteen century it was viewed differently. The following is an excerpt from Nature's Body: Gender in the Making of Modern Science by Londa Schiebinger,

Mother's milk was considered a miracle fluid which could cure people and give wisdom. The mythical figure Philosophia-Sapientia, the personification of wisdom, suckled philosophers at her breast and by this way they absorbed wisdom and moral virtue.

Pictured below is the “Ten Reasons Why A Mother Should Nurse Her Baby” as written by the New York Bureau of Child Hygiene in 1914. The modern ten reasons may differ from the ones written in 1914 in many ways, however, reason #4 on the list should be considered as a fact today as well.  Reason #5 is also true though the food safety now may be better, artificial baby milk is now and never will be equal to breast milk. There is a misconception in today’s society that breast milk is equal to infant formula, but that is simply not the case. We knew it in 1914, and that has not changed. Breast milk is still far superior to artificial formula. 

Breastfeeding is not always simple and easy at the beginning; many moms need to have assistance.  Help for breastfeeding in Kern County can be found in many ways; here are a few: 

La Leche League: lllofbakersfield@gmail.com

International Lactation Consultant Association: Ilca.org  

Baby Café:  babycafebakersfield@yahoo.com

San Joaquin Community Hospital: (661)869-6438

Clinica Sierra Vista WIC: (661) 862-5422

CAPK WIC: (661) 327-3074

References:

Schiebinger, Londa (1993). Nature's Body. Gender in the Making of Modern Science. Boston: Beacon Press. page 60

AAP policy: Breastfeeding and the Use of Human Milk

La Leche League Media release 2004: Exclusive Breastfeeding: The Gold Standard to be the Theme of World Breastfeeding Week