Breastfeeding and biting

When C was about 2 months old, I exchanged baby-related pleasantries with a lady in a shoe shop. After she had made the standard enquiries — how old was C, what was her name — she asked me whether I was breastfeeding. Although this was a fairly impertinent question, I was still in the midst of 2-hourly feeds, and therefore quite happy to talk to strangers about nursing. She then started telling me about her own grandchild, who was a few months older than C, and teething. I mentioned an acquaintance who’s son had just cut a tooth at three months. ‘That is early,’ she said, ‘and it’ll mean the end of breastfeeding!’

I knew, of course, that it meant nothing of the sort: from a physiological perspective teeth pose no problem at all, and  it is perfectly possible to breastfeed babies who have any number of them. My sister and I were both early teethers, and there was a possibility that C would be too. There was no way I was going to let that stop me from breastfeeding prematurely, and it simply wasn’t something I worried about.

I was right, of course, not to worry about teething and breastfeeding. Unfortunately, that didn’t mean it was going to be quite as trouble-free as I expected. When C’s bottom teeth came through, it was fine — I genuinely couldn’t tell when I was nursing. This is not altogether surprising, as the tongue extends over the bottom teeth during suckling, making biting pretty much impossible. When her top teeth started to appear, she let me know about it, however. Problems ranged from the odd isolated nip, to scraping her teeth along my nipple when she drew it into her mouth, to looking me in the eye and chomping down quite deliberately.

While I could tolerate the first two, the third I found both upsetting and eye-wateringly painful. I also took it personally. I could accept on a rational level that C probably wasn’t trying to hurt me deliberately, but it really didn’t feel like that. Tears and remonstrations followed these early biting episodes, and neither of us was very happy at the end of them.

I searched hard for a scientific perspective on the problem. How common was biting, how long would it last, and most importantly, was there anything I could do about it? Unfortunately, I couldn’t find any research addressing these issues. There were plenty of midwives voicing their thoughts on the issue, but none backing it up with any evidence.

Opinions about the appropriate course of action can be divided roughly into two camps: tell your baby quite clearly not to do it and stop nursing immediately; or pretend it hasn’t happened and carry on. I tried both, and I have no idea which, if either, worked. All I do know, is that after a difficult few weeks of C biting on and off, she finally stopped sinking her teeth in, and hasn’t done it now for several months.

Many mothers find biting understandably difficult to cope with, and view it as a reason to stop breastfeeding, often because it appears to be a deliberate rejection of the breast. I took the view that although this might have been the reason C was doing it, a more likely scenario was that she was ill, tired, irritable, and/or just wanting to try out her freshly-grown teeth. As she’s got older, she indicates that she doesn’t want to feed by pulling away, shaking her head, and in certain extremely cute moments, waving goodbye to me. I’m optimistic that from now on, biting will remain a thing of the past.

Nipple shields and milk yields: an update

In a previous post I questioned the received wisdom that using nipple shields will have a negative impact on your ability to nurse your baby (see nipple shields: always a bad thing?). The post challenged one of the main criticisms made of shields — that they slow milk transfer and may therefore mean your baby is inadequately nourished — on the grounds that most of the studies demonstrating this were conducted a long time ago, and more recent research indicates that this problem does not exist for modern shields1.

The researchers who conducted the study in question concluded that nipple shields do not affect the amount of milk babies consumed in a feed by weighing before them before and after they nursed: when a mother was using a shield, the amount by which her baby had increased in weight at the end of the feed was roughly the same as when she was breastfeeding directly. Whilst this result looks positive for nipple shields, ‘test-weighing’ babies in this way is not without its critics, so one could argue that concluding nipple shields have no effect on milk consumption based solely on this evidence is a little premature.

Since writing the post, a follow-up study has been published, this time looking at the relationship between shield use and infant weight gain over a much longer period2. 54 mothers who used a nipple shield provided by a nurse or lactation consultant in the period just after the birth of their babies were recruited for the study, and completed interviews when their babies were 2 weeks, 1 month and 2 months old. Over time, the proportion of mothers using shields diminished (at 2 weeks,  69% of the mothers were still doing it, at 1 month 48%, and at 2 months 33%) and at each stage the responses of women who were still using the shields were compared with those who weren’t.

The main aim of the study was to determine whether nipple shields had a negative impact on weight gain — if babies whose mothers were still using shields grew more slowly than those whose mothers had stopped, then this could be taken as an indication that medium to long term use of shields was causing a real problem. Happily, there was no difference between the groups: whether a mother used a shield made no difference to her baby’s pattern of weight gain.

There were a few complaints about nipple shields: 8 women thought they caused nipple soreness; 2 found them messy; 2 found them inconvenient and 3 had problems with them falling off. In spite of this, 90% of the mothers in the study said that using the shield was a positive experience, and 67% felt it helped prevent them from giving up breastfeeding.

If you are a mother who relies on a nipple shield to breastfeed, these results make reassuring reading. Although shields appeared to cause difficulties for a few women, these were generally minor, and crucially they concerned practical issues, not the health of their babies. As most women felt that shields helped to prolong the period that they were able to breastfeed, this study ultimately supports the view they could be an important intervention for mothers who are having problems, rather than something that will make them worse.

  1. J Obstet Gynecol Neonatal Nurs. 2006 Mar-Apr;35(2):265-72.
  2. J Clin Nurs. 2009 Nov;18(21):2949-55.
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