I have been woefully neglectful of this blog over the past few months. I’ve been looking into a great deal of research, but never quite finding the time to publish it. I have, however, finally been shamed into getting it together by a thread on mumsnet.
Thanks to everyone who has posted comments in the meantime – it’s great to have your feedback/input/suggestions.
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.
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.
Since starting solid food, C had had a remarkably relaxed attitude to breastfeeding: she never gave any indication she actually wanted to do it, but when offered the chance she was always happy to tuck in. This was particularly true when she was ill. Often she would go off solids, but would still be happy to breastfeed frequently, which reassured me she was receiving at least some form of nutrition.
When C was got a particularly nasty cold at around 11 months, I didn’t worry too much about her loss of appetite, assuming that I would be able to top her up with breast milk as usual. Unfortunately, C had other ideas. After a few tentative sucks, she turned her head and pushed me away with a resounding, ‘no!’ Although part of me was delighted at how well she had articulated her refusal, the rest of me was upset, almost alarmed at the suddenness of it. C had never refused to breastfeed before. Certainly, some days she was keener than others, but this outright rejection was completely new. Although the following morning I managed to feed her again when she was half-asleep, it was the only time she nursed in a 24-hour period.
This pattern repeated itself the following day, leaving me frantic with worry. What had happened to put her off? Was it something I’d done? Was it simply her time to wean? How would I know the difference? Obviously if C genuinely did want to wean, I didn’t want to pressure her to carry on breastfeeding, but as stopping was pretty final, I didn’t want to do it unless I was absolutely sure it was what she wanted.
I was shocked at how C’s nursing strike impacted on me emotionally. I was teary, overwrought and pretty much incapable of thinking about anything else. It seemed important to get it into perspective, however, so I eventually pulled myself together enough to consider the issue rationally. One major clue to the source of refusal was staring me in the face: not only was she shunning breast milk, but she was also refusing bottles, and with the exception of yoghurt, pretty much any food or drink. Whilst this was incredibly worrying in some respects, it did point to the fact that the problem may be less to do with breast milk, and more to do with consumption generally. I then started to think about the nature of her illness, and concluded her symptoms were pretty similar to the ones that I had at the time – a runny nose, cough… and a sore throat. I didn’t know whether C’s throat was also sore of course, but if it were, then it would be a pretty convincing reason for not swallowing unless it was absolutely necessary. The cold I was suffering from had left the roof of my mouth pretty tender too, which, if you think about it, could make breastfeeding particularly unappealing.
I continued to offer C feeds, which she would sleepily accept once a day, and after a week or so she was almost back to her normal routine. I can only assume that the strike occurred because of her illness, and now she was feeling better, she was happy to breastfeed again. Although the incident was traumatic in some ways, it did at least leave me confident that if C goes off breastfeeding because she’s ill, it’s something we can get through, and if she’s stopped because she wants to stop… well, that’s something we can get through too. When the time comes for her to genuinely wean herself, I now think I’ll be able to cope with it a little bit better, and simply be happy that she’s growing up and gaining independence.
One of the many healing properties attributed to breast milk is the ability to cure eye infections such as ‘pink eye’ — conjunctivitis — or ‘sticky eye’ — a gooey discharge that often accompanies conjunctival inflammation. Conjunctivitis is a common condition that rarely requires treatment, usually clearing up by itself within a week or two. For newborns, however, it can occasionally be quite serious, so ensuring it is properly treated is very important. For everyone else, it can be irritating and unpleasant, so any way of reducing the length of the infection is naturally welcome. Can breast milk really provide any relief?
A study in a hospital in New Delhi, India, examined the effect that routinely applying colostrum to babies’ eyes had on the likelihood of them developing an eye infection1. On one hospital wing, mothers were asked to put a drop of colostrum in their babies’ eyes three times a day; on another wing, mothers were asked not to apply anything. The infection rate was much lower in the babies who received colostrum: only 3 out of 51 babies in this group (6%) developed an infection, compared to 26 out of 72 in the control group (35%).
At first glance, this seems like a convincing result for colostrum, but a closer examination of the figures indicates this isn’t necessarily the case. The normal neonatal eye infection rate recorded at the hospital was just over 5% – roughly the same as the one recorded in the colostrum group. Rather than infection rates going down in the babies who received colostrum, it seems they went up – considerably – in those who didn’t. This may have occurred because the normal practice of wiping eyes with a sterile swab just after birth was abandoned during the study. Fewer babies in the study group may have got infections simply because their eyes were rinsed, not necessarily because it was with colostrum.
There is other evidence that breast milk could help ease the symptoms of conjunctivitis, however: in vitro tests show that colostrum, and to a much lesser extent mature breast milk, can potentially combat some of the bacteria known to cause neonatal eye infections2,3, and another study provides evidence that it does seem to be an effective treatment for eye infections in young babies4. At a hospital in Spain, babies diagnosed with neonatal sticky eye were treated either with antibiotics or breast milk. Babies treated with breast milk generally recovered much faster: 26 out of 45 (57%) of those receiving milk had recovered after 30 days, compared with 3 out of 20 (15%) of those receiving antibiotics. Whilst this does not provide conclusive evidence that breast milk is the optimal treatment for eye infections in newborns, the study’s results were deemed sufficiently encouraging to switch from antibiotic drops to breast milk at the hospital where it took place.
So does this limited evidence that breast milk can treat some neonatal eye infections mean it can be used to treat infections in older children, or even adults? Whether breast milk would have a beneficial effect is not clear: its antibacterial properties mean that it may help to clear up an infection caused by certain types of bacteria, but not necessarily one resulting from an allergy or a virus. Having said this, there is, of course, no harm in trying the breast milk option. If you’re currently nursing, it’s simple and free, and whilst it may not get rid of the symptoms, it almost certainly won’t make them any worse.
The Truth About Breastfeeding 