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Breast Feeding

Tandem nursing- how does it work?

03/19/1999

Question:

I am breastfeeding a 15-month old child, and am currently pregnant. I am strongly considering nursing my child through the whole pregnancy and then tandem nursing when the next child arrives. I have discussed this with my doctor and realize it is a personal decision. I am curious if it is possible to have a successful breastfeeding relationship with a toddler and an infant? Are there things I should be doing now to prepare my toddler for the arrival of her sibling? Any input would be appreciated. Thank you

Answer:

Congratulations on your expected baby! When a mother breastfeeds two children of different ages (non-twin siblings), it is called "tandem nursing," and many mothers have had successful tandem breastfeeding relationships. Breastfeeding during pregnancy is considered safe as long as an expectant mother has no risk factors for preterm labor, such as a history of repeated miscarriage, a previous preterm labor, or a current multiple pregnancy. You will want to make sure you are eating a nourishing diet, so you can maintain a normal pregnancy weight gain pattern and have plenty of energy for running after a toddler, as continued milk production does consume some of your calories each day.

Breast milk production often decreases at around the third month of pregnancy, as the fetus's placenta takes over making pregnancy-related hormones and maternal estrogen levels increase. This usually isn't a nutritional problem for a nursling of 15 months, since most toddlers also eat a lot of solid foods. If your daughter's diet still depends on breast milk to a great extent, it will be important to make sure she is getting enough nourishment as your pregnancy progresses.

Child-initiated weaning is fairly common during a mother's pregnancy-in part because of the decreased milk production but also because breast milk apparently changes in taste. Older toddlers have said it tastes "salty," which makes sense because colostrum and preterm milk are higher in sodium than mature breast milk. Sometimes an expectant mother chooses to slowly wean an older child, especially if continued breastfeeding is associated with extreme nipple or breast tenderness, exaggerated nausea, or higher levels of fatigue. They do this by gradually offering other foods and other kinds of attention in place of one breastfeeding at a time. Other mothers feel very comfortable during the pregnancy, and their babies don't seem to mind the changes in milk quantity or taste.

When still breastfeeding at the time of a second baby's arrival, mothers do produce colostrum for the newborn. Since colostrum is so important and the second baby's growth and development depends on breast milk, it is important that the newborn takes priority at the breast. This means the toddler may sometimes have to wait to breastfeed, but toddlers can learn this concept of waiting by 15-18 months as their ability to understand language increases.

It isn't unusual for an older nursling to want to breastfeed more often once a new baby comes home. After all Mother suddenly has a lot more milk, and the older child is in the midst of adjusting to sharing mother with a sibling. Anticipating this possible response, some mothers institute a few flexible "rules" about when, where and/or how long a toddler may breastfeed during their pregnancy, so the child will be used to some restrictions long before the new baby arrives and "competes" for the breast (and Mother's time and attention).

Any tandem feeding plan will work as long as the newborn's nutritional needs are given top priority. Many mothers breastfeed both children for some feedings; other mothers prefer to always breastfeed one at a time. Mothers' feelings about breastfeeding both children may range from very positive to ambivalence to resentment. Mothers often report their feelings fluctuate, especially during the first months when they still are recovering from the birth and everyone in the family is adjusting to having a new family member. Most mothers are positive about the overall experience, but they also say tandem nursing is stressful at times.

For more information and to possibly speak with other mothers about their experiences tandem nursing, contact La Leche League International (LLLI), 1400 N. Meacham Rd., PO Box 4079, Schaumburg, IL 60168-4079; phone: 847/519-7730 or 800-LALECHE; fax: 847/519-0035; email: lllhq@llli.org.

References: Gromada KK (1992). Breastfeeding more than one: Multiples and tandem breastfeeding. NAACOG's (AWHONN) Clinical Issues in Perinatal and Women's Health Nursing, 3(4), 656-666.

Mohrbacher N & Stock J (1997). The breastfeeding answer book (rev. ed., p. 344-352). Schaumburg, IL: LLLI.

All the best to you and your growing family.

Related Resources:

La Leche League

For more information:

Go to the Breast Feeding health topic, where you can:

Response by:

Karen Kerkhoff Gromada, MSN, RN, IBCLC
Adjunct Clinical Instructor
College of Nursing
University of Cincinnati