Deena, you say

>>However, remember that with determination mothers
continue breastfeeding under many circumstances<<

This is true.   The concern I have is this.  If mom HAS to leave her baby, at
a time she is not ready to wean, she will go to enormous efforts to preserve
 her milk, and protect weaning in every way possible.

This, however, is a mom who is CHOOSING to leave her baby.  While we
should not tell her it is impossible to preserve breastfeeding, we would be
 remiss if we did not tell her also that many babies will not go back to the
breast when then they are deprived for a week.   Maintaining milk supply is
only half the battle of continuing breastfeeding.  And doesn't this separation
 come precisely a time when many moms wean because of a perceived
 restlessness/distractability in their babies, which they interpret as baby
not wanting to nurse any more?

I think at different stages babies have different awarenesses of their needs
for the breast.  You talk about how yours came back at 15 months.  Mine
had totally weaned himself at a year, but got quite ill shortly after.  Between
 teething problems, travel/diarrhea and roseola he sought the breast again. I
 think it was much more fore comfort, than for food.  But in fact, for awhile it
was the only food stuffs that didn't come instantly out the other end.  By
the time, he was well again, about two weeks breastfeeding was firmly
reestablished.  But just because we had this wonderful luck with our
babies, doesn't mean that this mom will, and we owe it to give her all the
information.

I think it is really important that we tell this mom the possible sequelae of
leaving her baby, as well as telling her how to maintain her milk supply, and
 pass on some of the tricks of maintaining an infant's memory of mom while
 she is gone, e.g. wearing her bathrobe to feed baby in, or similar
 strategies.  And then hope the baby isn't too mad/bereft to go back to the breast when mom returns.

Chanita, San Francisco



 .-------
From:   Deena R. Zimmerman MD MPH[SMTP:[log in to unmask]]
Sent:   Monday, February 16, 1998 2:19 PM
Subject:        Re: LACTNET Digest - 15 Feb 1998 to 16 Feb 1998 - Special issue

I agree with all the comments on the importance of taking nursing children
with the mother and certainly in a four month old it is difficult to be
away for a long time. However, remember that with determination mothers
continue breastfeeding under many circumstances and we should hesitate to
condemn choices we wouldn't make ourselves. At age 15 months I left my son
for a week thinking that he was weaned and when I came back he went right
back to the breast for another month. What amazed me was despite not
pumping for the week I still had milk (15 months is different than four of
course). While it would be better to take the baby, pumping for a week and
dealing with possible refusal on return is better than weaning. If you tell
this mother that this is completely impossible she may decide to stop totally.

A bit on a tangent, I often hear the advice to working mothers that if away
from your baby you need to pump as frequently as you would nurse. While
this is certainly the ideal,this advice has convinced many a mother that
she cannot pump with her schedule and thus she will stop nursing when she
returns to work. In fact the human body can adjust to all sorts of things
including erratic schedules and nights on call in particular if the mother
just does not believe that artificial substitutes are an option. Once
again, personal experience.


At 08:25 AM 2/16/98 -0500, you wrote:
>Date:     Mon, 16 Feb 1998 08:25:30 -0500
>Reply-To: Lactation Information and Discussion <[log in to unmask]>
>Sender:   Lactation Information and Discussion <[log in to unmask]>
>From:     Automatic digest processor <[log in to unmask]>
>Subject:  LACTNET Digest - 15 Feb 1998 to 16 Feb 1998 - Special issue
>To:       Recipients of LACTNET digests <[log in to unmask]>
>
>There are 12 messages totalling 354 lines in this issue.
>
>Topics in this special issue:
>
>  1. vocal chord
>  2. Iron (2)
>  3. Natural weaning time
>  4. Military bf network
>  5. iron & introducing solids
>  6. Breastmilk Supply for 4mos. old
>  7. Weaning
>  8. autoimmune hemolytic anemia
>  9. Offering to nurse
> 10. away for a week
> 11. breast milk for 4 month old
>
>
>To post a note  to the 1700+ subscribers of  LACTNET, send your note to
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>For further help, write to Lactnet Listmoms at:
>
>Kathleen B. Bruce BSN, IBCLC [log in to unmask]
>Kathleen G. Auerbach Ph.D, IBCLC [log in to unmask]
>Date:    Sun, 15 Feb 1998 12:16:02 -0500
>From:    Anne Merewood <[log in to unmask]>
>Subject: vocal chord
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>Dear Mary
>I'm not sure exactly what a 'paralyzed vocal chord' is. But here is
>experience related to the general area: a good friend had a baby that had a
>laryngal web and made no sound at birth or for the first 10 months of life
>until she underwent major surgery to free up the vocal chords and
>reconstruct part of the airway. Child also had severe stenosis and drs.
>commented later it was amazing she made it out of the delivery room alive.
>The mother breastfed the baby from birth (after the initial panic on
>delivery when everyone thought baby was not crying because she was not
>breathing) and weaned her around 12 months. Up until the surgery the baby
>had a trach but nursed just fine. She was of course high risk for all sorts
>of things including aspiration. But Mom just nursed her normally, only
>taking care not to block the trach during nursing with clothing etc.
>Child is now 2 yrs. 2 months, highly prone still to infections/pneumonia,
>slightly behind on speech but otherwise basically healthy.
>Hope this helps...
>Anne Merewood
>Date:    Mon, 16 Feb 1998 03:55:11 EST
>From:    "Helen M. Woodman" <[log in to unmask]>
>Subject: Iron
>MIME-Version: 1.0
>Content-Type: text/plain; charset=US-ASCII
>Content-Transfer-Encoding: 7bit
>
>Hello David, In a message dated 16/02/98 04:17:37 GMT, you write:
>
><<  In my personal experience after 10 years of doing hematocrits
> (blood counts) on 9 month babies who have basically been exclusively
> breastfed for four to six months and then fed whatever the mother eats
> (rice, peas, callalloo, fish, mango etc. etc) from then on, I have still to
> find a baby who was anaemic >>
>
>Why the need to carry on doing this when you know the result? !!  Having a
>needle stuck into you hurts, hope you always encourage the mother to have a
>breast ready for instant comfort if baby hurts or is frightened.
>
>My kindest regards to you in Trinidad where you are top dogs in Test Match;
>where my bestest, bestest friend comes from; where we plan to go for our 25th
>WA and where my husband is going in a weeks time on work (during Carnival, of
>course) and I can't go, boohoo.  Helen M. Woodman, National Childbirth Trust
>Breastfeeding Counsellor, UK
>Date:    Mon, 16 Feb 1998 03:26:38 -0600
>From:    Kathy Dettwyler <[log in to unmask]>
>Subject: Natural weaning time
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>My research (and I'm the ONLY person, so far, who has done research on this
>topic) indicates that the "natural" age of weaning for humans ranges between
>2.5 years as the absolute minimum, and 7 years as the maximum, with many of
>the indicators falling at the 6-7 year end of the range.  There is no
>scientific evidence to suggest a natural weaning time of 6 months or 9
>months or 16 months or 18 months or even 2 years or 2 years 3 months.  I
>think that many mothers give LOTS of signals to their children, whether
>consciously or unconsciously, that they don't really want to breastfeed any
>more -- giving them more solids than are really appropriate, offering water
>and juice, suggesting that the child wait until the mother is less busy, in
>a less public place, in the mood, etc.  I think it is the rare baby who is
>truly ready to wean, physiologically, before 2 or 2.5 years.  Obviously,
>with plenty of adequate other sources of nutrition, few diseases, and very
>little in-arms time, many children are able to survive and thrive without
>extended breastfeeding.  That doesn't change the underlying physiology, or
>indicate that there is anything "natural" about weaning at 16 months.
>
>Katherine A. Dettwyler, Ph.D.
>Associate Professor of Anthropology and Nutrition
>Texas A&M University
>Author of "A Time to Wean" in the book Breastfeeding: Biocultural
>Perspectives
>Date:    Mon, 16 Feb 1998 01:47:57 -0800
>From:    Debbie Codding <[log in to unmask]>
>Subject: Military bf network
>MIME-Version: 1.0
>Content-Type: text/plain; charset=ISO-8859-1
>Content-Transfer-Encoding: 7bit
>
>Hello everyone,
>        If you work with military families and want to network with same -
a few
>of us are starting a mail group.  Please email me personally because I have
>to go no mail.  (I have to be a good girl and study for the GRE)
>
>Debbie Codding
>[log in to unmask]
>Date:    Mon, 16 Feb 1998 04:08:41 -0700
>From:    Sue Petracek <[log in to unmask]>
>Subject: iron & introducing solids
>MIME-Version: 1.0
>Content-Type: text/plain; charset="US-ASCII"
>
>The discussion on adding iron to a baby's diet and sharing family food
>reminded me of a comment my mother-in-law made. She said in was common
>for a mother to pre-chew food and then give it to the baby. In this way,
>a small bite of meat (for instance) would be tenderized and softened for
>the baby. I think I had heard of that before.
>
>Since meat is a good source of iron, but it is somewhat difficult to make
>palatable for a baby, there is some logic to it.
>
>My question is this: does the mom chewing the food and then transferring
>it to the baby's mouth alter the nutritional value of the food in any way?
>
>Thanks,
>Sue
>
>********************************************************************
>Sue Petracek              * [log in to unmask]
>Bosom Buddies, Inc.       * www.bosombuddies.com
>(888) 860-0041 Toll Free  * Helping mothers breastfeed successfully
>********************************************************************
>Date:    Mon, 16 Feb 1998 07:10:00 -0500
>From:    Patricia Young <[log in to unmask]>
>Subject: Re: Iron
>MIME-Version: 1.0
>Content-Type: text/plain; charset=ISO-8859-1
>Content-Transfer-Encoding: 7bit
>
>We do routine hcts at 6 mo in the inner city.  Most babies are bot fed,
>some BF.  RARE anemia, usually related to prematurity or twins.  More
>anemias at 12 mo hcts, but in US inner city people live on soda, chips and
>fast food!  But still, not really that many.  Only 2 lately have both been
>BF! (I'm so embarrassed)  I know for sure that one of these moms is giving
>solids appropriately.  The other is questionable, but baby has always been
>small, following her own private 12%tile line on chart.  Both had normal 6
>mo hcts.
>I wish inner city people ate better in US, family pot concept sounds great.
> I've taken to giving out good family recipes that make a lot and are easy
>and nourishing!  So sad that so many think all food needs to come out of a
>box!  Sincerely, Pat in SNJ, USA
>Date:    Mon, 16 Feb 1998 06:40:24 -0500
>From:    Patricia Young <[log in to unmask]>
>Subject: Re: Breastmilk Supply for 4mos. old
>MIME-Version: 1.0
>Content-Type: text/plain; charset=ISO-8859-1
>Content-Transfer-Encoding: 7bit
>
>Dear Sharie, I'd tell her How-to and then concentrate on how-can she take
>baby with.  It will probably be the end of nursing otherwise.  Not many 4
>mo old are that forgiving.  Plus I'd sure hate to be the caretaker.  I've
>suggested, in the past, a caretaker to go along with, skip the cruise - you
>have the rest of your life, babies are only babies for such a short time.
>Another point of view is baby's.  Tell her how baby will feel about the
>whole thing.  One time my s-i-l borrowed my oldest for a medical conv.
>They flew in from their respective states to a third state.  Then Kay kept
>the baby and fetched her down to Aunt Peg whenever it was mealtime. (Like
>many moms do at LLL and ILCA conv.)  I've had bridesmaids keep baby in
>church nursery with a helper or in a nearby hotel.  The possibilities are
>endless really.  She just needs to expand her possibilities.  Isn't it a
>shame that these young moms don't have an old mom's perspective? (My
>youngest is 28, soon to be 29 and they're expecting their 2nd - #14
>grandchild for me!)  Another hopeful thing is that as she gets more and
>more tied into the baby she'll realize on her own that this won't work.
>Sincerely, Pat in SNJ
>Date:    Mon, 16 Feb 1998 06:47:32 -0500
>From:    Patricia Young <[log in to unmask]>
>Subject: Re: Weaning
>MIME-Version: 1.0
>Content-Type: text/plain; charset=ISO-8859-1
>Content-Transfer-Encoding: 7bit
>
>Dear Merilee, Over the years I've noticed a sort of natural disinterest
>stage for some babies between 13-15 mo.  Then it seems as if the baby or
>mom doesn't capitalize on it, nursing continues for a long time.  Has
>anyone else noticed any other ages when this seems to happen.  After
>reading "The Vital Touch" I realize that some of this is American
>disconnected-ness to our babies.  We are busy!  Sheller says part of it is
>because we mother all alone, without the helping hands of the extended
>family or the village.  Sincerely, Pat in SNJ
>Date:    Mon, 16 Feb 1998 14:42:32 +0200
>From:    Barry & Yael Wyshogrod <[log in to unmask]>
>Subject: autoimmune hemolytic anemia
>MIME-Version: 1.0
>Content-Type: text/plain; charset=us-ascii
>Content-Transfer-Encoding: 7bit
>
>I am working with a pregnant mom who has autoimmune hemolytic anemia.
>It is well controlled with 5 mg/day prednisone before she was pregnant,
>and 15 mg/day during pregnancy.
>Is there anything about this condition that would effect breastfeeding
>in any way?
>Thanks for any information on this.
>Yael Wyshogrod
>Rehovot,Israel
>Date:    Mon, 16 Feb 1998 12:50:01 +0000
>From:    Lisa <[log in to unmask]>
>Subject: Offering to nurse
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>What could be wrong with offering a one year old breastmilk?  Even if a
>toddler is busy running around doing toddler things, wouldn't a responsible
>person offer them something to eat?  Not force them to eat, but at least
>encourage them.  Should we really only give a toddler food when they ask?
>Human breastmilk is the ideal food for a human child, much better than most
>of the other foods toddlers like.
>
>Not offering at the age of one is an active method of weaning on the
>mother's part, it is not natural weaning.
>
>Lisa Haider
>Date:    Mon, 16 Feb 1998 08:15:15 +0000
>From:    newman <[log in to unmask]>
>Subject: away for a week
>MIME-Version: 1.0
>Content-Type: text/plain; charset=us-ascii
>Content-Transfer-Encoding: 7bit
>
>Does she *really* have to be away for a week?  That's the real question.
>Away for a week even if she is pumping may result in a baby who will not
>take the breast.  But that is not the most important thing.  I cannot
>imagine what cannot be cancelled, delayed, or done with the baby with
>her.  At least suggest it.  Many mothers have such plans and then
>realize that the baby is more important than whatever they were
>planning.
>
>Jack Newman, MD, FRCPC
>Date:    Mon, 16 Feb 1998 08:24:25 EST
>From:    Chris Mulford RN IBCLC <[log in to unmask]>
>Subject: breast milk for 4 month old
>MIME-Version: 1.0
>Content-Type: text/plain; charset=US-ASCII
>Content-Transfer-Encoding: 7bit
>
>To Sharie Aikins:
>Congratulations for your first post on Lactnet!  Now that wasn't so hard, was
>it?
>
>I'll answer your question from a purely theoretical and numerical point of
>view. This mom's baby is 3 weeks old, and she wants to know how much milk
>she'll need to leave for feeds when she goes away from the baby for a week at
>4 months.  Figuring that she has 9 weeks, each 7 days long, before she goes,
>that's 63 days.  Figuring 8 feeds a day for a 7 day week that she'll be away.
>that's 56 feeds.  So if she expresses once a day every day from now until she
>goes away, and saves the milk, she ought to have enough.
>
>I once rented a pump to a mom who was going back to work, and she did just
>that.  Every morning after the first morning feed (when her baby often did
not
>"empty" both breasts anyway), she pumped and froze that milk.  By the time
she
>went back to work she had a nice stash in the freezer.
>
>Expressing at the same time every day should stimulate the breasts to make
>enough for an extra feed at that time every day.
>
>Another theoretical and numerical answer, and one which really doesn't help
>much, is to remember that the average daily milk production for exclusively
>breastfed babies 0-5 months is 750-800 cc (Nutrition during Lactation, p
>81-2), with a range of 450 to 1200.  Hatloy & Oshaug in JHL Dec 1997, report
>global figures ranging from 400 to 961.  The main reason for her to know this
>is not to panic if she does not end up with a quart a day of milk for the
>baby, because the baby probably will not drink that much, although people
>might percieve that her baby needs that much, especially if it's a big baby.
>
>Another theoretical musing...would it make sense to plot the baby's weight on
>a breastfed babies growth chart (not the chart that Ross hands out, natch!)
>and assume that a baby at the 50% percentile for weight would take about the
>mean amount of milk, while a baby at the 25% or the 95% would take a
>correspondingly lower or higher daily amount?  I wonder....
>
>Now, speaking practically, I have three thoughts.  1) Be sure she has a
>reliable means of milk expression, whether that's manual expression or a
pump.
>2) Be sure she understands that she'll have to express milk while she's away
>about as often as the baby nurses.  This requirement will have a major impact
>on whatever she's doing during that week.  If the baby is still nursing at
>night at 4 months, she may need to wake up and express milk at night.  What
>will she be doing and will keeping on "Baby Time" with her breasts fit in
with
>that schedule?  3) Explore with her thoroughly the possibility of taking the
>baby along.  What is she doing for that week?  If it's something that
>absolutely precludes having the baby with her---offhand I can't think what
>that could be if she's not in the diplomatic corps, the military, or
>inspecting a toxic waste dump somewhere---she should think carefully about
>ways to have the baby with her, even if that means bringing an extra person
>along to care for the baby during the day.  Plans we make or agree to before
>we have a baby can look very different after the baby arrives and we have
>fallen in love.
>
>One mom I have never forgotten called me for help with planning a week-long
>trip to Hawai'i that her husband had won for being the best widget
salesman in
>his company.  She planned ahead carefully, wrote a detailed manual for her
>mother in Maine who was to mind the baby (who was around 4 months old) for
>her, pumped gallons of milk, taught her baby to drink from a bottle.  She
flew
>with her baby and her frozen milk to Maine a couple of days before the
trip to
>Hawai'i and spent time seeing that her baby was well settled in with Grandma.
>She called me on the night that she was back in Delaware getting ready for
the
>flight to Honolulu the next day.  She was grieving, mourning, devastated,
>couldn't stop crying.  She missed her baby so much that she couldn't imagine
>how she'd make it through a week without her.  She was angry at her husband
>for wanting to take her away from the baby; she was angry at herself for
>agreeing to go; she was angry with his company for giving him this nice
>"reward" that felt like torture to her.  She knew that, however much fun her
>husband would manage to have in Hawai'i under the circumstances, she would
>have very little.  All in all, this event which is every American's idea of
>the epitome of luxury and class---a trip to Hawai'i---was a bomb for her.
And
>all because no one could stretch their minds enough to see that a 4-month-old
>nursing baby is still physically a part of her mother, and needs to go where
>she goes.  Imagine flying to Hawai'i with a baby that age---the perfect age
>for air travel---and hanging out in a fancy hotel, having your meals
served to
>you and the bed made every day by someone else, walking on the beach or
>strolling around to see the sights with the baby in a sling---it could be a
>perfect vacation.  But, although the mom and I had explored this option, she
>was told flat out that she could not bring the baby, and she had chosen
not to
>push it further.  I think her husband was not keen on bringing the baby with
>them---but he certainly hadn't understood the torture his wife would be going
>through without the baby.  Other options, like declining the prize with
>thanks, or asking for a rain check, or taking someone else---his mother or
>father???---had not been explored.
>
>Another mom who went to Hawai'i for a week when her baby was about a year old
>came back to a baby who refused to nurse---ever again.
>
>So, after you answer her questions and help her see how she can arrange for a
>week away from the baby, please also discuss other options with her.
>
>Peace.  Chris
>