Dear Linda,

Here is my experience with a breastfeeding autistic preschooler.  I hope
it can be helpful in this case.

There was a wonderful and very dedicated mother with professional
expereince with special needs children who was my League group. Her son
was diagnosed as PPD at about 2 y.o. and then as autistic at about 3
y.o.  I was in close contact with her as she took her non-speaking son
from specialist to specialist.

THe child nursed very frequently, by any standard.  It was his comfort,
his escape and almost his only source of nutrition. He was a very big
child and spent a lot of time on the breast.   I think that this is
fairly typical of autistic children who take to breadtfeeding.  THese
children make transitions very slowly and they are not on the same
developmental calendar as most children.

In this case, his nursing at age 2 and 3 years and way beyond made the
professionals very uncomfortable.  THeir goal was to shape the cild's
behavior to what they saw as age appropriate behavior and that did not
include nursing. Also they thought that all the nursing was interfering
with his speech development (although, given the diagnosis, that was a
bit farfetched, it seemed to me.)

The county's early intervention team wanted this child to leave MOm at
the age of 2 1/2 years and take a school bus to an early intervention
site where he was get therapy and intervention from 9 AM-4 PM  5 days a
week.  THey wanted him weaned because nursing was something that they
didn't know how to accomodate and they didn't count the interaction as a
positive one.

Eventually, this mother found a psychiatrist who was not only a
recognized expert in the field but also the father of an autistic child.
He backed her up.  She kept her son home and did a Lovaas Program with
him. Not forcing the separate was as important--maybe more
important--than the breastfeeding. Actually, sSHe found that in order to
carry out the program, she needed to limit the breastfeeding to some
extent. THis was ok with her--the constant day and night nursing
something she was ready to limit, although she didn't want to forceably
wean him.

He did transition to other foods, but slowly and he was an very very
picky eater. I think that he went to sippy cups--he couldn't "do"
bottles at all. She watched his output carefully for dehydration, but
mostly it was other calories he needed as he curtailed the breastfeeding
somewhat, not fluids.

Whenever a child has special needs, everything in the parents' parenting
style is put under a microscope.  Specialists want to know every detail
and of course many are uncomfortable with the family bed, prolonged
breastfeeding, etc. For the mother, this just adds to the guilt  and the
feelings of inadequacy.

THere may or may not be valid reasons to get this little girl to take
fluids aside from the breast.  As an LC, you can help the mother
separate out a number of issues:

1.what is "normal" breastfeding and eating behavior for preschoolers who
nurse and how far from the norm is this child's behavior?

2.what does the mother want/need (tandem nursing and having a special
needs child can be stressful--she has  2 babies dependent on her)--is
partially weaning this child important to her?

3.what are the real issues the OT and others are trying to address by
getting her to take fluids other ways?

4.how important are those goals relative to other ones--can this partial
weaning goal be put on hold?

5. what  are the realistic possibilities --if any--for accomplishing the
goal of getting this child to take fluids other ways at this time?

I hope this helps.

Warmly--
Judy Gelman, IBCLC
Washington, DC