Barbara asks:
"In your experience, how common is mastitis for moms
of babies 1 1/2-2 yr. who breastfeed very
infrequently, 2-4 times/day?"
I wouldn't say it was common but it does happen. Many
babies are nursing 10-12 times a day at that age; some
are down to 1-2. So why do some mothers experience
plugged ducts and mastitis?
All of the usual reasons apply, and a few more:
Sometimes the change in nursing frequency is more
abrupt than Mom realizes.
The well-known toddler acrobatic nursing.
Sometimes mothers consider night nursing as "one"
nursing even if baby nurses several times. When the
child suddenly sleeps through the night or alone, Mom
thinks of it as just "one" skipped nursing.
Changes in routine make Mom think she's nursing as
often as usual because she's so busy. Toddler
independence tricks Mom because she may be too busy to
notice ineffective, inoften, and/or incomplete
nursing.
Sometimes Mom is more ready to wean than she realizes.
Or says.
Pacifiers. Thumb sucking. Sometimes self-soothing
behavior increases when baby takes off running. (Self
soothers don't scream when baby takes off with
them...)
Sore mouth or throat. Busy toddlers have a lot of
plans for the day and may not react as quickly (or
obviously) to mouth soreness as younger babies who
have fewer items on their little dayplanners.
New and un-improved nursing techniques. While we do
wish to encourage our children's creativity, painful
or uncomfortable nursing techniques beg for mother's
response. Mothers should be alert to mouths lowering
on the nipple, mouths rubbing the skin on one side of
the breast against skin on the other, any technique
that leave the nipple misshaped or ribbed or white,
suspicious use of teeth, and toddlers who attempt to
leave the room still latched. I often remind moms to
get back to basics (wide open etc.) in order to assure
the most effective nursing. I suspect the phenomenon
of creative nursing technique inspired the well-known
"Loving Guidance" school of nursing thought.
Tandem nursing. Mothers nursing two or more sometimes
report the erratic and unpredictable nature of a
sibling's nursing can affect milk supply. (While
older nurslings are famous as Breastfeeding Helpers,
they can also be fickle and uncooperative for reasons
beyond the scope of this post ...)
Diet. For example, some mothers feel dairy products
contribute to their recurrent plugged ducts. They may
avoid dairy the first year for various reasons and
then reintroduce it after the baby turns one and all
is well.
Nursing 2-4 times over a few hours is not the same as
2-4 times over 24 hours. (Sometimes there is a sudden
change in routine which Mom still interprets by
"number" of nursings.)
Mothers often have more milk than they realize, even
if nursing infrequently. Pumps are not always as
effective for mothers of older nurslngs, particularly
if they are new to pumping.
(Personal anecdote: Due to injury, I was forced to
pump temporarily on one side when my daughter was 17
months. Imagine my surprise/horror when I quickly
pumped 17 ounces from one breast.)
All of the reasons above are exasperated by the fact
that Mom feels like a pro at this point and may be
taking routine, position, & the relationship for
granted.
Susan Johnson MFA, IBCLC
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