Dear Jennifer:
I stopped in for a Lactnet visit and noticed your post. I can certainly appreciate your hesitation to consult with health care professionals, given widespread ignorance about biologically normal patterns of breastfeeding in humans. I have a few thoughts on your situation based on my background in clinical psychology as well as in breastfeeding. Though there will likely be much in my comments that you already know as an IBCLC and experienced breastfeeding mother, I hope something is useful to you:
1. Nursing at the age of four or five (and older) is well within the realm of biologically normal for human beings. Health care providers, including mental health care providers, may need education about this. A useful reference might be: Dettwyler, K. A time to wean: The hominid blueprint for the natural age of weaning in modern human populations. Breastfeeding: Biocultural Perspectives. New York: Aldine de Gruyter 1995. Also, Kathy Dettwyler has several commentaries available online related to this subject, including: Extended Breastfeeding Survey (http://www.kathydettwyler.org/detsurvey.htm), How Long Should I Nurse My Baby? (http://www.kathydettwyler.org/dethowlong.htm), and A Natural Age of Weaning (http://www.kathydettwyler.org/detwean.html).
2. In my experience with many breastfeeding mothers, maternal ambivalence about weaning is common and normal. Mixed feelings are part and parcel of making good decisions about important issues. A book that can help mothers sort through their feelings and options (e.g., full, partial, what pace, specific approaches) in regard to weaning is: How Weaning Happens by Diane Bengson (available from La Leche League International www.lalecheleague.org). Talking about feelings and options with someone likely to understand them (an LLL Leader, another IBCLC, an experienced breastfeeding mother who is good at listening) can also be very helpful. Also, as a member of Mothering magazine's website's Expert Panel, I answered a question regarding how to set limits on toddler nursing. While there are many differences between your situation and the one in the question, some of my comments might still apply. That answer can be read at: http://www.mothering.com/experts/mojab-archive.shtml#tandem.
3. It makes sense that children may sometimes experience ambivalence about weaning, too, though they may be less able than adults to express their feelings. Distress about those mixed feelings--or distress about a definite lack of readiness to wean--can manifest in a child's behavior. The behavior may be "ordinary" and expected, such as crying. Or it may be "unusual" and unexpected. For example, I know one three-and-a-half-year-old nursling who began biting his hands when weaning was proceeding too rapidly; when the pace slowed down, he stopped biting his hands. Mothers can experiment with changing the pace or nature of the weaning process to see what happens with their child's behavior. Books that can provide children an opportunity to talk about breastfeeding and weaning include: We Like to Nurse by Chia Martin and Maggie's Weaning by Mary Joan Deutschbein (both available from La Leche League International). Reading such books together may open a door to conversation, providing the chance to talk about feelings in calm and private times and places. Of course, books aren't the only way to open doors to such conversations, but they can be a useful tool.
4. You can practice at home (many times) what you want her to do in public. That way your daughter will have lots of experience actually doing what it is that you want her to do--all in a calm, proactive setting: "Let's imagine we're out at the playground. If you want to nurse, here's what I want you to do.... Let's act it out!" You can switch roles, too, so she experiences being the Mama and sees you doing what you want her to do. Such role-reversals generally yield much laughter on both mother and nurslings part. : ) And, you can find out if there's anything she'd like to contribute to the interaction. Maybe she has some preferences that you can integrate into the role-play--and into real life when you actually are out in public.
5. Breastfeeding is not pathological. Breastfeeding past the cultural norm is not pathological. Natural weaning is not pathological. They are biologically normal, healthy, human processes. For this reason, it does not make sense for breastfeeding or natural weaning to be causing pathology. So, if an unusual symptom occurs (in this case, distress-triggered handwashing), breastfeeding or natural weaning would not be the cause. However, if the pace or nature of the weaning does not match the child's needs, unusual behavior changes may result. See the example of hand-biting above. Experimentation can help a mother figure out if a mismatch is happening.
6. Unusual handwashing behavior is associated with Obsessive-Compulsive Disorder (see http://anxiety.psy.ohio-state.edu/ocd1.htm) and with Pervasive Developmental Disorders (see http://www.autism-biomed.org/dsm-iv.htm) which include Autism, Asperger's Disorder, and Rett's Disorder. A mental health professional can help you evaluate whether your daughter's handwashing behavior is part of a bigger issue. Finding a professional who is knowledgeable (or truly willing to be educated) about the normalcy of breastfeeding and natural weaning can be a challenge. You can ask other breastfeeding mothers, LLL Leaders, and IBCLCs if they have anyone they recommend. You can also interview mental health professionals over the phone, asking questions like "What do you know about breastfeeding/attachment parenting/weaning/etc.?" or "How long do you believe a child should nurse?" How they handle such questions will give you an idea of whether or not you are willing to hire them to serve as a consultant to your family.
7. All things have a context. Any decent evaluation of an unusual behavior should include a consideration of general medical conditions (e.g., behavior changes have been seen in children with food sensitivities and with vaccine reactions) as well as psychosocial and environmental problems (e.g., problems in the primary support group [family], with housing, etc.). Context can affect diagnosis, treatment, and prognosis.
8. It can be scary to contemplate evaluating an unusual behavior in a child. Mothers, of course, don't want anything to be "wrong" in the first place, even when their "gut" is telling them that something isn't quite right. Trying to find a mental health professional knowledgeable about breastfeeding can be challenging and distressing in and of itself. And, in many societies some people attach a stigma to anything related to mental health issues. Hardly anyone would hesitate to evaluate and treat a broken leg. Yet, many people delay or avoid seeking assistance with depression, anxiety, etc. It's OK to feel whatever you are feeling as you go through this. And, it's OK to seek help and support, whether from friends, family members, health care professionals, or support groups. Seeking help is a sign of courage, strength, and wisdom, not of weakness or failure.
(I am currently nomail from Lactnet. So any replies must be carbon copied to my personal email address if I am to read them.)
Best wishes to you and your daughter,
Cynthia
Cynthia Good Mojab, MS clinical psychology, IBCLC, RLC
Ammawell
Website: http://home.comcast.net/~ammawell
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