Laktation_und_Stillen_2016-3 EN Web p1-10

Lactation & Breastfeeding
Magazine of the European Lactation Consultants Alliance • www.elacta.eu • ISSN 1614-807x
COVER STORY
Long-term Breastfeeding -
Breastfeeding in the Second and Third
Years of Life and Beyond – page 4
COVER STORY
Prosecution of a Long-term
Breastfeeding Mother in
Switzerland – page 11
SCIENCE
Breastfeeding Rate Increases
Slightly Whereas Breastfeeding
Duration Stagnates – page 19
3 • 2016 28 th Volume
Foto: Field exchange 48

2
EDITORIAL
EDITORIAL
Dear members, dear readers,
IMPRINT
Company Information:
ELACTA European Lactation
Consultants Alliance
www.elacta.eu
Email: magazin@elacta.eu
ZVR-Nr.: 708420941
ELACTA president:
Karin Tiktak, IBCLC
president@elacta.eu
It is a pleasure and an honour to write my first editorial for
L&S/L&B.
The moment I´m writing this, my family and I are watching the
Olympic Games. We feel a bit strange: we´ve just arrived back
from our holidays in Brazil and we now see all these events in
Rio. As a lot of you will experience, holiday time is mostly time
for your family life. We had a wonderful journey and saw the
many faces of Brazil. From busy cities to little villages; from the
jungle to the amazing waterfalls; from huge ants to anteaters; from crowds to local
families eating cassava, bananas and coconuts.
Speeding across the Amazon a proud Brazilian mum caught my eye. She was
breastfeeding her 2-year-old in the splashing waters of the boat. During our many
flights (Brazil is huge!) I saw a lot of women breastfeeding. In shops, on the way, in
waiting places, everywhere the babies snuggle up at the breast. And most of them
were not newborns anymore. I felt sympathy, joy and affection towards these
mums. I dared not make pictures of the dyads - I was ashamed to do so - for it is
such a normal, natural and integrated behaviour in their culture. With a smile, my
eyes clicked on “save this memory” in my brain and right now, this is the place to
write it down and share it with you. Now you have to use your own imagination!
I wish you pleasure in reading this issue on topics like among others prolonged
breastfeeding!
Karin Tiktak, IBCLC
President of ELACTA
Editorial and project
coordination:
Eva Bogensperger-Hezel, IBCLC
Email: magazin@elacta.eu
Team:
Andrea Hemmelmayr, IBCLC
Stefanie Frank, IBCLC
Elke Cramer, Ärztin, IBCLC
Kathrin Meier, IBCLC
Bärbel Waldura, IBCLC
Zsuzsa Bauer, Dr. phil
Márta Gúoth-Gumberger, IBCLC
Gudrun von der Ohe, Ärztin,
IBCLC
Translations:
Márta Gúoth Gumberger, IBCLC
Elizabeth Hormann, IBCLC
Annika Cramer
Photos: © as mentioned on the
photos; Coverphoto: iStock
Layout: Christoph Rossmeissl
Production: EinDRUCK
Edition: 2.500
Published quaterly at the end
of March, June, September and
December
Deadline: 15 January, 15 April,
15 July, 15 October
With its articles, Lactation
and Breastfeeding wants to
go beyond expert information
about breastfeeding and also
stimulate discussion. Therefore,
we welcome your views. Please
send Letters to the Editor to
the following email: magazin@
elacta.eu.
The articles published in
Lactation and Breastfeeding
do not necessarily reflect the
opinions of the editors or of
ELACTA. Rather, they are the
author’s own personal views
www.elacta.eu Lactation & Breastfeeding 3 • 2016

CONTENTS
3
© Enzenhofer
© BDL
2 EDITORIAL
4 COVER STORY
Long-term Breastfeeding – Breastfeeding
in the Second and Third Years of Life and
Beyond
Prosecution of a Long-term Breastfeeding
Mother in Switzerland
9 HANDOUT
12 FROM MEMBER ASSOCIATIONS
Questionnaire Breastfeeding
Recommendation in Europe
© Karl Grabherr
16 ELACTA NEWS
Short Report on ELACTA General Assembly
CERPs International Training Course
Meeting of the Presidents
MILK
19 SCIENCE
Breastfeeding Rate Increases Slightly
Whereas Breastfeeding Duration Stagnates
21 PARTNER ASSOCIATIONS
A Roadmap of WABA Actions and
Achievements
22 WORLD BREASTFEEDING WEEK 2016
World Breastfeeding Week 2016
© Andrea Hemmelmayr

4
COVER STORY
Long-term Breastfeeding – Breastfeeding in
the Second and Third Years of Life and Beyond
The expression “long-term breastfeeding” is, in itself, controversial: What does “long” mean in the
context of breastfeeding? Author: Elizabeth Hormann
It begins with the discussion on the
optimal duration of exclusive breastfeeding.
In 2009, following a systematic
review of 3000 studies – including studies
from industrialized countries and
developing nations, among them two
controlled studies – WHO announced
its recommendation for six months of
exclusive breastfeeding for all babies,
world-wide. [1] That should have settled
the issue – but this was not to be. It
was not even two years before The British
Medical Journal (BMJ) published a
commentary which questioned this recommendation.
[2] Commenting on this,
Professor Mary Renfrew, Director of
the Mother and Infant Research Unit,
University of York wrote: “This is not
a report of a systematic review, but a
critique of literature the authors have
chosen to examine. No methodological
details are given either of how they
decided to include studies, or how they
critiqued them in terms of appropriateness
and quality”. [3]
In a press release, the UK’s Baby Milk Action
noted that “Three of the four authors
of the piece, Mary Fewtrell, Alan Lucas and
David Wilson, receive funding from the
baby food industry” and criticized the suggestion
that introducing complementary
foods between four and six months offers
the best protection against celiac disease. [4]
There is evidence that the risk of celiac disease
is reduced in children younger than
two if they are still being breastfed when
dietary gluten is introduced. Continuing to
breastfeed babies after introducing small
amounts of gluten provides even more protection.
[5]
In the German-speaking area, I have
heard the argument that, because mothers
don’t usually breastfeed very long anyway,
a general recommendation to begin complementary
feeding between the beginning
of the 5 th month and the beginning of
the 7 th month (in other words, four to six
months), would make sense so that these
babies could have the advantage of beginning
other foods while they are still breastfeeding.
A golden opportunity to combine
the insights of the celiac disease research
with the case for six months of exclusive
breastfeeding was missed. Unfortunately,
many professional associations and organizations
that had supported the WHO
recommendation in the past, quickly took
over the new recommendations. WHO issued
a statement in 2011 reiterating the
2009 advice. [6] Five years on, opinions are
still divided. Recommendations for the
optimal duration of any breastfeeding are
also – as they have been in the past – still
divided.
So, how long should a mother
breastfeed? What is too long?
And the situation for these mothers can
get even worse. It has only been seven
years since a breastfeeding mother in Germany
was given an eight month suspended
sentence for “sexual abuse”. The mother –
who had arrived from Vietnam only a few
months previously – was still breastfeeding
her 6 year old son and her 8 year old niece a
bit. Certainly unusual in European cultures
– but sexual abuse? [7] International recommendations
and anthropological research
paint a completely different picture.
Quelle: Internet
This picture caused outrage when it appeared
on the cover of Time Magazine. Intentionally
provocative, it did long-term breastfeeding
mothers and babies no favors.
© Time Magazine
International Recommendations
The 1990 Innocenti Declaration stated
that “all women should be enabled to
practice exclusive breastfeeding and all
infants should be fed exclusively on breast
milk from birth to 4 -6 months of age.
Thereafter, children should continue to be
breastfed, while receiving appropriate and
adequate complementary foods, for up
to two years of age or beyond.” [8] Further
studies [9, 10, 11] have shown that six months
exclusive breastfeeding – or sometimes a
bit more – is appropriate for most infants.
Resolutions from the World Health Assembly
[12, 13, 14] and the 2005 revised Innocenti
Declaration have confirmed this. [15]
“Our vision is of an environment that
enables mothers, families and other caregivers
to make informed decisions about
www.elacta.eu Lactation & Breastfeeding 3 • 2016

COVER STORY
5
optimal feeding, which is defined as exclusive
breastfeeding for six months followed
by the introduction of appropriate
complementary feeding and continuation
of breastfeeding for up to two years of
age or beyond.”
This is the international standard. The
regional and national standards and, above
all the practice, often look quite different.
When we look at the weaning curve of
64 developing countries [16] at a time when
only very few commercial or Western influences
disturbed traditional feeding patterns,
we see something quite interesting:
in almost none of these societies were the
babies weaned before the age of one year.
Also, at the age of two years there was
only a small number of children who no
longer received mother’s milk. These figures
increased in the second half of the
third year of life but, nevertheless, one
quarter of the children were still breastfed
up to their third birthday. Most of them
weaned over the next year. A very few waited
until sometime in the fifth year of life to
bid adieu to breastfeeding entirely.
In the comparable curve for the USA,
there were also children who breastfed
for a very long time, but the proportions
are entirely different. The vast majority of
the children were weaned in the first few
months of life. By their first birthday, 90 %
were no longer breastfed.
An expansive answer to the question:
“How did it happen that children wean
so early in industrialized countries compared
to children in other countries of the
world and to children throughout the history
of humankind?” would go beyond the
framework of this article. But a glance at
the scientific basis for continuing breastfeeding
after the first months of life – the
time in which the inferiority of artificial
feeding versus breastfeeding is very well
documented and broadly accepted – gives
some indications of what we could consider
the be “biologically normal”.
Breastfeeding up to one year
From about the middle of the first year of
life, most children show great interest in
what other people are eating. If it isn’t offered
to them, they make their displeasure
very clear. It is an intellectual jump, but
also a reaction to the body’s signal that the
time has come to expand their gastronomic
horizons somewhat. That does not mean
that mother’s milk suddenly has no value
anymore. For the entire first year of life –
and frequently beyond – it still remains the
most important food, is still a source of
high quality calories, protein, vitamins and
minerals. The next six months – or longer
– are a time of getting acquainted during
which solid foods complement but do not
replace mother’s milk.
Immune protection too [17] and support
for the development of the central nervous
system continue and the effects can be
seen during childhood right up into adulthood.
[18, 19, 20, 21]
For formula-fed children, the risk of developing
certain diseases is, by comparison
to breastfed children, even clearer – partially
due to the protective factors in mother’s
milk, provided by Nature.
Proportion
0,5 –
0,4 –
0,3 –
0,2 –
0,1 –
0,0 –
| | | | |
0 1 2 3 4
United States
Traditional Societies
Source: Ford, C.S:
A Comparative
Study of Human
Reproduction. Yale
University Publications
in Anthropology, No. 32,
1945. New Haven,
T: Human Relations
Area Files Press.
Allergies
Children who have been breastfed for less
than six months have more eczema, food
intolerance and respiratory tract allergies.
Protection against these increases with
longer duration of breastfeeding. The authors
of a study [22] which followed children
up to the age of 17 expressed it this way:
“We conclude that breastfeeding is prophylactic
against atopic disease – including
atopic eczema, food allergy, and respiratory
allergy – throughout childhood and adolescence.”
They noted that six months of
breastfeeding are needed to protect against
eczema in the first three years of life and
possibly also against more serious allergies
in puberty.
Respiratory infections and otitis media
Many studies show that the risk for infections
of the respiratory tract increas-
›

6
COVER STORY
› es if the child is breastfed for less than six
months. [23, 24] And not breastfeeding for at
least this long increases the risk of middle
ear infections. [25]
Diabetes
Not breastfeeding increases the risk of diabetes
type 2 (IDDM). This correlation is
dose-dependent both for children and for
[26, 27, 28, 29]
their mothers.
Obesity
The less time a baby is breastfed, the higher
the risk of obesity in childhood. [30]
Childhood Cancer
Breastfeeding for six months reduces the
risk of leukemia in childhood by 19 %. [31]
The high amount of TNF-related apoptosis-inducing
ligands (TRAIL) in colostrum
and mature mother’s milk also act against
other kinds of cancer in childhood. [32]
Malocclusion
The connection between breastfeeding and
normal oral development is not yet completely
clear – partially due to the small
number of subjects and partially due to
confounding factors, such as partial breastfeeding
and the use of pacifiers. Nevertheless,
a recent study [33] has shown that
children who were exclusively breastfed
between 3 and 5.9 months had 41 % less
malocclusion than children who were never
breastfed. Those children who were exclusively
breastfed for six months had 72 %
less malocclusion.
Multiple Sclerosis
There are still very few studies which explore
the effect of breastfeeding on the
development of multiple sclerosis in the
child’s later life. According to one study
from the 1990s [34] there is a two- to threefold
increased risk for multiple sclerosis if
a baby is breastfed for fewer than seven
months (or not at all). Newer research indicates
that breastfeeding for at least four
months halves the risk of MS in later life. [35]
Long-term Breastfeeding is also good
for mothers
For young women and those of middle age,
a shorter breastfeeding duration increases
the risk of developing diabetes 2. For
women who have given birth within the
previous 15 years, every year of breastfeeding
reduces the risk by another 15 %. [36]
A study in China indicates that a mother
who breastfeeds less than six months
compared to a woman who breastfeeds
a child for two years, doubles her risk
of breast cancer. [37] A meta-analysis of
30 countries also confirms that increased
risk. [38] The relative risk of breast cancer
is reduced by 4.3 % for every 12 months a
mother breastfeeds. This study also shows
that the advantages for mothers who have
breastfed for more than two years over
their lifetime were doubled by comparison
to mothers who breastfed for one year.
The risks for ovarian [39] and uterine [40]
cancer for women under 55 who have had
a shorter period of breastfeeding are also
increased.
Breastfeeding in the Second Year of
Life and Beyond
What arguments are there for continuing
breastfeeding after the first birthday? Surprisingly,
there are quite a lot of them. Nutrition,
for example.
Mother’s milk has 70 [41] -75 [42] kilocalories
per 100 ml. These calories can make a
great difference to the toddler’s nutritional
status – especially, but not only, in developing
countries. A classic but still relevant
work in this area [43] cites research to the
effect that, in some areas, children over
18 months who are still breastfeeding in
addition to eating complementary foods,
may have a 17 % higher energy intake than
those who are weaned from the breast. Between
the 6 th and the 24 th month of life, the
amount of breastmilk is about 500 ml per
day and, thus, contains a large proportion
of the calories that a child needs in these
months. Should it be necessary, the milk
production can be increased and a child
who normally eats solids can again, for a
short period, be exclusively nourished by
breastmilk.
Between 12 and 23 months, 448 ml of
mother’s milk covers: [44]
29 % of the energy requirement
43 % of the protein requirement
36 % of the calcium requirement
75 % of the Vitamin A requirement
76 % of the folic acid requirement
94 % of the Vitamin B12 requirement
60 % of the Vitamin C requirement
Bioavailability, Vitamins and Minerals
The calories in mother’s milk are not empty
calories. Mother’s milk remains an important
source of protein, vitamins and other
nutrients – high quality and bioavailable.
How much of a nutrient is in the milk is
not the most interesting question. Rather,
we should be asking: “Is it bioavailable?” It’s
no use if it is only there and the baby cannot
make use of it.
Protein in mother’s milk, for instance
is particularly well-absorbed. In the second
year of life, mother’s milk covers about
29 % of the child’s protein needs. And the
story with vitamins and minerals is even
more gratifying. In the second year of life,
mother’s milk covers three-quarters of the
child’s vitamin A requirements. In developing
countries this can be particularly important.
In Africa, for instance, non-breastfed
children have a six-to-eight fold increased
risk of being afflicted with xerophthalmia
(“dry eyes”), caused by a lack of vitamin
A, compared to breastfed children. [45] This
protection continues throughout the entire
breastfeeding period.
About 43 % of the iron requirement
between one and two years can be met
through the mother’s milk. The iron level
is, indeed, lower in mother’s milk than in
cow’s milk but up to 50 % is absorbed [46]
(4 % of the iron in cow’s milk is absorbed)
so a breastfed child is better supplied with
iron than is a non-breastfed child.
Immune Factors
Immune factors remain important in
the second and third years of life and beyond.
Today it is known that the amount
of immunoglobulin rises after the sixth
month of life, apparently as a reaction to
the declining amount of milk. In a new
article [47] the authors write “Human milk
in the second year postpartum contained
significantly higher concentrations of total
protein, lactoferrin, lysozyme and immunoglobulin
A, than milk bank samples…”
The milk in the second year postpartum
was compared to pooled, unpasteurized
milk samples from 51 approved donors less
than one year postpartum.
When we consider this, it is also quite
logical that some protective factors increase
at this time because children become
quite mobile from about six months. They
go everywhere and put everything in their
mouths. They need as much protection as
we can offer them!
This protection comes about through
various immune factors, among them:
Lysozyme, an unspecific antimicrobial
factor which is concentrated in mother’s
milk reaches its highest level after six
months. [48] 1 ml of mother’s milk contains
around 4000 living cells (predominantly
lymphocytes and macrophages) which hinder
the growth of bacteria, virus, fungi and
parasites.
The bifidus factor in mother’s milk
continues to promote the growth of lactobacillus
bifidus in the child’s intestine
www.elacta.eu Lactation & Breastfeeding 3 • 2016

COVER STORY
7
so that staphylococci cannot proliferate.
Interferon, an anti-virus factor and lactoferrin
which hinders the growth of E. coli,
salmonella, staphylococcus aureus and
some forms of candida, are also in mother’s
milk.
The “natural” weaning age
It is clear from the research that mother’s
milk retains its nutritional and immunological
value as long as it is produced. Nevertheless,
the breastfeeding relationship must
come to an end at some point – but when?
The anthropologist, Katherine Dettwyler,
has attempted to give an approximate
answer to this question through comparative
cultural and primate studies. I will skip
many of the comparisons with other primates
here – although they are very interesting
and persuasive – and mostly consider
the comparative cultural studies. In her
search for a “hominide blueprint” for the
“natural” weaning age, Dettwyler looked at
a variety of criteria:
› The age at which the child quadrupled
his birth weight [49]
› The age at which the child reached ⅓ of
the average adult weight [50]
› By comparison to the gestational time
(6x the number of weeks for a full-term
pregnancy – based on comparative
primate data) [51]
› The age at which the first permanent
molars break through [52]
Using any of these criteria, the earliest
weaning age would be 2.3 years and the
upper limit would be six years for girls and
seven years for boys. Incidentally, the time
when the (human) child’s own immune system
is mature and independent is six years.
Up to this point, Dr. Dettwyler writes, the
lymphokines in mother’s milk can increase
the active immune response – both in the
serum and also in the secretory cells. [53]
Is the idea that mother’s milk could
have a positive effect on the child’s immune
system up to the age of six so extreme?
Actually it’s not. Consider this: The
use of donor milk with older children and
adults as a treatment for various illnesses
has been reported repeatedly.
› Marinkovich [54] (1988) reported treatment
of IgA insufficiency with 100 ml of
fresh mother’s milk daily.
› Merhave and colleagues [55] reported
on treating a liver transplant patient
for IgA insufficiency with 12 ounces
(ca. 340 ml) mother’s milk daily.
› Asquith [56] reported on the use of mother’s
milk during therapy for leukemia
and bone marrow transplantation.
› Young [57] reported on the use of mother’s
milk to provide burned children
with an energy source that is easily
metabolized and, in addition, has immunoglobulins,
bacteriostatic protection
and growth factors for healing wounds
› Wright [58] used fresh mother’s milk for
adults in the first few days after a liver
transplant and
› Wiggins and Arnold reported on a successful
use of donor milk to treat gastroesophageal
reflux in an adult patient. [59]
Is it then so difficult to believe that the milk
of a child’s own mother can serve as an effective
stimulus for the child’s immune
system for a long period of time – even
up to primary school age? But should we
set our recommendation for an appropriate
weaning age so high? Not necessarily.
As La Leche League has long said: “Ideally,
the breastfeeding relationship will continue
until the child has outgrown it.” One
child grows out of the stage earlier, another
one later. And, because breastfeeding is a
partnership, the mother’s needs and wishes
also play a part. We don’t want to issue
new regulations but rather, by looking at
the scientific and anthropological data, create
an expanded vision of a “normal” weaning
age and greater tolerance for mothers
whose breastfeeding practices deviate from
the cultural norm.
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Maria Valentina Abate, Giovanna Ventura,
Erika Rimondi, Paola Secchiero, and
Sergio Demarini. Human Colostrum
and Breast Milk Contain High Levels of
TNF-Related Apoptosis-Inducing Ligand
(TRAIL). Journal of Human Lactation.
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of Dental Malocclusion. Karen Glazer
Peres, Andreia Morales Cascaes, Marco
Aurelio Peres, Flavio Fernando, Demarco,
Iná Silva Santos, Alicia Matijasevich and
Aluisio J. D. Barros, Pediatrics, originally
published online June 15, 2015. DOI:
10.1542/peds.2014-3276
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R. et al. Breastfeeding and multiple
sclerosis. British Medical Journal 1994;
308:1411-1412.
› [35] Breastfeeding is associated with
lower risk for multiple sclerosis. Conradi
S, Malzahn U, Paul F, Quill S, Harms L,
Then Bergh F, Ditzenbach A, Georgi T,
Heuschmann P, Rosche B .Mult Scler.
2012; Sep 4. PMID: 22951352
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WC, Manson JE, Michels KB Duration
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4(20):2601-10.
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reduces breast cancer risk in Shadong
Province, China. American Journal of
Epidemiology 2001; 152 (12):1129-35
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hormonal factors in breast cancer). Breast
cancer and breastfeeding: collaborative
reanalysis of individual data from 47
epidemiological studies in 30 countries…
Lancet 2002; 360: 187-95
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and Colin W Binns, Ovarian cancer risk is
reduced by prolonged lactation: a casecontrol
study in southern China January
2, 2013 Am J Clin Nutr doi: 10.3945/
ajcn.112.044719.
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Collaborative Study of Neoplasia and
Steroid Contraceptives. Int J Epidemiol.
1995;24(3):499–503
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of Food Policy: Report on Health and Social
Subjects 32. Her Majesty's Stationery
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In Alnwick, D. Moses, S., Schmidt, OG, eds.
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and breastfeeding. Pediatric Clinics of
North America, 48 (2), 401-413
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› [50] Ibid. S. 49
› [51] Ibid. S. 52
› [52] Ibid. S. 55
› [53] Ibid, S. 56
› [54] Markinkovich V: IgA deficiency and
allergies. Presentation at the annual
meeting of the Human Milk Banking
Association of North America, San Jose,
CA, September 30, 1988
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deficiency in liver transplant recipients
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8:327-9, 1995
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Clin Perinatol 14:173-85, 1987
› [57] Young VR, Motil KJ, Burke JF. Energy
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Pediatric nutrition. New York: Raven, 1981:
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Raleigh, NC, (USA), March 1, 1996.
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www.elacta.eu Lactation & Breastfeeding 3 • 2016

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Breastfeeding – as Long as We Wish
You have been breastfeeding for 9, 12, 15 months or perhaps for a number of years? You
and your child enjoy it? Congratulations!
Breastfeeding is part of a special relationship
between mother and child. The decision for or
against breastfeeding and/or the timing of weaning
should, ideally, be determined between the mother
and the baby. Perhaps you have already had to defend
this or you have already felt uneasy because of
some comments.
10 Reflections on Breastfeeding
Young Children
The world-wide public health
1 recommendation by the WHO
(WHA 54.2-Resolution of 2001) reads as follows:
“exclusive breastfeeding for six months followed by
the introduction of appropriate complementary feeding
and continuation of breastfeeding for up to two years of
age or beyond”
Breastfeeding young children is normal
2 it represents the species-specific standard for
Homo sapiens. For 99% of human history,
physical closeness and long breastfeeding were “part of
the non-negotiable protective and living conditions for
young children” (Dr. Herbert Renz-Polster)
Mother’s milk remains a valuable food
3 In the second year of life (12 to 23 months),
448 ml of mother’s milk cover 29% of the
child’s daily requirements for energy, 43% of the requirements
for protein, 36% for energy, 75% for vitamin A,
76% for folic acid, 94% for vitamin B12 and 60% for Vitamin
C. Thereby, mother’s milk remains a valuable source
of protein and vitamins and provides valuable minerals
and long-chain polyunsaturated fatty acids, which are
important for the development of the central nervous
system.
Photo: © Karl Grabherr
Mother’s milk supports the young child’s
4 immune response
After the 6 th month of life, the amount of immunoactive
content (immune globulin, lysozyme and
lactoferrin) increases again and may reach concentrations
similar to those in colostrum. All of this is a valuable
support for the young child’s own immune system, which
is still developing.

HANDOUT
Breastfeeding promotes the mother’s
5 health
thereby, the effects of breastfeeding are frequently
dose-dependent. Every year of breastfeeding reduces
the risk of developing breast cancer by 4.3%. The
risk of falling ill with uterine cancer, cervical cancer and
ovarian cancer can also be significantly reduced.
Young children “tank up” on security at
6 their mother’s breast
The instinctive behaviour and the hormones
which mother and child release while breastfeeding, support
the mother-child-bond and promote effective communication
between the two. All of this strengthens the
child’s basic sense of trust.
Breastfeeding during a subsequent
7 pregnancy or tandem breastfeeding
Sometimes a breastfeeding pair is surprised by
a subsequent pregnancy. There are no proven risks for the
mother or the unborn baby if breastfeeding is continued
during a healthy pregnancy. Some mothers complain
about hormone-induced nipple pain and most mothers
notice a decline in the milk production. If the breastfed
baby is still exclusively breastfed, regular weight control
is important. Older children will get the necessary
calories from complementary foods. But it may be that
these children lose interest in breastfeeding during the
pregnancy or the mother decides against continuing breastfeeding.
Even if breastfeeding continues, the milk production
goes through a colostral phase again after birth.
Once the newborn has arrived, the older child can be breastfed
too, provided that the newborn gets the necessary
calories via breastfeeding.
Weaning a young child
8 Breastfeeding is a relationship and, as in every
relationship, both partners have wishes and
needs. It is rare that mother and child want to wean at
the same time. Sometimes the children end breastfeeding
and the mother grieves for it a little. Far more frequently,
however, mothers wish to limit or end breastfeeding. The
planned weaning of an older and self-confident breastfed
child does sometimes require more imagination and certainly
more sensitivity, however, it can also turn out to be
a very positive experience.
Breastfeeding promotes oral health
9 Sucking at the mother’s breast supports the
development of the jaw, promotes the correct
positioning of the teeth and trains the oral muscles. If the
first teeth have broken through, the worry about whether
breastfeeding increases cavities arises. Science does not
provide any clear answers. Possibly, very frequent and, in
particular, night-time breastfeeding can increase the risk
of cavities if there are also other risk factors. With careful
oral hygiene, intact milk teeth can be retained even with
night-time and frequent breastfeeding. Human milk is
low-cariogenic and promotes healthy mouth flora. The
biomechanics of breastfeeding are different than those of
bottle-feeding: When drinking from the bottle, the teeth
have a lot of contact with the milk, while with breastfeeding,
the milk is swallowed directly and scarcely washes
around the teeth.
Young breastfed children also manage
10 without Mama sometimes
As a young child grows older and is already eating
solids, the times when he is cared for without the
mother can be expanded little by little without any need
for final weaning. Thus the mother’s return to work, other
enterprises or visitation arrangements are also possible
with a young breastfed child.
Andrea Hemmelmayr, IBCLC
Photo: © Füreder
CONTACT YOUR IBCLC
IBCLC
International Board Certified Lactation Consultants are the
only internationally approved breastfeeding and lactation
specialists having a medical background.
The decision to breastfeed or not to breastfeed has shortand
long-term impact on the health of child and mother.
However, breastfeeding sometimes turns out to be difficult
and perhaps professional, competent assistance is needed.
www.elacta.eu Lactation & Breastfeeding 3 • 2016