Adoptive Breastfeeding Beyond Infancy
Niagara Park NSW Australia
From: LEAVEN, Vol. 40 No. 5, October-November 2004, pp. 99-102.
Not many people know that it is possible to breastfeed newborn adopted babies and fewer still have actually done it. However, many children are adopted well past the newborn stage.
In Australia, where I live, there are no newborn adoptions, so adoptive breastfeeding is an interesting proposition. At what age is it no longer possible to initiate breastfeeding in an adopted child? Some have said six months, others have said a year. What is the real answer? As a researcher in the area of adoptive breastfeeding as well as the mother of a daughter adopted as a toddler, this is a question in which I have both a personal and professional interest.
Delving into the literature as I prepared for the adoption of my daughter, I discovered that very little had been written about initiating breastfeeding beyond the newborn stage. In fact, the only description of breastfeeding an older adopted baby that I could find was Darillyn Starr’s article, "Nursing Julia: My Supreme Challenge," in the 1993 September-October issue of NEW BEGINNINGS, in which she describes how she approached breastfeeding with her daughter who started nursing at one year of age.
After I located Darillyn via the Internet, I asked her lots of questions and enlisted her support as I looked forward to the adoption of my own daughter. As it turned out, following my experience with adoptive breastfeeding, Darillyn and I teamed together to collect the experiences of women who have attempted to breastfeed children adopted as non-newborns for an ongoing research study. The information contained in this article is a summary of what we have discovered thus far.
How Likely Is It That an Adopted Child Will Breastfeed?
This is a very difficult question to answer because there are so many variables. Although it is not often talked about, it is relatively common for adopted children, ranging in age from babies to school aged at placement, to indicate a desire to breastfeed from their new mothers. Some children appear to have a conscious memory of previous breastfeeding experience. In others, the desire may be more deeply rooted in subconscious memory of early life and their relationship with their birth mother (Gribble 2003). In either case, allowing the child to breastfeed is beneficial.
How easily older children will learn to breastfeed depends on their history of past care and their personality. If the child is under nine or 10 months of age and has been well cared for (i.e., excellent foster care since birth), there is a good chance that the child will take to breastfeeding easily.
However, if the child has not been in good care (i.e., institutional care, multiple placements, or hospitalization) or is older than nine or 10 months at placement, there is less likelihood that the child will breastfeed immediately. Such children appear to need time to build a relationship of trust with their new mother in order to be able to tolerate the physical and emotional closeness associated with breastfeeding.
It is also likely that breastfeeding will need to be introduced slowly to an adopted child. A child who is relatively young and has been in "good" institutional care will likely take several weeks. Older children, and those whose care has been poor or who have experienced abuse, may need months, perhaps many months, before they are willing to breastfeed. For some children breastfeeding may not ever be possible.
Strategies for Encouraging Breastfeeding
It is a good idea for mothers to approach the possibility of breastfeeding their older adopted child with the expectation that it may take some time. Nevertheless, it is always worth a try to just offer and see what happens. An initial rejection does not mean that the child will never breastfeed or that the mother should stop gently encouraging the child to breastfeed. There are many different ways that mothers can try to encourage their child to breastfeed, but the most important thing is for them to be both patient and persistent. It is also vital that they do not attempt to force their child to breastfeed; not only will this not work, but it could create an aversion to the breast and make the situation more difficult.
One strategy frequently used to help a baby who is still receiving bottles is to gradually make bottle feeding more like breastfeeding. This might include holding the child in the "breastfeeding position" while they are being bottle-fed (facing toward the mother’s chest), using a slow-flow bottle teat (nipple), changing sides while bottle feeding, and bottle feeding with baby next to the mother’s bare breasts. These simple changes help some babies to be willing to breastfeed. Some mothers have had success with threading the tube of a breastfeeding (nursing) supplementer through a bottle teat or nipple shield. It is then placed over the top of the mother’s nipple so that the child is able to obtain milk from the supplementer. Mothers have also filled a bottle teat with milk and placed it over their nipple. Once the child is used to obtaining milk in this way, the teat or shield can be removed, leading to direct suckling from the breast. It is a good idea to make any changes in feeding when the baby is relaxed and happy. Many mothers find that their baby first latches on when full after a bottle feed or when sleepy. It is very important that mothers make changes slowly as they bring their children to breastfeeding. They also need to be mindful of their children’s past feeding experiences.
Many adoptive families have found that children from orphanages are used to being bottle fed quickly from teats with very large holes. Bottle feeding for those babies, has often been a case of getting the milk in without choking on the fast flow. Changing gradually from fast-flow to medium, and then to slow-flow teats will not only prepare the child for the slower flow of breastfeeding, but may also allow them to recapture what should be a natural pleasure for a baby in sucking for food.
Mothers of children who are no longer bottle feeding at placement sometimes find it helpful to reintroduce bottle feeding as a step toward breastfeeding. Others just offer the child the opportunity to suckle at the breast, perhaps using the methods described earlier (e.g., bottle teat over their own nipple). Children will often start with an occasional quick lick of the nipple, progress to a one-second suck, and gradually build from there to breastfeeding. It is important to remember that something that did not work this week might work next week; anything is worth trying because you never know what might work.
It is important to remember that the intimacy associated with breastfeeding may initially be overwhelming to adopted children. Most progress will be seen when they are feeling secure. Thus, reducing stress for the child is a priority. Another point to take into consideration is that newly adopted children are often very observant as they learn how to live in a different environment, and this can work to the advantage of a mother wishing to breastfeed. It is helpful for mothers to be around breastfeeding couples and to look at pictures of breastfeeding in books so the child can see others breastfeeding. Obtaining video footage or placing a breastfeeding poster in a prominent position in the home may also be helpful. Pointing out the mother and child in breastfeeding couples and making comparisons to their own relationship (i.e., "I’m your mother, you are my baby.") allows children to learn that breastfeeding is normal behavior between mothers and babies. Children adopted at greater than one year of age who have successfully breastfed have almost always been in environments where they have seen a lot of breastfeeding.
An adoptive mother who wishes to breastfeed will find it helpful to concentrate on developing trust and attachment with her child. Breastfeeding is a very intimate act and new adoptive mothers are strangers to their children. It is the transformation from "stranger" to "mother" in a child’s eyes that will enable breastfeeding. Many things can be done to facilitate this, including:
- mother remaining in close physical contact with her child (e.g., cosleeping, co-bathing, and carrying the child in a sling);
- being responsive to the child’s needs;
- playing games with the baby that involve initiating eye contact;
- hand feeding even if the child can feed himself;
- limiting separation and contact with others.
All of these activities are worth doing, not just for the sake of breastfeeding, but because they will also help to develop the attachment relationship, which is vitally important for every child’s long-term well being (Gray 2002). Even mothers whose children didn’t end up breastfeeding have said they felt that working toward breastfeeding was extremely beneficial to their developing relationship, and therefore they have positive feelings about their attempts to breastfeed.
How Breastfeeding Helps Adopted Children
There are a number of reasons why breastfeeding is especially significant for adopted children. Many non-newborns placed for adoption have experienced abuse, neglect, or multiple placements, and have also been institutionalized or hospitalized. In addition, all adopted children have experienced the loss of their birth mother. Such histories can make it difficult for children to develop positive relationships with their new parents (Gray 2002; Hughes 1997). Mothers who have breastfed their adopted children have observed these behaviors:
- prolonged eye contact;
- calming and comfort;
- removal of tension;
- emotional vulnerability;
- an increase in the child’s desire to be with them;
- melding of the child to their body (cuddliness);
- reduction in pain;
- gentle behaviors in older children reminiscent of the actions of young babies (e.g., placement of their fingers in their mother’s mouth, stroking of their mother’s face);
- a softening of their own attitude toward their child;
- feeling more connected to their child (Gribble 2003).
Thus, as the mother provides comfort to her child through her own body, suckling at the breast strengthens the attachment relationship.
Mothers have also found that breastfeeding will help to calm their child when distressed or overwhelmed. Being able to comfort children by breastfeeding them has been highly significant for mothers whose children previously rejected comforting. The breastfeeding of a child who has had a rough time pre-placement is especially meaningful, because breastfeeding provides great closeness between mother and child and requires a high level of trust and acceptance.
Children with difficult histories are at risk of having attachment issues, and therefore often have a great need to be in control of situations. It was this very self-reliance that enabled them to survive prior to adoption. As a result, post-adoption they may try to keep control of relationships with his or her parents (Thomas 2000). However, there is a physical acceptance of the mother when a child breastfeeds and adoptive mothers have also described an associated emotional, spiritual, and intellectual acceptance that they see as part of the healing process for their children.
Mothers have also described how their children use breastfeeding and the related physical closeness to regulate themselves in a similar way to infants who use their mothers as regulators of their emotional life and physiology (Hofer 1994). When children have become disorganized or stressed they seek breastfeeding as a way of connecting with their mothers and centering themselves.
Initiating breastfeeding beyond infancy is not something every mother wants to try. Many mothers who work toward breastfeeding express concern that they may be selfish in trying to "impose" breastfeeding on their children. They can be reassured that breastfeeding is a part of normal development and there is no harm in gently encouraging a child to breastfeed. Moreover, children who initially resist breastfeeding sometimes end up becoming enthusiastic breastfeeders who clearly benefit from it.
In addition, adoption experts often suggest that newly adopted children be given the opportunity to be bottle-fed (an artificial substitute for breastfeeding) at least once a day, regardless of the age of the child (Hopkins-Best 1998). This is because the emotional age of a child may be very different from their chronological age. It is often suggested that the emotional age of a child be gauged by how long he or she has been in his or her adoptive family. Breastfeeding can help nurture the baby inside the older body.
Attempting to breastfeed an older adopted child does not always go as planned. Some mothers wonder if it might be safer for their own emotional health not to even attempt breastfeeding because they may "fail." If breastfeeding is something that a mother wishes to do and she decides not to attempt it, she may find later that she has regrets and wonders what would have happened if she had tried. If a mother decides to try to breastfeed her older adopted child, it is probably a good idea to approach it with the goal of doing the best she can and determine that she will enjoy any amount of success she has along the way. At the same time, she should be prepared to grieve if her desire for breastfeeding is not fully met; loss of the breastfeeding relationship she desired is a very real loss.
LLL Leaders’ Role
La Leche League Leaders have an important role to play in supporting and encouraging mothers who wish to breastfeed their older adopted children. Sharing this article, as well as other adoptive and general breastfeeding information, will be helpful. Professional Liaison Leaders are valuable resources for Leaders who do not yet have sufficient knowledge or experience to assist mothers in the practical aspects of adoptive breastfeeding. However, adoptive mothers need a Leader’s encouragement and support more than anything else. It is likely that many of those working toward breastfeeding will take some time to achieve their goals and they may have no other supporters.
La Leche League Groups can also assist in providing a "breastfeeding culture" for the new mother and child—an environment within which they can both see breastfeeding and where breastfeeding is encouraged. This will greatly increase the likelihood that an older adopted child will breastfeed. La Leche League Groups are also environments that support a style of parenting that promotes child-mother attachment, and hence, breastfeeding. Leaders can encourage adoptive mothers to attend La Leche League meetings and ensure that Group meetings welcome the adoptive mother who may not yet have her child placed or who may be bottle feeding her child. Leaders can also encourage mothers to access other adoptive mothers breastfeeding older adopted children via Internet support groups (Gribble 2001).
For more information:
- La Leche League International Web site: The article, "Nursing Julia: My Supreme Challenge," which inspired the author is available online along with other information on adoptive breastfeeding. Do a general search for adoptive breastfeeding on the homepage at www.lalecheleague.org
- THE BREASTFEEDING ANSWER BOOK : Chapter 15, "Relactation and Induced Lactation," contains helpful information about adoptive breastfeeding.
- Relactation and Adoptive Breastfeeding: This booklet contains the information in this article (and much more). It is written for mothers and can be purchased at www.mothersdirect.com.au/ prod141.htm
- World Health Organization: The WHO provides a booklet on re-lactation at www.who.int/child-adolescent-health/New Publications/NUTRITION/RelactationEN.html
Online support groups
Karleen Gribble is an Australian Breastfeeding Association Community Educator and Adjunct Research Fellow in the School of Nursing, Family and Community Health at the University of Western Sydney. Her research interests focus on adoptive breastfeeding (particularly on breastfeeding of older children and the contribution of breastfeeding to the development of secure attachment in adopted children) and the non-nutritional impact of breastfeeding (including breastfeeding of older children). She is mother to two children: one breastfed, biological child and one child adopted from China, who started breastfeeding at three-and-a-half years old. Special thanks to Norma Ritter, who was the Contributing Editor in the development of this article.
Editor’s Note: This article provides a new perspective on adoptive breastfeeding beyond infancy. While this is not an issue that many LLL Leaders encounter, the information will inform and expand the mind so that Leaders can continue to help and support all mothers who wish to breastfeed their babies.
The information in this article comes from an ongoing study of older adoptive breastfeeding. Leaders who are in contact with mothers who have attempted to breastfeed a child four months or older at placement, whether successfully or not, are invited to let mothers know about the study. For more information contact Karleen Gribble at karleeng at uws.edu.au.
We can only further our understanding of this specialized area of breastfeeding when the experts in older adoptive breastfeeding—the mothers who have done it—share their experiences. So, how old is too old to breastfeed? There is no definitive answer, but the study thus far includes mothers of children from four months to more than three years at placement who have successfully breastfed.
Gray, D.D. Attaching in Adoption. Indianapolis: Perspectives Press, 2002.
Gribble, K. Mother Comfort: The Breastfeeding of Older Adopted Children. International Lactation Consultants Association Conference, Sydney 1-3rd August, 2003.
Gribble, K. Mother-to-mother support via the Internet: a new method for an old model. Breastfeeding Review 2001; 9:13-19.
Hofer, M.A. Early relationships as regulators of infant physiology and behavior. Acta Paediatrica Supplement 1994; 397:9-18.
Hopkins-Best, M. Toddler Adoption: The Weavers Craft. Indianapolis; Perspectives Press, 1998.
Hughes, D. Facilitating Developmental Attachment. New Jersey: Jason Aronson Inc., 1997.
Thomas, N. "Parenting Children with Attachment Disorders," in Handbook of Attachment Interventions, (San Diego: Academic Press, 2000) 67-109.