Προβολές σελίδων τον προηγούμενο μήνα

Τετάρτη, 22 Ιουνίου 2011

sleeping through the night

sleeping through the night

Σάββατο, 18 Ιουνίου 2011

πολλές μαμάδες ρωτούν πόσο πρέπει να κοιμάται το παιδί τους ανάλογα με την ηλικία για να μεγαλώνει σωστά. Έτσι:

νεογνά
16 ώρες /24ωρο
2-3 ώρες/φορά
<6 μηνών
14-16 ώρες ύπνου/24ωρο
6-12 μηνών
13-14 ώρες ύπνου/24ωρο
>12 μηνών
12-14 ώρες ύπνου/24ωρο

πότε το μωρό είναι ετοιμο για στερεές τροφές?

Υπάρχουν σημάδια που μας δείχνουν ότι το μωρό είναι έτοιμο για στερεές τροφές. Αυτό εξαρτάται τόσο από την ωριμότητα του πεπτικού συστήματος του μωρού, όσο και από την αναπτυξιακή ετοιμότητα του. Αν και η ωριμότητα του πεπτικού συστήματος του μωρού δεν είναι κάτι που μπορούμε εύκολα να προσδιορίσουμε, οι έρευνες δείχνουν ότι στους 6 μήνες είναι μια ιδανική ηλικία για την αποφυγή των αλλεργιών και άλλων κινδύνων. Το κάθε μωρό είναι έτοιμο για στερεές τροφές σε διαφορετικές εποχές - η αναπτυξιακή ετοιμότητα του κάθε μωρού για στερεές τροφές δεν μπορεί να προσδιοριστδεί χρησιμοποιώντας ένα ημερολόγιο. Τα περισσότερα μωρά είναι εξελικτικά έτοιμα για στερεές τροφές, κάπου μεταξύ 6 και 8 μηνών.


Σημάδια που δείχνουν το μωρό είναι αναπτυξιακά έτοιμο για εισαγωγή των στερεών τροφών είναι:

1. Να μπορεί να κάθεται καλά χωρίς στήριξη.

2.Να μην έχει το αντανακλαστικό ώθησης της γλώσσας και δεν βγάζει αυτόματα με τη γλώσσα του, τα στερεά από το στόμα του .

3. Να είναι έτοιμο και πρόθυμο να μασάει.

4. Να πιάνει τα αντικείμενα μεταξύ του αντίχειρα και του δείκτη.

5.Να είναι πρόθυμο να συμμετάσχει στο οικογενειακό γεύμα και να προσπαθεί να αρπάξει τα τρόφιμα και να τα βάλει στο στόμα του.

Συχνά αναφέρεται ότι ένα σημάδι ετοιμότητας για στερεές τροφές, είναι όταν το μωρό ζητά να θηλάσει περισσότερο. Αυτό από μόνο του δεν μας δείχνει την ετοιμότητα του βρέφους για στερεές τροφές. Μπορεί απλά να οφείλεται σε ασθένεια, πόνο οδοντοφυΐας, μια αλλαγή στη ρουτίνα ή σε ένα κύμα ανάπτυξης.

Μερικά μωρά μεγαλώνουν μόνο με το μητρικό γάλα και μετά τους 6 μήνες- εφόσον το μωρό συνεχίζει να κερδίσει βάρος και να αναπτύσεται όπως πρέπει,

το γάλα της μαμάς του ικανοποιεί τις ανάγκες του ικανοποιητικά και κάποτε θα την ευγνωμονεί για αυτό!


Αναστασία Kαραθανάση, Παιδίατρος, Σύμβουλος Γαλουχίας IBCLC

Τετάρτη, 15 Ιουνίου 2011

υπνος και μάθηση

Σκεφτήκατε ποτέ ότι μπορείτε να τοποθετήσετε απλά ένα βιβλίο κάτω από το μαξιλάρι σας, και όλες οιπληροφορίες που χρειάζεστε ακριβώς θα μπούν στο μυαλό σας, ενώ κοιμάστε;

Αν και εξακολουθεί να υπάρχει κάποια συζήτηση σχετικά με το ποιά φάση του ύπνου είναι η πιο σημαντική για τη μάθηση των δεξιοτήτων, τα περισσότερα από τα πρόσφατα άρθρα περιοδικών σχετικά με το ρόλο του ύπνου στη μάθηση συμφωνούν σε ένα πράγμα: Η μεταφορά των νέων πληροφοριών και δεξιοτήτων, από την προσωρινή μνήμη στην μακροπρόθεσμη μνήμη, συμβαίνει ενώ κοιμόμαστε. Δεν είναι μόνο αυτό, αλλά ο χρόνος που δαπανάται στον ύπνο επιτρέπει στο μυαλό να βελτιστοποιήσει το πώς και το πού θα αποθηκεύσει τις νέες γνώσεις στον εγκέφαλό και να μπορεί πράγματι να βελτιώσει το επίπεδο των ικανοτήτων σας ενώ κοιμάστε!

μάθηση ΚΑΙ εγκέφαλος!

Ακόμη και ένας υπνάκο - μετά από μια επιτυχημένη μελέτη - θα σας βοηθήσει να διατηρήσετε τη γνώση και τις δεξιότητες που κυριάρχησαν κατά τη διάρκεια της μελέτης και την πρακτική σας, αλλά ένα σταθερό 8 ώρο ύπνου θα βοηθήσει πολύ περισσότερο, δεδομένου ότι μόνο στο SWS, NREM και REM ύπνο κερδίζετε την αβίαστη βελτίωση των δεξιοτήτων σας.

Έτσι, περισσότερος ύπνο, λιγότερο εσπευσμένος και καλύτερα αποτελέσματα σε τεστ ...

Τι περιμένεις;



Κυριακή, 12 Ιουνίου 2011

Πόση ποσότητα φρούτων/λαχανικών πρέπει να τρώνε τα παιδιά μας;


Ο Παγκόσμιος Οργανισμός Υγείας συστήνει την κατανάλωση κατά μέσο όρο 5 μερίδων φρούτων και λαχανικών ημερησίως στην παιδική ηλικία. Βέβαια, ο αριθμός των μερίδων ποικίλει ανάλογα με την ηλικία του παιδιού. Όσο μεγαλώνει, συστήνονται περισσότερες μερίδες.

Συγκριμένα, η ημερήσια κατανάλωση διαμορφώνεται σύμφωνα με την παρακάτω κλίμακα. Για παιδιά:

1-3 χρονών, 2 μερίδες φρούτων και 1 μερίδα λαχανικών

4-8 χρονών, 2 μερίδες φρούτων και 2 μερίδες λαχανικών, και

9-18 ετών, 3 μερίδες λαχανικών και 2 μερίδες φρούτων.

Πηγή: Αμερικανικός Καρδιολογικός Σύλλογος

Tι εννοούμε όμως με την έννοια, «Μερίδα»;

Μερικά παραδείγματα μερίδας φρούτων (ενδεικτικά*):

Ένα μικρό μήλο, αχλάδι, πορτοκάλι, μπανάνα ή ροδάκινο

12 ρώγες σταφυλιού

5-6 μέτριες φράουλες ή 3 μεγάλες

Ένα μικρό ποτήρι χυμού (χωρίς προσθήκη ζάχαρης)

2-3 κουταλιές κομπόστα

2 κουταλιές της σούπας σταφίδες

3 αποξηραμένα βερίκοκα, δαμάσκηνα ή σύκα

Μερικά παραδείγματα μερίδας λαχανικών (ενδεικτικά*):

2 κουταλιές αρακάς, φασόλια χάντρες ή καλαμπόκι

2 κομμάτια μπρόκολο

1 καρότο

1 μικρή ντομάτα ή 4 μικρά ντοματάκια

7-8 φέτες αγγουριού ή ένα μικρό αγγουράκι

Για περισσότερες πληροφορίες και επιλογές απευθυνθείτε στο διατροφολόγο σας.

Πως μπορούμε να εντάξουμε στη διατροφή των παιδιών τα φρούτα/λαχανικά αποτελεσματικά;

Παρά τη γνωστή ωφελιμότητά τους για την υγεία των παιδιών, μελέτες δείχνουν ότι πολλά παιδιά στις ΗΠΑ αλλά και στην Ευρώπη δεν καταφέρνουν να φτάσουν τις διατροφικές συστάσεις όσον αφορά τα τρόφιμα αυτά. Οι γονείς αλλά και οι υπεύθυνοι φροντίδας παιδιών θα πρέπει να χρησιμοποιούν στρατηγικές οι οποίες θα βοηθήσουν στην αύξηση πρόσληψής τους και στην ενίσχυση υγιεινών διατροφικών συνηθειών μακροπρόθεσμα.

Μελέτες που εξετάζουν στρατηγικές ένταξης φρούτων και λαχανικών στο παιδικό διαιτολόγιο.

Πρόσφατη έρευνα στο Πανεπιστήμιο της Πενσυλβάνια από τον Kral et al.(2010) σε παιδιά 5 και 6 χρονών μελέτησε πως επηρεάστηκε η πρόσληψη φρούτων και λαχανικών χρησιμοποιώντας τα ως συνοδευτικά πιάτα σε ένα κυρίως γεύμα. Τα αποτελέσματα της έρευνας έδειξαν ότι διπλασιάζοντας το μέγεθος της μερίδας φρούτων και λαχανικών, τα παιδιά αύξησαν την πρόσληψή τους σε φρούτα, αλλά όχι στα λαχανικά, μειώνοντας παράλληλα την πρόσληψη του κυρίως γεύματος. Τα φρούτα είναι περισσότερο αποδεκτά από τα παιδιά, λόγω της γλυκύτητας και της εύκολης διαθεσιμότητας τους.

Επακόλουθη έρευνα από τον Mathias et al. (2009), έδειξε ότι όταν στα παιδιά σερβίρονταν βρασμένα λαχανικά με βούτυρο και αλάτι, αυξήθηκε η πρόσληψη λαχανικών όταν διπλασιάστηκαν οι μερίδες. Τριπλασιάζοντας όμως την ποσότητα των λαχανικών, δεν παρουσιάστηκε καμία διαφορά στην πρόσληψη τους από τα παιδιά σε σχέση με το διπλασιασμό της μερίδας.

Συμπερασματικά, διαπιστώνουμε ότι είναι σημαντικό να διαπαιδαγωγήσουμε τα παιδιά μας να συμπεριλαμβάνουν τα φρούτα και τα λαχανικά στο καθημερινό τους διαιτολόγιο, χρησιμοποιώντας στρατηγικές, όπως για παράδειγμα τα ροφήματα φρούτων και λαχανικών, που θα βοηθήσουν στην αύξηση της πρόσληψής τους. Θα πρέπει να κατανοήσουν ότι τα λαχανικά και τα φρούτα θα πρέπει να αποτελούν συνοδευτικά πιάτα όλων των βασικών γευμάτων, παράλληλα όμως καλό είναι να μην ξεπερνούν τις συνιστώμενες ημερήσιες προσλήψεις ανάλογα με την ηλικία του παιδιού.

Γράφει η Φωτεινή Χανιωτάκη, Διαιτολόγος - Διατροφολόγος, MSc

Τρίτη, 7 Ιουνίου 2011

Εspecially for Partners




By choosing breastfeeding for your baby, you and your partner have made a very important decision, for both yourselves and your baby.

Breastfeeding is important

* Breastfeeding is important.
Human milk is the natural food for human babies. It is always available, safe from germs and easy to digest. For the first 6 months, babies do not need anything else to eat or drink if they can have breastmilk whenever they are hungry or thirsty.

After you start giving your baby family foods, breastmilk is still a very important part of the diet.

Breastmilk changes as your baby grows and is always just right for each stage of development.

* Protection for your baby
Babies who are not breastfed are more likely to have allergies. This is the case whether the artificial baby milk is based on soy, cows' or goats' milk.

* The best medicine
Babies who have artificial milk formulas get sick more often. Human milk helps to protect babies from sickness. If they do get sick, it isn't usually as bad. This means fewer trips to doctors or hospitals when your baby is breastfed.

* An insurance policy
Breastfeeding protects against many illnesses that develop later in life, even after baby has weaned. Breastfeeding also helps baby's speech, sight and face muscles develop properly.

* Brain food
Breastmilk has the perfect balance of ingredients to make sure your baby has good brain development. Artificial milks are very different and research shows that artificially-fed babies may have a lower IQ.

* Cheap and convenient
Breastmilk is always there for your baby. It's always the right mix and the right temperature. The money you save not needing to buy artificial baby milk and equipment in just 1 year could buy you a major household appliance.

* Good for mothers too
Breastfeeding helps a woman's body get back to normal. Women who do not breastfeed have higher risks for breast and ovarian cancer, osteoporosis and heart disease later in life.

* Portable babies
Breastfed babies are easy to take out. There is no need to carry special equipment or find places to warm bottles. Babies can be breastfed anywhere anytime.

* Great for the planet
Breastfeeding is 'environmentally friendly': no waste, no chemicals, no bushland cleared for cow pastures, no factories, packaging, transport costs or excess energy used. Mums just need to eat a normal, healthy diet.


Your role as a new parent

Father and son's* Hands-on parenting
You may think breastfeeding means you will spend less time with your baby, but feeding is only a small part of being a parent. Bathing, nappy changing, massage, cuddling to sleep and playing are great ways to get to know your new baby. While your baby is feeding, you can sit and chat to your partner or help with meals for the rest of the family, care for your other children or do things that you need to do. When it's not feed time, you can enjoy special times with your baby. It's important that baby learns that love can also come without food.

* Changes and challenges
Pregnancy and breastfeeding change a woman's body. It can be exciting and also worrying at times. However these changes and these feelings are usually normal. Your partner may need reassurance that her body can do what it needs to do to grow and feed this baby.

* A learning experience
Mothers and babies both need to learn to breastfeed. Sometimes it takes a little time to work well. If baby has a good birth and is healthy, then breastfeeding often has an easier start. You may not be able to learn the skills of breastfeeding, but you can help your partner to learn how breastfeeding works. You can read books and ABA booklets together, and go to breastfeeding education classes before your baby is born.

Going to Australian Breastfeeding Association get-togethers is a good idea too, as you can meet other families in the area who have babies and young children.

Breastfeeding is like any new skill, it gets easier once you know how to do it. At first, you need lots of support and then it becomes much easier. You can help by getting her a pillow if she seems uncomfortable, making sure she has a drink of water handy and being available to chat.

In the first few days, baby needs to breastfeed often. Every 2 hours is normal. Some babies may be tired from the birth, some may still be feeling the effects of drugs given to their mother in labour or not seem very hungry, but it is good for them to have lots of 'practice feeds' at the breast. This will also make sure that plenty of milk is produced and help to stop the breasts from becoming too full and uncomfortable.

Put baby against mother's chest, skin-to-skin. This keeps baby warm and helps trigger baby's instinct to breastfeed. The first few weeks after baby is born can mean lots of waking during the night. There may be even times when breastfeeding or even parenting seems too hard. It's normal to feel like this some times. Remind each other that it will be easier once you learn more about your baby and remember that you can always ask for help. Things will get better. ABA's breastfeeding counsellors can help to sort out feeding problems and family or friends can sometimes help if you are feeling stressed in other ways. It's OK to ignore the housework, buy some takeaway meals or just take some time out to go for a walk with your baby and your partner or even by yourself.


Some concerns?

* Going out
Mothers can breastfeed their babies anywhere they can legally be. However some mums or their partners are uncomfortable with the idea that other people may be looking at the mother's breasts while she is feeding. Tops that lift up show less skin than ones that need to be unbuttoned. Layering singlet tops and shirts can also give more cover. Look on the Mothers Direct website for special tops that make breastfeeding in public easy and comfortable. A wrap or shawl can also help to keep mum and baby covered or warm. You can practise at home, sitting on chairs as if it was a café, or garden seats for outdoor venues. Soon breastfeeding while you are out will be easy. Most people don't even notice that baby is being fed. They just see a mum holding her baby close. For mums who prefer extra privacy or babies who have special feeding needs, there are parents' rooms available in most cities and towns where you can feed and change your baby.

* Tall tales
There are many strange ideas around about breastfeeding. Most of them come from when not much was known about why breastfeeding is important. Many of these seem to be about what foods a mother needs to eat. Remember that mothers all around the world breastfeed their babies and they have very different diets. When you have a question, ask someone who has successfully breastfed their own baby. When you ring our Helpline or look at our website, it helps to know that all Australian Breastfeeding Association counsellors have breastfed at least one baby for at least 6 months, are trained to help mothers to breastfeed and have access to the most recent research findings.

* Back to work
Many mothers keep breastfeeding even when they go back to work. Most women feel worried about leaving their babies, and are happy to know that they can keep breastfeeding. Babies in child care who don't get any breastmilk get sick more often, so breastfeeding helps mothers and babies. ABA has lots of helpful information about paid work and breastfeeding, and expressing and storing breastmilk in our books, booklets and our website. Also visit the Breastfeeding Friendly Workplace Accreditation website.

* Support
Let your partner know that she has your support for breastfeeding. Tell other people too. By supporting her, your families and friends will know that breastfeeding is important for your baby and your partner. Mothers have fewer problems breastfeeding when their partners know how important breastmilk is for babies. If you encourage your partner to go to Australian Breastfeeding Association group meetings or get-togethers, she will meet other mothers from your local area who also have young children. Meeting other families in your area gives all of you extra support and friendship.


A sensual experience

* Not tonight
A woman's body goes through many changes when she is pregnant and then gives birth to a baby. These can make some women lose interest in sex for a while. This happens to both breastfeeding and bottle-feeding women. Childbirth affects women's sex lives more than breastfeeding does. Some mothers also feel contractions in their uterus when they are breastfeeding their babies. This is because of the hormones that cause your milk to let down. This can be arousing and worries some women. It is a normal hormonal reaction.

* When will we have sex again?
Not all women are ready for sex at the same time after birth. Some women won't want sex because of soreness or extreme tiredness caused by a difficult birth and lack of sleep. Some women say that the emotional and physical effort of looking after a baby makes them feel 'all touched out' by the end of a day.

After their baby is born, some women experience dryness in the vagina, but this is easily overcome by using lubricating products available at supermarkets or pharmacies. A woman needs her partner to be patient and sensitive as she recovers from the birth experience and gains confidence in breastfeeding and as a mother. Sharing the care of your new baby is a loving act too.

* Birth Control
Breastfeeding delays the return of a woman's periods and is the basis of one type of birth control (called the Lactational Amenorrhoea Method). There are other contraceptive options available. A discussion with your doctor or family planning clinic either before the birth or soon after is a good idea to help you choose the method that's best for you both.


Time Flies

Parenting a new baby can be tiring and challenging, but it is also a very exciting time in your lives and it will soon be past. Enjoy it! Don't forget to take time to just cuddle your baby and discover what a precious and unique little person you have brought into the world. You'll need to look after each other as well. You both need a good balanced diet to help you cope with the extra demands that the work of caring for your baby and interrupted sleep can make on your body. A few easy, healthy snacks can help when you're busy. Fresh fruit, cheese and nuts are better than cakes.

Good Luck, and happy parenting.


πηγή:Australian Breastfeeding Association

Watch Your Language!

The Language of Breastfeeding


Watch Your Language!
By Diane Wiessinger, MS, IBCLC
(Reprinted from the Journal of Human Lactation, Vol. 12, No. 1, 1996)

"The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. These are difficult words, but they have an appropriate place in our vocabulary."

The lactation consultant says, "You have the best chance to provide your baby with the best possible start in life, through the special bond of breastfeeding. The wonderful advantages to you and your baby will last a lifetime." And then the mother bottlefeeds. Why?

In part because that sales pitch could just as easily have come from a commercial baby milk pamphlet. When our phrasing and that of the baby milk industry are interchangeable, one of us is going about it wrong...and it probably isn't the multinationals. Here is some of the language that I think subverts our good intentions every time we use it.

Best possible, ideal, optimal, perfect. Are you the best possible parent? Is your home life ideal? Do you provide optimal meals? Of course not. Those are admirable goals, not minimum standards. Let's rephrase. Is your parenting inadequate? Is your home life subnormal? Do you provide deficient meals? Now it hurts. You may not expect to be far above normal, but you certainly don't want to be below normal.

When we (and the artificial milk manufacturers) say that breastfeeding is the best possible way to feed babies because it provides their ideal food, perfectly balanced for optimal infant nutrition, the logical response is, "So what?" Our own experience tells us that optimal is not necessary. Normal is fine, and implied in this language is the absolute normalcy--and thus safety and adequacy--of artificial feeding. The truth is, breastfeeding is nothing more than normal. Artificial feeding, which is neither the same nor superior, is therefore deficient, incomplete, and inferior. Those are difficult words, but they have an appropriate place in our vocabulary.

Advantages. When we talk about the advantages of breastfeeding--the "lower rates" of cancer, the "reduced risk" of allergies, the "enhanced" bonding, the "stronger" immune system--we reinforce bottlefeeding yet again as the accepted, acceptable norm.

Health comparisons use a biological, not cultural, norm, whether the deviation is harmful or helpful. Smokers have higher rates of illness; increasing prenatal folic acid may reduce fetal defects. Because breastfeeding is the biological norm, breastfed babies are not "healthier;" artificially-fed babies are ill more often and more seriously. Breastfed babies do not "smell better;" artificial feeding results in an abnormal and unpleasant odor that reflects problems in an infant's gut. We cannot expect to create a breastfeeding culture if we do not insist on a breastfeeding model of health in both our language and our literature.

We must not let inverted phrasing by the media and by our peers go unchallenged. When we fail to describe the hazards of artificial feeding, we deprive mothers of crucial decision-making information. The mother having difficulty with breastfeeding may not seek help just to achieve a "special bonus;" but she may clamor for help if she knows how much she and her baby stand to lose. She is less likely to use artificial milk just "to get him used to a bottle" if she knows that the contents of that bottle cause harm.

Nowhere is the comfortable illusion of bottlefed normalcy more carefully preserved than in discussions of cognitive development. When I ask groups of health professionals if they are familiar with the study on parental smoking and IQ (1), someone always tells me that the children of smoking mothers had "lower IQs." When I ask about the study of premature infants fed either human milk or artificial milk (2), someone always knows that the breastmilk-fed babies were "smarter." I have never seen either study presented any other way by the media--or even by the authors themselves. Even health professionals are shocked when I rephrase the results using breastfeeding as the norm: the artificially-fed children, like children of smokers, had lower IQs.

Inverting reality becomes even more misleading when we use percentages, because the numbers change depending on what we choose as our standard. If B is 3/4 of A, then a is 4/3 of B. Choose A as the standard, and B is 25% less. Choose B as the standard, and A is 33 1/3% more. Thus, if an item costing 100 units is put on sale for "25% less,"the price becomes 75. When the sale is over, and the item is marked back up, it must be marked up 33 1/3% to get the price up to 100. Those same figures appear in a recent study (3), which found a "25% decrease" in breast cancer rates among women who were breastfed as infants. Restated using breastfed health as the norm, there was a 33-1/3% increase in breast cancer rates among women who were artificially fed. Imagine the different impact those two statements would have on the public.

Special. "Breastfeeding is a special relationship." "Set up a special nursing corner." In or family, special meals take extra time. Special occasions mean extra work. Special is nice, but it is complicated, it is not an ongoing part of life, and it is not something we want to do very often. For most women, nursing must fit easily into a busy life--and, of course, it does. "Special" is weaning advice, not breastfeeding advice.

Breastfeeding is best; artificial milk is second best. Not according to the World Health Organization. Its hierarchy is: 1) breastfeeding; 2) the mother's own milk expressed and given to her child some other way; 3) the milk of another human mother; and 4) artificial milk feeds (4). We need to keep this clear in our own minds and make it clear to others. "The next best thing to mother herself" comes from a breast, not from a can. The free sample perched so enticingly on the shelf at the doctor's office is only the fourth best solution to breastfeeding problems.

There is a need for standard formula in some situations. Only because we do not have human milk banks. The person who needs additional blood does not turn to a fourth-rate substitute; there are blood banks that provide human blood for human beings. He does not need to have a special illness to qualify. All he needs is a personal shortage of blood. Yet only those infants who cannot tolerate fourth best are privileged enough to receive third best. I wonder what will happen when a relatively inexpensive commercial blood is designed that carries a substantially higher health risk than donor blood. Who will be considered unimportant enough to receive it? When we find ourselves using artificial milk with a client, let's remind her and her health care providers that banked human milk ought to be available. Milk banks are more likely to become part of our culture if they first become part of our language.

We do not want to make bottlefeeding mothers feel guilty. Guilt is a concept that many women embrace automatically, even when they know that circumstances are truly beyond their control. (My mother has been known to apologize for the weather.)

Women's (nearly) automatic assumption of guilt is evident in their responses to this scenario: Suppose you have taken a class in aerodynamics. You have also seen pilots fly planes. Now, imagine that you are the passenger in a two-seat plane. The pilot has a heart attack, and it is up to you to fly the plane. You crash. Do you feel guilty?

The males I asked responded, "No. Knowing about aerodynamics doesn't mean you can fly an airplane." "No, because I would have done my best." "No. I might feel really bad about the plane and pilot, but I wouldn't feel guilty." "No. Planes are complicated to fly, even if you've seen someone do it."

What did the females say? "I wouldn't feel guilty about the plane, but I might about the pilot because there was a slight chance that I could have managed to land that plane." "Yes, because I'm very hard on myself about my mistakes. Feeling bad and feeling guilty are all mixed up for me." "Yes, I mean, of course. I know I shouldn't, but I probably would." "Did I kill someone else? If I didn't kill anyone else, then I don't feel guilty." Note the phrases "my mistakes," "I know I shouldn't," and "Did I kill anyone?" for an event over which these women would have had no control!

The mother who opts not to breastfeed, or who does not do so as long as she planned, is doing the best she can with the resources at hand. Shemay have had the standard "breast is best" spiel (the course in aerodynamics) and she may have seen a few mothers nursing at the mall (like watching the pilot on the plane's overhead screen). That is clearly not enough information or training. But she may still feel guilty. She's female.

Most of us have seen well-informed mothers struggle unsuccessfully to establish breastfeeding, and turn to bottlefeeding with a sense of acceptance because they know they did their best. And we have seen less well-informed mothers later rage against a system that did not give them the resources they later discovered they needed. Help a mother who says she feels guilty to analyze her feelings, and you may uncover a very different emotion. Someone long ago handed these mothers the word "guilt." It is the wrong word.

Try this on: You have been crippled in a serious accident. Your physicians and physical therapists explain that learning to walk again would involve months of extremely painful and difficult work with no guarantee of success. They help you adjust to life in a wheelchair, and support you through the difficulties that result. Twenty years later, when your legs have withered beyond all hope, you meet someone whose accident matched your own. "It was difficult," she says. "It was three months of sheer hell. But I've been walking every since." Would you feel guilty?

Women to whom I posed this scenario told me they would feel angry, betrayed, cheated. They would wish they could do it over with better information. They would feel regret for opportunities lost. Some of the women said they would feel guilty for not having sought out more opinions, for not having persevered in the absence of information and support. But gender-engendered guilt aside, we do not feel guilty about having been deprived of a pleasure. The mother who does not breastfeed impairs her own health, increases the difficulty and expense of infant and child rearing, an dismisses one of life's most delightful relationships. She has lost something basic to her own well-being. What image of the satisfactions of breastfeeding do we convey when we use the word "guilt"?

Let's rephrase, using the words women themselves gave me: "We don't want to make bottlefeeding mothers feel angry. We don't want to make them feel betrayed. We don't want to make them feel cheated." Peel back the layered implications of "we don't want to make them feel guilty," and you will find a system trying to cover its own tracks. It is not trying to protect her. It is trying to protect itself. Let's level with mothers, support them when breastfeeding doesn't work, and help them move beyond this inaccurate and ineffective word.

Pros and cons, advantages and disadvantages. Breastfeeding is a straight-forward health issue, not one of two equivlent choices. "One disadvantage of not smoking is that you are more likely to find secondhand smoke annoying. One advantage of smoking is that it can contribute to weight loss." The real issue is differential morbidity and mortality. The rest--whether we are talking about tobacco or commercial baby milks--is just smoke.

One maternity center uses a "balanced" approach on an "infant feeding preference card" (5) that lists odorless stools and a return of the uterus to its normal size on the five lines of breastfeeding advantages. (Does this mean the bottlefeeding mother's uterus never returns to normal?) Leaking breasts and an inability to see how much the baby is getting are included on the four lines of disadvantages. A formula-feeding advantage is that some mothers find it "less inhibiting and embarrassing." The maternity facility reported good acceptance by the pediatric medical staff and no marked change in the rates of breastfeeding or bottlefeeding. That is not surprising. The information is not substantially different from the "balanced" lists that the artificial milk salesmen have peddled for years. It is probably an even better sales pitch because it now carries very clear hospital endorsement. "Fully informed," the mother now feels confident making a life-long health decision based on relative diaper smells and the amount of skin that shows during feedings.

Why do the commercial baby milk companies offer pro and con lists that acknowledge some of their product's shortcomings? Because any "balanced" approach that is presented in a heavily biased culture automatically supports the bias. If A and B are nearly equivalent, and if more than 90% of mothers ultimately choose B, as mothers in the United States do (according to an unpublished 1992 Mothers' Survey by Ross Laboratories that indicated fewer than 10% of U.S. mothers nursing at a year), it makes sense to follow the majority. If there were an important difference, surely the health profession would make a point of not staying out of the decision-making process.

It is the parents' choice to make. True. But deliberately stepping out of the process implies that the "balanced" list was accurate. In a recent issue of Parenting magazine, a pediatrician comments, "When I first visit a new mother in the hospital, I ask, 'Are you breastfeeding or bottlefeeding?' If she says she is going to bottlefeed, I nod and move on to my next questions. Supporting new parents means supporting them in whatever choices they make; you don't march in postpartum and tell someone she's making a terrible mistake, depriving herself and her child." (6)

Yet if a woman announced to her doctor, midway through a routine physical examination, that she took up smoking a few days earlier, the physician would make sure she understood the hazards, reasoning that now was the easiest time for her to change her mind. It is hypocritical and irresponsible to take a clear position on smoking and "let parents decide" about breastfeeding without first making sure of their information base. Life choices are always the individual's to make. That does not mean his or her information sources should be mute, nor that the parents who opt for bottlefeeding should be denied information that might prompt a different decision with a subsequent child.

Breastfeeding. Most other mammals never even see their own milk, and I doubt that any other mammalian mother deliberately "feeds" her young by basing her nursing intervals on what she infers the baby's hunger level to be. Nursing quiets her young and no doubt feels good. We are the only mammal that consciously uses nursing to transfer calories...and we're the only mammal that has chronic trouble making that transfer.

Women may say they "breastfed" for three months, but they usually say they "nursed" for three years. Easy, long-term breastfeeding involves forgetting about the "breast" and the "feeding" (and the duration, and the interval, and the transmission of the right nutrients in the right amounts, and the difference between nutritive and non-nutritive suckling needs, all of which form the focus of artificial milk pamphlets) and focusing instead on the relationship. Let's all tell mothers that we hope they won't "breastfeed"--that the real joys and satisfactions of the experience begin when they stop "breastfeeding" and start mothering at the breast.

All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances. A vital first step toward achieving those goals is within immediate reach of every one of us. All we have to do is...watch our language.

References

  1. Olds D. L., Henderson, C. R. Tatelbaum, R.: Intellectual impairment in children of women who smoke cigarettes during pregnancy. Pediatrics 1994; 93:221-27.
  2. Lucas, A., Morley, R., Cole, T.J., Lister, G., Leeson-Payne, C.: Breast milk and subsequent intelligence quotient in children born preterm. Lancet 1992; 339 (8788): 261-64.
  3. Fruedenheim, J.L., Graham, S., Laughlin, R., Vena, J.E., Bandera, E., et al: Exposure to breastmilk in infancy and the risk of breast cancer. Epidemiology 1994, 5:324-30.
  4. UNICEF, WHO, UNESCO: Facts for Life: A Communication Challenge. New York: UNICEF 1989; p. 20.
  5. Bowles, B.B., Leache, J., Starr, S., Foster, M.: Infant feeding preferences card. J Hum Lact 1993; 9: 256-58.
  6. Klass, P.: Decent exposure. Parenting (May) 1994; 98-104.


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