Breastfeeding a Toddler in the PICU

On Christmas Eve, my 21-month-old fell headfirst onto a brick landing. We quickly found ourselves in the Pediatric Intensive Care Unit to treat a skull fracture and bleeding of the brain. During our 3-day stay, breastfeeding became our greatest strength and refuge (outside the support and prayers of family, of course). These are some thoughts about our experience:

1) Hydration and hunger. By the time little K had his first meal following his accident, it had been nearly 20 hours since he last ate. What's more, he was vomiting as a result of the injury, so he didn't actually hold down food and water until a few hours later. Despite that, he required IV fluids only once during that time. The nurses marveled over how well-hydrated he was, which I attribute directly to the almost constant nursing we'd been doing while in the hospital. Though my supply was not nearly what it had been, I was able to provide for my toddler's most basic needs.

2) Comfort and calm. With the exception of inserting IVs and any large scans that needed to be done, every procedure and vitals check was completed while K was latched. Though he was obviously uncomfortable and hated all the poking and prodding, he would stay still and quiet while doctors and nurses repeatedly took his temperature, heart rate, blood pressure, felt his head, or flushed his IVs. Though he certainly cried often from fear and pain, he could always be calmed by the breast, and nursed so often that he was probably latched more often than not. In truth, my nipples hurt almost as badly as when he was a newborn, but I wouldn't have traded that ability to comfort him for anything.

3) Surprising attitudes toward breastfeeding. Maybe I've just spent too long in hard core hippie California, but I was completely caught off-guard by some of the reactions I received toward my openly breastfeeding a toddler during a crisis. I expected medical professionals, at least (and especially in pediatrics), to be pretty supportive, but many of them were downright squeamish. One nurse got flustered and closed the curtain on us, saying "You don't want anyone seeing THAT. It's an intimate moment." When I thanked her but assured her that I didn't mind (or care) if anyone saw, she began complaining about her friend who "just whips it out at the food court." Another nurse commented "Well, this isn't the most PRIVATE of places," even though we were behind a curtain and it was just us and her. One doctor practically ran away when he walked in on me breastfeeding, muttering "I'll come back when you're finished," and I had to yell for him to come back. And the majority of the staff did an awkward double-take at first.

On the other hand, there were a few bright spots: one of our favorite nurses, a guy, never batted an eye or made a comment. He made sure K was comfortably on the boob before checking him, and chattered cheerfully the whole time as though breastfeeding was total normal (which it is, but ya know). And one nurse passed us while K was pulling at my shirt and said "He looks like he wants to eat! I breastfed both of mine until 30 months!" Still, I was surprised at overall attitude I saw.

There was also the fact that I was giving my son antibodies that may have protected him from some of the nasty germs that inevitably circulate in a hospital, but since all three of us left with a cold, that wasn't quite as successful as advertised.

Naturally, it was a pretty horrible and frightening experience, but I feel that it would have been so much worse if we were not still breastfeeding. A week later, K is still nursing very frequently, whereas we were down to only twice a day before the accident. Also previously, I was working on setting boundaries with him, limiting when and where he could nurse, but that went out the window during his recovery. I can't help but wonder if this may push back weaning a bit (I was not planning to actively wean yet anyway, but I felt like he might lose interest soon). For now, I'm just happy to continue providing what my little man needs.

See also: Nursing in the NICU

Breastfeeding as Birth Control

Did you ever consider that breastfeeding can be a method of contraception? Many women will go an extended period of time while breastfeeding and not have a menstrual cycle. The hormones associated with breastfeeding can suppress the menstrual cycle for quite some time, although this length of times varies for each individual since no two women are the same. Breastfeeding can impact fertility, which can be seen as positive or negative depending on how you feel about conceiving again. As a Catholic, I practice NFP, or natural family planning. I don't use artificial methods of preventing pregnancy and I accept that every time my husband and I have sex, we have to be willing to welcome a new life into our family.

Before I go any further, let me say that this is not a foolproof method and I think knowing your body and your cycle extremely well are crucial for using this method. With that being said, Ecological Breastfeeding can serve as a great form of contraception and natural child spacing. While it isn't for everyone, it can be extremely effective. As evidenced by the chart on this page from KellyMom, LAM (lactational amenorrhea) has a 98-99.5% effectiveness rate when used properly.

The Seven Standards for Ecological Breastfeeding include:

• Breastfeed exclusively for the first six months of life, offering no other liquids (including water)
• Pacify or comfort your baby at your breasts
• Don't use artificial nipples (bottles, pacifiers)
• Sleep with baby for night feedings, continuing to feed on demand
• Sleep with your baby for a daily nap feeding
• Nurse frequently day and night, and avoid schedules
• Avoid any practice that restricts nursing or separates you from your baby

Photo Courtesy of Whitney Morales Photography

Now I realize this isn't realistic for everyone. It works great for me now because I only have one child. When I have another child someday, I may not be able to follow all the rules exactly. Perhaps following futures births, I'll regain my fertility much quicker. However, Nora is 16 months old now and I have yet to have my cycle return. I've actually been hoping to get pregnant soon but haven't had any luck yet. I've considered some gentle night weaning, or at least cutting back the number of times she nurses at night, but that is proving to be quite difficult. For now, I'll continue to cherish our naps together and hope that at some point, I won't be an all night buffet. 

I'd love to hear your thoughts. Do you (or would you) practice ecological breastfeeding? What do you think would be challenging about it and what do you think would be rewarding?

If I would have written myself a letter...

...with what I know now, what I'm doing now, and read it before all of this started, I would have laughed. Hard. I breastfeed my toddler and even though I thought he was ready to wean, (a few times), he is nowhere near done. The kink in this whole thing is, when I try to hand express, there's hardly anything there!

Is it ok to comfort nurse my toddler?

I really struggle with this for some reason. Some days, I feel like a super-mom for continuing to nurse him but other times I feel like just the opposite and that I'm using nursing him as a crutch to delay learning other coping mechanisms. Toddler trips and bangs his head: whip out the boob. Toddler isn't feeling great: snuggle and snack all day in bed. Then the thoughts come full circle and I realize that I am a good mom. The same people who side-eye me when I even talk about breastfeeding my son beyond a year, compliment me on how happy he is, how well-behaved he is, how healthy he looks. Would all of this be if he wasn't still nursing? 

Let's dissect this for a moment, shall we?

Toddler bangs his head and wants to nurse. Toddler nurses. Toddler feels better. ===> Weirdo Mom With No Coping Skills or Awesome Partnership?

Toddler is sick and wants to nurse all.day.long. Toddler nurses. Toddler feels better. ===> Weirdo Mom With No Coping Skills or  Super Efficient Way to Get Toddler Antibodies and Fluids at the SAME TIME?

So I guess I answered my own questions. In my mind, there's no difference in my son using me or a blanket/toy/[insert other lovie here] when he's down, ill, hurting (physically or emotionally). Actually, there is a difference. The lovie isn't going to provide DHA, immunity, a strong bond. Like any lovie, he will grow out of me eventually but for now I will enjoy it. I just have a hard time believing that one of these is more ok than the other: 

15.5 months vs 6 months

Til Next Time, Mamas

Keep Calm and Nurse On