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Milk for Two? Facts About Tandem Nursing

With the help of two lactation specialists, Laura El Alam addresses some common questions and concerns about tandem nursing – when two siblings of different ages breastfeed together.

Twice in my life, I have discovered that I was pregnant while I was still nursing a child.  The first time this happened, my immediate thought was, Oh no! Will I have to wean my toddler right away? I did not know if it would be safe or practical to continue breastfeeding during a pregnancy, and yet the thought of weaning my enthusiastic 18 month old nursling was heartbreaking. I wanted to fulfil his Islamic rights to at least two years of my milk, and furthermore I enjoyed the closeness, healthiness and ease of our nursing relationship.  Fortunately, I had excellent sources of information to guide me in my breastfeeding decisions: my sister, Jaynee Will, who is a Registered Nurse as well as an International Board Certified Lactation Consultant and a Registered Lactation Consultant, and my dear friend and mentor, Karima Khatib, who has been a leader of La Leche League (an international nonprofit breastfeeding advocacy group) for 40 years.


With their words of encouragement and wisdom, I realised that tandem nursing was both a natural and a beneficial option for me. To help educate other mums about tandem nursing, I am going to share some reflections on the topic from the two breastfeeding experts.


Laura: First of all, is it safe to breastfeed while pregnant?
Jaynee Will: So many mothers and even some doctors assume that women have to wean their child when they become pregnant again. In a healthy pregnancy, there is no need to wean. If after 24 weeks, the mother experiences preterm labour, in rare cases weaning may need to take place, but can resume breastfeeding after delivery.


Laura: I experienced some nipple soreness while nursing during my pregnancies. Is this normal, and can mums do anything alleviate the pain?
Jaynee: Nipples will likely be more tender during pregnancy. Mums can use lanolin to provide some relief. Milk supply decreases during pregnancy, so the nursing child may lose interest and nurse less, giving those sore nipples a break.


Laura: Do mums need to make any changes to lifestyle or diet if breastfeeding while pregnant?
Jaynee: Unless a mother is severely malnourished, she will be able to keep up with her body’s needs, her unborn baby’s needs and produce a good milk supply. She will require more calories and more fluids. I advise my patients to listen to their bodies and eat when hungry and drink when thirsty. You want to aim for at least 64 oz of water per day and have clear urine. Continue to take prenatal vitamins until both children are weaned. Mum’s iron and vitamin D levels should be checked by her obstetrician because if her levels are fine, then the nursing baby won’t need a supplement. Most women have low vitamin D, especially Muslim ladies, who cover so much of their skin. That’s why many pediatricians automatically supplement breastfed babies with vitamin D. But if mum’s levels are good, her breast milk levels should be fine.


Karima Khatib: I would add that the mother’s body will automatically protect the new baby, who is the most vulnerable. Thus the milk supply goes down for the older baby to whatever level it must for the mum to provide safely for both children during pregnancy and tandem nursing. I think that this is a comfort to know. Of course the mother must allow herself the rest she needs.

Laura: What about colostrum (the antibody-rich “foremilk”)? In the first day or two after baby is born, can I nurse my toddler freely, or does the newborn need to drink all the colostrum?
Jaynee: After delivery for the first few days when colostrum is present, the newborn should nurse first since there is only a limited quantity of colostrum, which the newborn needs. After the milk comes in, the supply will adjust to tandem nursing and there will be enough milk for both. At this point, the older child can nurse first.


Laura: Can the toddler and infant nurse at different times from the same breast, or should we worry about the transfer of germs?
Jaynee: They can share breasts. Nipples secrete an antimicrobial substance. An exception to this is if one child has thrush, they should nurse from separate sides until the thrush has been treated.


Laura: What are the benefits of tandem nursing?
Karima: Breastfeeding is a mothering tool which helps a woman achieve the nurturing relationship she hopes to have with her child. She gains a lot of close-up, eye-to-eye contact with the older baby, which she may be otherwise tempted to forget in her busy day. Tandem nursing is a practice among human beings all over the world in the past and at present. It is a natural way women mother their babies. It is an option that women should know about, and the choice should be left up to the mother and the older baby. She is the one responsible for mothering the older baby, and breastfeeding provides an excellent opportunity for her. The younger the older baby is, the more he needs to be offered this perfect nourishment and nurturing in his mother’s arms, along with his sibling.


Jaynee:  A mother may experience engorgement as her milk supply increases. If her breasts are too full, making it difficult for newborn to latch, her toddler can help soften breast by nursing first.


After tandem nursing two sets of children, I can personally attest to additional benefits. The older child’s adjustment to the new baby is greatly facilitated when the siblings nurse together. The new baby is not perceived as a foe who steals mummy’s milk and arms and who dominates all of mummy’s attention, but rather a companion who frequently shares a pleasant dining and bonding experience. My tandem nurslings often held hands, exchanged smiles, or patted each other as they nuzzled happily on my chest.


Also, when a mum nurses her babies, her body releases the hormones prolactin and oxytocin. Both of these chemicals promote relaxation, emotional bonding and a sense of well being. The milk itself calms the babies. So, when a mum nurses her newborn and toddler, all three are wrapped in a nurturing, relaxed and happy triangle, and the older sibling is not left out of the picture.


One might wonder about logistics: how does one balance, hold and breastfeed two babies at once? Since the newborn obviously needs the majority of mum’s arm support as well as help getting properly latched on, mum should get the newborn into a comfortable nursing position first. Pillows or wrap-around-the-waist breastfeeding supports like “Boppy” or “My Breast Friend” can be a huge help, freeing up at least one of mum’s hands. Many tandem nursing mothers like to nurse while reclining in bed or in a soft chair. My own cosy, upholstered rocking chair is the one piece of baby equipment – in addition to nappies – that I find indispensable. Once the newborn is comfortably latched on, the toddler should have no problem helping himself to the other breast. Since toddlers are known to perform gymnastics while nursing – attempting to climb, twist and turn while still latched on – they usually have no problem positioning themselves on the available breast. They might nurse for a couple minutes and then scamper off to play, or they might settle in for a longer session, but either way, they require little help from mum.


Finally, I would like to point out that many doctors – including paediatricians and obstetricians – have never studied the art or science of breastfeeding. Unless they have pursued the topic independently, outside of medical school, they probably do not know much about it. They will often give incomplete or incorrect breastfeeding advice. Some of them are influenced by the companies that produce baby formula and actually try to pressure mums to formula-feed. Some doctors feel too busy to take the time to help solve complicated breastfeeding problems, so they will take the quicker route of advising mum to give baby a bottle. Doctors who do not know the benefits of breastfeeding nor encourage mums to try it are behind the times, at the very least.


Cultural beliefs – no matter how deeply rooted they are – are often not a reliable source of breastfeeding information, either. Many cultures hold opinions about breastfeeding that are incorrect and outdated. I cannot tell you how many aunties – from various countries – expressed shock and concern when they discovered I was breastfeeding while pregnant.  They were convinced it was unsafe and bizarre. In addition, over the years, women have advised me to wean my toddler as soon as he got teeth, urged me to supplement with solids long before it was necessary and made me unnecessarily paranoid about my milk supply. So, although women in our community might have excellent advice about many things, they very often do not know the scientific facts of breastfeeding. It is crucial, therefore, to get our breastfeeding information not from untrained doctors or well-meaning but clueless advisers, but from a certified lactation consultant or an experienced, educated breastfeeding specialist.


Islam recognises the importance of breastfeeding and in fact Allah (SWT) has told us that it is a child’s right to be breastfed for at least two years. For almost any obstacle or difficulty a mum might encounter while breastfeeding, there is a solution. For someone who has never tried it, nursing two children at once might sound difficult, but it can actually be a positive and easy experience for a mum and her babies. Lactation consultants and La Leche League International have a wealth of information, advice, troubleshooting and tips for mothers who are dedicated to initiating and sustaining a beautiful nursing relationship with their children. It is rewarding in this life and for the next to educate oneself about breastfeeding and to persist in this noble act of love.


Laura El Alam is a frazzled but grateful wife and mother of four in Southern California. She is a homeschooler, breastfeeder, lullaby singer, perpetual house tidier, amateur party planner, bibliophile and board game enthusiast. And she really likes to write. She embraced Islam 14 years ago and has felt whole ever since, Alhamdulillah.