Light and Momentary

Research shows that lead paint is A-OK!

I am very late to this party, but I am stopping by anyway. I started this post the day I read Judith Warner's screed, but it takes me forever to write anything non-bullet-point-y. Also, becoming a doctoral candidate has had an unexpected effect on me -- I find myself thinking thoughts like, "Should I really hit publish before I understand how they calculated the area under the curve in the lead study? Do I need to be clearer that neither of the studies I'm talking about can claim to be the last word on the topic?" Which is probably a little silly, so here's the post I wrote.

Judith Warner has jumped on Hanna Rosin's bandwagon, where the tune they're playing goes something like this: "I have zero public health credentials but I'm going to broadcast my ignorance to the widest possible audience anyway." There are already plenty of bloggers reacting to Rosin's piece, so I'm going to focus this on one maddening misperception in both pieces: the idea that breastfeeding has no significant impact on cognition.

Tandem Nursing: Notes from the Gladly House

In response to a couple of comments on that last post: I am tandem nursing for the fourth time. All of my sons, in other words, have nursed through and beyond a pregnancy. I am a quiet tandem nurser, because it is an odd choice in this culture. Some people assume you must be a freak doing it for nefarious reasons; others assume you must be a hardcore lactivist passing judgment on the non-tandem-nursing population.

Woe unto me if I ever walk around passing judgment on 99+% of the population. I harbor no illusions that tandem nursing will make for a more peaceable world -- or even a more peaceable household, though that's my hope. It works for us, so that's what we do. I asked Pete the 3yo for his point of view.

What do you think about sharing nonny?
It's good! And the new baby will say "Wummy wummy wummy." And it's good to share, right?

Do you ever wish you didn't have to share the milk, or is sharing no big deal?
It's no biggie, because there's lots and lots and lots and lots.  And it's for nobody else except the new baby and me.

I thought about posting the reasons why I've nursed my children past infancy given the widespread assumption that it must be for freaky kinds of personal gratification, but I'm not sure that assumption is actually very widespread among people who read this blog. Nursing is a happy but diminishing part of a happy and growing relationship with my 3yo: we read books, we do puzzles, we go to the kids' museum and drive the model tractor, and sometimes we nurse. I expect that during the next year, he'll wean peaceably. I also expect that, like his brothers, he'll dimly remember nursing as something that left him feeling safe and loved and content.

For the people who say darkly, "That woman must be getting something out of it for herself," about older nurslings, I will acknowledge that I do get something out of it for myself. I have a vicious oversupply problem, and an older nursling is a huge help in ramping down supply without drowning the new baby, or subjecting her to GI distress, or landing myself in bed with recurrent mastitis. I could pump, sure, but on Christmas Day when I was battling chills and misery it was so much nicer to lie down next to my Petely than it would have been to wash and assemble the parts for my little hand pump, hoping I remembered how they went together and mustering the muscle to move all that milk. (Many of the dark mutterings suggest that mothers of older nurslings get some kind of sexual charge out of the relationship, which is, not to put too fine a point on it, asinine.)

The first time I tandem-nursed, it was really hard. Really really really really hard. But then everything was hard about going from one to two -- not so much going from two to three, or three to four, or four to five. (So far.) As my pregnancy progressed I talked to Pete about what to expect when the baby came. He seems to have listened closely. (When he climbed into our bed in the morning of her birthday, he said, "Is the milk going to spray out now?" Probably tomorrow, I told him.) I don't pay much attention to how often Pete asks to nurse. I almost always say yes in the early days, when the youngest child has just become the big brother, but I don't worry about saying "Not now. Another time." And I'm not worried about weaning -- it will happen. It always does.

Carrying my children a lot didn't delay them when it was time for them to walk. Using words to interpret their early gestures and monosyllables didn't keep them from talking in sentences (and paragraphs and novellas) when the time was right. And being willing to nurse them for a period of years rather than weeks or months won't keep them from weaning in due time.

I was typing this with baby in the sling. She had just finished nursing, which prompted Pete to say, "More nonny?" We just had nonny, I reminded him. How about another muffin? He didn't want a muffin, but he didn't complain about waiting until later to nurse. Instead he leaned over and planted a spontaneous kiss on his sister's fuzzy head. It works for us. It works well.

Once more into the breach, dear friends

On Tuesday I got a copy of Faith & Family in the mail because my Petely's picture is in this issue. I was flipping through it, thinking idly about subscribing, when I saw this sentence in an article on taking kids to Mass:

No one will deny an infant his bottle, and some moms -- appropriately draped of course -- discreetly nurse their babies in a tucked-away space.

If you ever want to push my buttons with a nuclear-powered cattle prod, you can just call me up and read that sentence to me. It is wrong in so many ways I can't even count them, though I'm certainly going to give it a try. Before the counting commences, a quick note for anyone new to this blog: I recognize that women make all kinds of decisions for their families, for reasons that are pretty much never my business. I make no assumptions about why women use bottles, so no need to get your knickers in a twist. Three years ago I posted an essay on the web about breastfeeding Catholic mothers, and craziness ensued. I am too sick and too busy to deal with internet crazies this week. Please be crazy somewhere else.

So let's review: human milk is the food designed for human babies. Babies who do not receive human milk will be more vulnerable to a wide array of pathologies, including but not limited to enuresis, schizophrenia, alcohol-related hospitalizations, and death from SIDS. A nursing mother is conferring long-lasting protection against illness. She is shaping her child's brain, providing the right fats in the right ratio for building the retinas and the cortex with which he will learn about creation. She is shielding him from the subtle damage caused by in utero toxin exposure, and she is cutting his odds of developmental delay.

And it is crucial to note two more things: first, many of these effects are dose-related. A little human milk is great, in other words, and more is better. Second, humans are "carry mammals," meaning that their milk is designed for frequent consumption. God could have made us like bunnies, nursing every twelve hours (much easier to work around the Mass schedule that way). He could have made us like deer, but I have yet to spot any hooves or antlers on the children of my acquaintance. Human babies get hungry often. God has designed them, from top to bottom, to receive milk from their mothers' breasts.

Why then, why oh why oh why, would a magazine aimed primarily at Catholic mothers suggest that bottles should be the default for babies at Mass?

I don't really need an answer to that question. People get tetchy about the fact that human milk is made by humans. No other body fluids are foods, let alone foods with superpowers, and in general we avoid body fluids -- sensibly so. People get tetchy about the fact that breastmilk comes from breasts, when we're used to thinking about breasts as decorative or seductive.

But do you know what? It is not the normal behavior for the species that needs to change. It is the thinking that needs to change, because it is costing us all. Even if you have no children, you are paying for the higher healthcare costs of formula-fed infants (and, to a lesser extent, formula-feeding mothers). It may well be costing you in the workplace, because breastfeeding-unfriendly policies make for higher absenteeism among employed mothers. And I find it preposterous -- painfully absurd, in fact -- that Catholics are buying into the madness of a culture that equates nursing a baby with acts either sexual or excretory, things polite people would never do in public.

"Just pump," some will say. "Just pump" assumes that every woman has the money to buy a pump, and the time and willingness to use it -- a false assumption. "Just pump" is a tacit admission that the speaker thinks misplaced squeamishness trumps a baby's right to be breastfed -- a point of view with which, as you will have guessed by now, I disagree vigorously.

When a Christian woman gestates and births the baby God has given her, she says with our Lord, "This is my body, given for you." When she feeds her baby at the breast, giving him food synthesized from her own blood, she says, "This is my blood, poured out for you." (Those of us with overactive letdown modify it to "...spraying out for you rather like Old Faithful in an especially emphatic moment.") The Victorians hid away their heavily pregnant women, because those burgeoning bellies spelled s-e-x. I submit that we fall into the same error when we tell nursing mothers they need to drape or leave. "ATTENTION, PLEASE!" calls the drape. "Uncomfortable nursing mother, right here in this very spot!" And isn't it more distracting for me to be walking up and down the aisle, as I go back and forth from my private corner, than to be meeting my baby's needs quietly in the pew? (Say, did the Blessed Mother not get the memo about how modest Christian women are supposed to be using bottles or else draping? Maybe she needed Hooter Hiders, you think?)

Believe me, I don't want random parishioners catching sight of my bare breasts, any more than I want them to see my bare pregnant belly. That's why I dress for the occasion when I'm taking a small baby to church, and why I learned when my oldest was tiny how to nurse him without giving anybody an eyeful. It's not hard, especially when you can learn from other mothers around you who are also nursing their babies. Hint: this is more likely if they are sitting across from you at coffee and doughnuts, not hiding in the bathroom hoping there will be a Boston creme left by the time the baby's finished.

Here's the bottom line: we nurse our babies in obedience to God's call. We give them the food Jesus chose to receive himself -- living food that is an echo of the Eucharist in the way it nurtures and protects those who receive it frequently.  And that, in my view, is cause for celebration, not something to hide.

Conversation

Boys and I are sitting in the living room. Pete climbs up on the couch next to me. "Me Superman! Have nonny?"

"Raise your hand if you think Superman's mom gave him nonny," I say.

Pete looks around at his brothers (who do not think, apparently, that the Man of Steel nipped home for a quick little pick-me-up between stopping the speeding freight trains and going head-to-head with Lex Luthor) and defiantly thrusts his hand into the air. "Me Superman. Me have nonny with Mama."

The big boys discuss Superman's mother. They wonder, What happened to her anyway? Pete brings them back to the issue at hand. "Superman have nonny with Mama!"

"I know," says Joe. "You can be SuperBOY, Pete."

"Superboy!" Pete agrees. "Superboy have Mama's nonny."

Fee Fi Fo Fat

In one of the weekly literature updates that I subscribe to, I saw an abstract that caught my eye. The authors argue that there's inadequate evidence for the WHO recommendation for six months of exclusive breastfeeding. They say there might be a sensitive window in which babies need exposure to complementary foods, and that exclusive breastfeeding for six months could increase a baby's risk of developing allergies later. They also contend that babies exclusively breastfed for six months may be more vulnerable to micronutrient deficiencies.

At this point I detected the unmistakable aroma of a rat in the room. A rat with deep pockets, though whether it was a rat named Nestle or Mead Johnson or Wyeth or Abbott was not clear to me. I pulled up the full text and looked for a declaration of competing interests. There was none.

Five minutes of googling, however, confirmed my suspicions. The first author, Susan L. Prescott, has taken money from Mead Johnson and sits on Nestle's Scientific Advisory Board. (That's a .pdf link, if you've got a slow connection. Google will give it to you in HTML if you prefer.) At the same link, we learn that Ralf Heine has taken money from Nestle and Nutricia. Maria Makrides and Robert Gibson seem to have a Wyeth gig going, though they've also lent Nestle a hand (scroll down to the bottom of that page).

Why aren't these affiliations mentioned in their most recent article?

Some breastfeeding advocates assume that industry-funded research must be untrustworthy. I think that's an extreme position -- Alan Lucas, for instance, has done some work I'm happy to talk about even though I am mindful of his cozy relationship with the infant formula industry. But if you want me to take you seriously, you have to tell me that you're taking money from an entity with an enormous financial stake in the issue at hand. Industry flung back its collective head and howled when the WHO recommended six months of exclusive breastfeeding in 2001, and it sounds like they're still sulking.

Did you know that if you wait until six months to introduce complementary foods, most babies can handle fork-mashed table food without difficulty? What would the shareholders say about widespread recognition that commercially prepared baby food is mostly unnecessary?

If you're interested in truth and scientific accuracy, it seems to me that when you cite an article endorsing six months of exclusive breastfeeding, you should mention its conclusion even if you disagree with it. If you omit the conclusion, saying only that some breastfed babies have lower hemoglobin and failing to address the clinical significance of the difference, I have to wonder about your agenda. And I wonder, too: why wouldn't you touch on the conflicting reports in the literature about iron status after long-term exclusive breastfeeding? I am also going to be deeply skeptical about your article if you don't mention the tendency for allergic babies to reject solids. This creates a chicken-and-egg question: are they slow to accept solid food because of a predisposition to food allergies, or does the late introduction of solids cause food allergies? You are welcome, of course, to favor the latter hypothesis; in my view it is irresponsible to suggest only one possible causal mechanism when a plausible alternative exists.

Anyone who says unequivocally that breastfeeding will protect a baby against atopy isn't telling you the full story. Right now there are conflicting findings in the literature and we don't fully understand what's going on. But anyone who says that exclusive breastfeeding might be responsible for the marked rise in food allergies --well, you'll have to excuse me while I hold my nose.

Things to consider if your four-month-old baby coasts down the growth charts

This post was prompted by a woman who wrote that her four-month-old baby was gaining weight too slowly, and that she had decided to stop breastfeeding exclusively because of worries about her milk supply. I am hoping that this information will be helpful to mothers who google "four-month-old baby with slow weight gain" or "sliding down the growth charts 4 months" or "milk drying up four months." I don't provide as much hands-on breastfeeding support as I used to, so shoot me an email if you catch any errors, please.

When Top Management Wears a Clown Suit

Hey! I know! This is a great idea!

Oh, yeah? What's that?

Did you know that human milk plays an important role in normal immune function, that it protects against some forms of childhood cancer, and that it kills cancer cells in vitro*?  Also, did you know that the WHO recommends two years or more of breastfeeding for children worldwide?  Well, here's my great idea:  let's tell that mom staying here, the one whose toddler has a brain tumor, that she can't nurse in communal spaces!

Wha-?

Yeah, let's tell her she has to go to her room, up three flights of stairs, where no one is allowed to eat or drink.  Her kid won't eat anything but breastmilk right now, so maybe the inconvenience will motivate him to get back on a normal diet.

...You think?  But isn't there a law in this state about public breastfeeding being okay?

Well, yeah, but we can just blow them off if they bring that up.  Seventeen months is too old for that anyway.

You know, I heard the law doesn't say anything about age.  It just says if a mother can be there, she can breastfeed there.

Hm.  I know!  If they bring it up, we can THREATEN them! Yeah, that's it. I'll crack my knuckles and say they'd better be very careful.  We'll say we're going to give them the boot if they have the audacity to expect us to comply with state law.  That's exactly what they deserve while they're away from home with a seriously sick kid.

What if they want to know why we're saying no?

We'll tell them...uh...we'll tell them...hm...I know! We'll tell them it's important to be sensitive to the needs of multicultural families!

Babies from other cultures don't need their mothers' milk?

No, silly, every baby needs human milk.  But here in Texan culture, we would prefer it if breastmilk didn't actually come from, you know, [whispers] breasts.  I feel uncomfortable with that.  Which is obviously more important than the wellbeing of the actual families I am paid to assist.

It makes you uncomfortable that mammals lactate?

Listen, whose side are you on?  Do I have to remind you about our mission?

You mean, "The Ronald McDonald House of Houston offers a home away from home for families with children being treated at a Texas Medical Center institution for cancer or other serious illnesses"?

Yeah, what could be more homey than being bullied in flagrant violation of your legal rights?  Who could ask for anything more?

----

I wasn't going to blog about this because finals loom, but it is beyond preposterous that a facility intended to help sick children appears unaware of the importance of human milk to those same sick children.  I was going to link to the MDC pages where the whole thing was unfolding, but those threads have been pulled because of liability concerns about actual names posted in them.  Here's a blog post with some lengthy quotes from the original MDC thread, and people to contact if you are as incensed by this as I am.**

*ooh, look, it can kill cancer cells in vivo too!

**you might also consider contacting the TX Attorney General.

Don't Know Much About Lipidology

Fatty acids are complicated.  I cannot tell you much about them, but I can de-greekify the sentence a few of you asked about in my last post:

Low DHA levels are associated with low serotonin levels, and endogenous anandamide -- a cannabis-like substance -- is synthesized from arachidonic acid.

Okay.  DHA = docosahexaenoic acid, an omega-3 fatty acid.  I've been reading about DHA because it's hugely important in early neurodevelopment.  Infants lay down new neural tissue at an astonishing rate, and they need DHA as building material.  If they don't get it, they will build with other stuff, as documented by a researcher named Farquharson. He studied the brains of babies who had died of SIDS and found a striking difference between the breastfed babies and the formula-fed babies.  (I believe the study was from '92, before EFA-added infant formula.  I don't know if anyone has looked at what happens in the brains of babies fed formula with added algae and fungi.)

I don't know if DHA supplementation can raise serotonin levels; I haven't waded through the research on DHA in psych patients.  I do know that I was frustrated with the ineffectiveness and side effects of the SSRI I was taking for anxiety and decided in November to try fish oil instead.  Fish oil, or its potent placebo action, or a sudden spontaneous remission of this chronic problem, has kept my anxiety at an entirely manageable level.  I would have no qualms about trying my son on fish oil to see if it seemed to make a difference for him.

Moving on: "endogenous" = homegrown.  If, say, you have diabetes or hypothyroidism, you need exogenous insulin or thyroid hormone because you don't have an adequate endogenous supply. "Anandamide" = happy-making chemical.  It got its name from the Sanskrit word "ananda," which means bliss or delight.  So: your endogenous anandamides are substances that slot into your cannabinoid receptors and cause you to feel that all is groovy.  Like pot, only legal.

I know even less about arachidonic acid, an anandamide building block, than I do about DHA.  I don't know what foods are good sources; it seems that your body can make its own through a series of complicated maneuvers with other fatty acids.  If you are more clued in than me, please chime in. I had been thinking fish oil supplementation would provide AA (because why else would we say "happy as a clam"?) but I could be mistaken.

Sarah asked about flax oil vs. fish oil.  Flax oil is rich in alpha linolenic acid, which is good stuff.  Your body can convert ALA to DHA, but the conversion is inefficient.  I keep flax meal in my fridge for smoothies and muffins because the thought of a fish oil muffin gives me the shudders, but I don't buy flax oil capsules, personally.

Which leads me to: what to buy?  I got an email with that very question recently and I don't have a great answer.  You can spend beaucoup de money on highly purified pharmaceutical grade supplements.  Or you can go to Walgreen's and buy something cheaper.  I read labels in search of capsules made mostly from small ocean fish (salmon is the sixth ingredient on the bottle I have right now).  Big fish can pack a big wallop in terms of contaminant load.  I do not eat, and will not feed my children, freshwater fish because of my concerns about persistent organic pollutants like PCBs.  (I said weeks ago that I'd write a post about PCBs and I never did it, did I? Blogger's guilt strikes.)

Oh, I just found a Moxie post on EFA supplementation.  Go read it -- it's all kinds of practical.  But if you are ever writing a poem and casting about for a line of iambic tetrameter, remember this post, and the enDOGeNOUS aNANdaMIDES.

Toddler Nursing

Pete doesn't think we should sleep late on Sunday mornings.  He was up before seven this morning, trying to coax me to get out of bed and play.  I was not a willing coax-ee, so he played with my sleeping self.  I woke up to a game that made me laugh and laugh.

He lifted up my pajama top and said, "Ah! [Imagine packed into that 'Ah!' all the delight and feigned surprise a toddler could squeeze into a syllable.] Mama nana!"  "Who'd'a thunk it?" he was saying. "My mama has nana.  Perhaps it's a good time for a wee smackerel."  A minute later, the same thing again.  "Well, imagine that! Nana!"

On Valentine's Day we got takeout Indian food and Alex confused Pete.  "Want some naan?"  "Nana?" Pete asked, puzzled.  The two of them play a game sometimes, where Pete pretends he wants Alex to nurse him.  They both think it's hilarious.

As I was typing, Pete came in and reached up to me.  "Nana," he said decisively.  With my oldest son I was often vaguely worried about toddler nursing.  People seemed to think it was weird; I wasn't confident that he would ever wean peaceably.  He was very, very attached to nursing.  I wish I could send a message to my younger self:  Relax.  He will wean.  Enjoy the cuteness while it lasts.