How to manage going back to work when you’re breastfeeding an older baby or toddler
Article by Cordelia Uys, NCT Breastfeeding Counsellor
January 2021
If you would you like to continue to breastfeed your baby or toddler once you go back to paid employment, but aren’t sure how to make it work, this article is for you.
The statistics:
The U.K. has some of the lowest breastfeeding rates in the world at 6 months, and probably the lowest at 12 months, which is a real shame, because there are so many physical and emotional advantages, to both a mother and her child, of continuing to breastfeed past 12 months. UNICEF and the World Heath Organisation recommend exclusive breastfeeding for 6 months, and continued breastfeeding up to, and beyond, 2 years.
The last U.K. wide Infant Feeding Survey was conducted in 2010. Key findings were:
Breastfeeding initiation: 81%
Exclusive breastfeeding at six weeks was 24% in England
Exclusive breastfeeding at three months: 17%
Exclusive breastfeeding at four months: 12%
Exclusive breastfeeding at six months (as recommended by the world health organization) 1%
The rate of any breastfeeding at six months was 34%
At 6 months - percentage of babies getting any breastmilk:
The UK: 34%
The United States: 49%
Norway: 71%
At 12 months – percentage of babies getting any breastmilk:
The UK: 0.5% (ie 1 in 200 children)
The United States: 27%
Germany: 23%
Brazil: 56%
Senegal: 99% of babies
Why continue to breastfeed?
There are numerous benefits for your child
1) Nutritional benefits for your child
Nutrition past 6 months
From the Breastfeeding Network (BfN) website:
“Breastfeeding continues to be important for children’s nutrition, development and care after the first 6 months of life. On average, breastfed babies of 6-8 months obtain 75% of their energy needs from breastmilk, this falls to around 55% at 9-11 months, and 40% at 12-23 months. When breastfeeding is well established, it can contribute an even larger percentage to energy and nutrient requirements.”
Breastmilk can act as a valuable safety net when older nurselings are unwell and not eating much solid food.
Nutrition past 12 months
Breastmilk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.” (Dewey 2001). Dewey calculates that a nursling who is aged 12-23 months and is consuming 448ml of breastmilk daily will receive 29% of their energy requirements, 43% of their protein requirements, 36% of their calcium, 75% of their vitamin A, 76% of their folate, 94% of their vitamin B12 and 60% of their vitamin C.
2) Health and immune protections for your child
A child will continue to be protected by the antibodies in their mother’s breastmilk for as long as he or she is getting any breastmilk:
"Breastfeeding toddlers between the ages of one and three have been found to have fewer illnesses, illnesses of shorter duration, and lower mortality rates (Mølbak 1994, Van den Bogaard 1991, Gulick 1986).” If a toddler gets ill, they will often completely stop eating solid food. When a sick child is still being breastfed, they tend to go back to breastfeeding like a newborn, which helps them to fight the infection, and is enormously reassuring for parents, because a sick toddler can lose a lot of weight very fast.
“Antibodies are abundant in human milk throughout lactation” (Nutrition During Lactation 1991; p. 134). In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Lawrence & Lawrence 2011, Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991)
"Human milk in the second year postpartum contained significantly higher concentrations of Lactoferrin, Lysozyme and Immunoglobulin A, than milk bank samples collected from donors less than 12 months postpartum." (Perrin et all, 2017)
According to Emma Pickett, in her book Supporting breastfeeding past the first six months and beyond: “Lysozyme breaks down the cell wall of bacteria protecting against infections like salmonella and E. Coli. Lactoferrin binds with iron which makes iron more easily metabolised and also prevents its use by pathogens, preventing infection. One 2019 study looked at lactoferrin into the 48th month and suggested: “Evidence of stable or rising immunoprotein levels during prolonged lactation provides an argument for foregoing weaning. (Czosnykowska-Lukacka et al. 2019)”
3) Protection and reduced severity of illness from Covid-19 for your child
Now with Coronavirus, there’s an additional reason why a mother might wish to continue breastfeeding: your breastmilk will confer immunity to your child if you have had the virus, or if she has been vaccinated:
https://www.nytimes.com/2021/04/08/health/covid-vaccine-breast-milk.html
Breastfeeding mothers can be given any of the three vaccines currently authorised in the UK:
https://www.breastfeedingnetwork.org.uk/coronavirus/
4) Positive psychological impacts on your child
A couple of studies have shown a positive relationship between longer breastfeeding duration and social development. (Duazo 2010, Baumgartner 1984)
An Australian study found a longer duration of breastfeeding was associated with positive mental health outcomes into adolescence: “Breastfeeding for a longer duration appears to have significant benefits for the onward mental health of the child into adolescence. Following adjustments of the associated socioeconomic, psychological and birth exposures in early life, breastfeeding for 6 months or longer was positively associated with the mental health and well-being of children and adolescents.” (Oddy et al. 2010)
In her book Supporting Breastfeeding Past the First Six Months and Beyond, Emma Pickett writes: “Research suggests that continued breastfeeding is associated with reduced incidence of of ADHD and autistic traits: “After adjustment for several confounders, longer duration of breastfeeding was independently associated with better cognitive development and with fewer autistic traits.” (Boucher et all. 2017). It should be noted that is not the same thing as saying ‘breastfeeding reduces the chance’ of some of these behaviours. The researchers from this 2017 study noted: ‘we cannot rule out the possibility that infants who develop more autistic traits or ADHD symptoms during early childhood behaved in ways that incited their mothers to stop or reduce breastfeeding.’”
5) Positive impact on your child’s IQ
There's evidence that infants who are breastfed into their 2nd year have higher IQs. At around a year, when babies are experiencing a period of rapid brain growth, a mother's milk changes to have a higher fat content. A lot of that fat is in the form of triglycerides. Triglycerides form the main ingredient in myelin, the fatty sheath that coats the axon of a neuron and speeds up the transmission of messages from one neuron to another.
Here’s a study from Brazil linking duration of breastfeeding with IQ:
http://www.thelancet.com/journals/langlo/article/piis2214-109x(15)70002-1/abstract
And a more recent study: https://www.ndph.ox.ac.uk/news/new-study-finds-that-breastfeeding-directly-supports-children2019s-cognitive-development?fbclid=IwAR3tOjMPueDcQbT48uWrWXLGeb6aLbN_ri6P3Vn9PHDj3EoCpC4umPmMnQs
6) Health protections for you of continuing to breastfeed
There are also massive health advantages to mothers of continuing to breastfeed past 6 months. The protection against many of the ‘female’ cancers (breast, ovarian, uterine and endometrial) is dose-related, so the longer a mother breastfeeds, the more protected she is. And breastfeeding decreases the chances of women developing type 2 diabetes, osteoporosis and heart disease:
TEDMED - talk details - how mothers can nurse themselves healthy
7) Less time off work for you
Working mothers will need to take less time off work if their child is breastfed due to the immunological protections in breastmilk, so employers and the economy benefit too.
In her book Supporting Breastfeeding Past the First Six Months and Beyond, Emma Pickett writes: “In a 1995 study of parents returning from maternity leave after an uncomplicated birth: ‘Approximately 28% of the infants in the study had no illnesses; 86% of these were breastfed and 14% were formula-fed. When illnesses occurred, 25% of all one-day maternal absences were among breastfed babies and 75% were among the formula-fed group. (Cohen, Mrtek and Mrtek 1995).”
8) Emotional and hormonal benefits for you
A client called Natalia commented to me: ‘There is something I’ve noticed from my breastfeeding experience: I don’t know if there is any research on this, but I feel that the milk production hormones improve my mental health, and help me to tackle frequent night feeds, physical tiredness, lack of socialising, and other motherhood challenges! I would really like to keep this little help from Nature for a bit longer, so I hope I will be able to keep breastfeeding until 1 year and beyond.’
I replied that there is indeed research that shows that oxytocin and prolactin, the two main hormones involved in milk production, are mood enhancers. Prolactin, the hormone that creates milk, induces calmness & relaxation & helps with bonding; oxytocin, the hormone responsible for the let-down reflex, causes the contractions of orgasm, birth and lactation. Often called the hormone of love, it promotes feelings of love, bonding and well-being, and increases trust and empathy. It also increases one’s tolerance of monotony, which is very helpful for new parents.
9) Breastfeeding as a mothering tool
Above all, breastfeeding is the most brilliant mothering tool. It’s a lovely way for a working mother and her child to re-connect at the end of the day. One couple I know compared breastfeeding their toddler to using the ‘re-set’ button because no matter how worked up their child was, just a brief moment at the breast was enough to calm him down. I’ve seen toddlers in the playground fall over, run to their mother, have a quick breastfeed, wipe their tears and run off to play again. Breastmilk is full of calming hormones, as well as endocannabinoids, which are natural painkillers. These calming hormones can also help mothers feel less anxious about leaving their baby when they go back to work.
Many women worry that continuing to breastfeed when they go back to work will be a burden on top of an already busy working week, but it can be a wonderful way of reconnecting with your child after hours spent apart, and by far the easiest way of pacifying an upset child. Mothering through nursing is a kind of superpower. As one mother puts it: “It’s how I reconnect with him after a long day apart, I sit at night in a dark room and feed him to sleep. It’s one of my favourite parts of the day.”
The Association of Breastfeeding Mothers produced this document for breastfeeding mothers to share with their GPs:
This document from the ABM gives information for GPs about breastfeeding past infancy:
The difference between introducing solids to a breastfed baby and to a formula-fed baby
Because it’s not common in the U.K. for older babies still to be breastfeeding, many doctors and health visitors aren’t familiar with the differences between breastfed and formula-fed babies. If a baby is formula fed, it makes sense to drop formula milk feeds as the baby approaches the age of 1, because formula is just a food; a food which is processed and doesn’t vary at all in its ingredients. Therefore, it’s a good idea for a baby who is being formula fed to have a good variety of solid foods in their diet by the age of 12 months.
But breastmilk is a dynamic human fluid, that constantly changes and adapts; in fact, it’s personalised medicine. In addition, according to the breastfeeding network (BfN): “Breastmilk is a major provider of protein, vitamins, minerals, essential fatty acids and protective factors. It provides more calories and nutrients per millilitre than most of other foods, and much more than the soft cereals, baby rice or pureed vegetables that are typically some of the first foods given to older babies. If babies’ stomachs are filled with nutritionally poor foods, they will take less breastmilk and their overall diet and health will be inferior. The contribution of breastmilk is often overlooked in the enthusiasm to get complementary feeding started. The challenge is how to feed other foods so that they add to the nutritional contribution of breastmilk, rather than replace it.”
It's worth bearing in mind that there are 22kcal per fluid oz of breastmilk, 20kcal per fluid oz of formula, and only 7 kcal per oz of puréed carrot.
https://kellymom.com/nutrition/starting-solids/babyfoodcalories/
UNICEF calls introducing solids ‘complementary feeding’ because solids are supposed to complement, ie complete what a baby is getting from breastmilk, not replace it. All of this is to say that if you are breastfeeding an older baby, there is absolutely no need to ‘drop’ any breastfeeds. If you wish to, you can continue to breastfeed your baby ‘on demand’ when they are with you.
If older nurselings are allowed to take the lead, there tends to be a big variation in the age at which they start to decrease their breastmilk intake, but it’s rarely before 12 months. It helps to remember that up until around 12 months, solid food is mostly about play and experimentation, and breastfed babies should still be getting the majority of their calories from their mother’s milk. The brilliant thing is, older babies and their mother’s milk supply are very flexible.
How to do it?
Many women don’t realise how useful and beneficial it can be to continue breastfeeding past 6 months and have no idea of all the benefits of continuing past 12 months. It’s such a shame that just when breastfeeding becomes so easy and convenient, and just when a mother’s breasts are able to go much longer periods without having milk removed, many women think it’s time for them to start winding down and dropping feeds. And when mothers do continue to breastfeed, they tend to spend the last few months of their maternity leave worrying about how their baby and their breasts are going to cope when they return to work.
In the 13 years I’ve been an NCT Breastfeeding Counsellor, I’ve spoken to dozens of mothers of older babies who are massively worried about how to manage breastfeeding when they go back to work. As my client Sophie Lessar says: “I got unnecessarily worried about managing breastfeeding and the return to work first time and the message I’d give to other mothers is ‘Don’t waste your energy!’
Many mothers think that they will either need to pump at work or stop breastfeeding. In fact, at this later stage, breasts and babies adapt in the most magical way. Take the example of my colleague Kathryn Stagg (ABM breastfeeding counsellor, IBCLC and mother of 4), who went back to work when her third baby was 6 months old. Kathryn was very worried, because her baby refused to take a bottle. She discovered that on the days she was at work, her baby coped fine with solids and water. He made up for lost time by breastfeeding lots when they were reunited. This behaviour is known as reverse cycling:
https://kellymom.com/bf/normal/reverse-cycling
Another concern many mothers have is that if their baby isn’t feeding much during the day when they go back to work, they will wake more at night. In fact, babies often wake more at night once their mother goes back to work because they miss her, and it’s their time to reconnect. Breastfeeding provides a very easy way of both reconnecting and helping a baby go back to sleep. Fully formula fed babies also often wake more when their mothers go back to work, but it can be harder to coax a baby back to sleep without the magic power of the boob.
On the days Kathryn wasn’t working, her baby breastfed ‘on demand’ throughout the day. She said it was as if her breasts knew which days she was at work. Initially she pumped when she was at work, but soon realised there wasn’t any point, as her baby wouldn’t take a bottle.
If a mother starts to feel uncomfortably full when away from her older baby, and she can’t or doesn’t want to pump, she can hand express to relieve the pressure, but most women say they only need to do this for the first couple of days, and then their breasts adjust. Some mums do choose to pump, but it’s not essential.
Here’s what Elizabeth Foote, ABM mother supporter and mother of 2, says: “I went back with my first at 12 months. My little one never seemed to 'drop' a feed and would happily feed every couple of hours when I was with her, but would go hours and hours without when I wasn't. I chose to pump once per day when away but only because I was away 12-16 hours per day and leaving behind 100ml or so made me feel a bit better about it! But it wasn't really necessary. As she got older, I realised she would always want it more frequently if it was available but was fine without for a long time as well. Boobs just adjust and seem to have supply even when you have been gone for a while. Baby just takes more in one go.”
In addition, Elizabeth says: “It is understandable for mothers to be confused as we live in a formula-feeding dominated country, but the thing to remember is that breastfeeding is nothing like having formula. At 12 months, a child will ask for the breast much more frequently than they need from a nutritional perspective, because they are also using the breast for a whole bunch of other reasons (comfort, attachment to mum etc - all of which are fine by the way). So many children will have small amounts of milk throughout the day as a result. However, it is perfectly fine for them to have larger amounts of breastmilk less frequently. Going 10-12 hours without breastmilk in the day is no different to an older baby sleeping through the night and not feeding for that length of time.”
When to go back to work
Many women don’t have a choice about when to go back to work, but if you do, it might be worth bearing in mind that nine months is when many babies are experiencing a particularly intense period of separation anxiety, whereas 12 months often marks a bit of an independent streak. So, a mum who is going back to work at 12 months might worry a lot about how her baby is going to cope but find that things are much easier by the time her baby is a year old.
After 12 months, a breastfeeding mother’s supply should be well established enough to sustain (for example) just morning and evening breastfeeds.
Cow’s milk
From 12 months, it's fine to give babies full-fat cow's milk as a drink, preferably organic, unless they have a dairy allergy or intolerance. (Over the age of 12 months, no baby needs formula). Of course, it’s also fine to continue breastfeeding for as long as a mother and her baby want to. (N.B. cow’s milk can be used for cooking from 6 months. However, even after 12 months, it’s not recommended to give cow’s milk as a drink at meal-times, as cow’s milk impedes the absorption of iron.)
Please bear in mind that if a child is having breastmilk at least 3 or 4 times in 24 hours, or other dairy products, or other calcium and fat-rich foods, there is no need at all for them to drink any cow’s milk. Cow’s milk is just a convenient source of calcium, protein, fats and vitamin D. There are many people in many parts of the world who do not drink cow’s milk and still manage to get all the calcium, protein, fats, vitamin D, etc. they need.
https://kellymom.com/nutrition/starting-solids/toddler-foods/
Mums’ experiences of going back to work:
Mothers who don’t pump:
Rachel Winifred: “I went back to work at 9.5 months with baby not really taking much solid food and breastfeeding every 2 hours day and night. I sent her to child care with expressed milk and she didn’t touch the stuff and she was totally fine. She drank water from a sippy cup non-stop.”
Anonymous: “I went back to work when my baby was 11 months. I really didn’t want to pump at work (i’m lucky if i get 15 mins to grab a sandwich), but reading about others’ experiences gave me the confidence that my baby would be fine without the boob while i was at work. I leave him for 8 hours, and he’s perfectly happy. I haven’t noticed him reverse cycling anymore than he always did - he’s always night time snacked anyway. He has started to eat more food though - he can pack away a roast chicken dinner quite happily! In a couple of weeks i’ll let him have cow’s milk at nursery too, so all in all it’s worked out really well. I’m glad i didn’t spend time worrying - babies really are very adaptable!
Mary Keogh: “I went back to work two weeks after Róisín turned one. My company maternity policy allows a phased return to work after maternity leave, to allow mum and baby a chance to adjust gradually. I took advantage of this, and although I have only returned 3 days a week, I gradually increased my hours over the first four weeks, only working 5-hour days during my first week back. I was away from her for about 7 hours in total including travel time. Róisín has never had a bottle, and wouldn't drink expressed milk from a cup on the couple of occasions we've attempted it, so I didn't leave any milk for her while I was at work. I think my mum (who looks after her) would have preferred to have milk to give her, but i don't want her to drink cow’s milk, she's never had it before. She just had food and water while I was away, and was fine with it. We saw a step change in her solids intake, she began eating more on my working days. She still breastfeeds on demand on non-working days, sometimes as often as hourly! I bought a manual breast pump before I returned, but the shorter days in the first weeks meant I never felt I needed to use it. I was certainly very full by the time I got home each day, but Róisín was keen for a big feed as soon as I got home, and drained each breast. My body quickly adjusted, and even as I increased my working hours each week, I didn't feel the need to pump at work. She's 15.5 months now, and still likes a big feed as soon as I'm home from work. She pats the sofa to let me know that I need to sit down to feed her. Róisín and I bedshare, and I found this particularly useful when I returned to work. She has always woken at least 3-5 times during the night, and I don't remember the frequency changing dramatically once I was back at work. When she wakes, I don't have to get up, I just turn to the side and help her find a boob, then I can go back to sleep while she feeds, so it is possible feeds went on for longer, but I didn't notice. I think the hardest bits about returning to work haven't been breastfeeding related. Finding a routine that works morning and evening has been difficult, and even now I'm still not sure we have really nailed it. Bed sharing has some downsides as I’ve struggled to work out how to get ready while she sleeps. She wakes if i try to move her to a cot, and I worry about leaving her in the bed alone. I now put a pillow lengthwise next to her when I get up, which I think sometimes fools her into thinking I'm still there when she reaches for me, and also stops her rolling out of bed. We've also stuggled with late naps and late dinner, but I think we're getting there gradually!”
Sophie Buxton: “I went back to work when my first was 13 months, I didn’t pump at all or leave any milk during the day and fed him twice a day. He fed from the minute we got home at 6pm until I unlatched him for bath time at 7, and then didn’t feed again until he woke at 5am. But then he would cuddle and boob until i unlatched him at 7am to get ready for work. It really helped us both handle the transition.”
Lan-lan Smith: “I went back to work a couple of weeks before my son turned one. I knew he was a good eater so decided to not express at all. He now feeds first thing in the morning when we get up around 6:30, and I feed he as soon as we get home from nursery (around 17:30). He then has some more boob time when getting him to bed at 7/7:30. He still wakes up several times during the night, which is no different from before I went back to work. We co-sleep and I usually feed him back to sleep around 22:30, 1:30, and 3:30. The feeds are never that long, between 5-10 mins. I should add that it didn’t take long for my breasts to adjust, there was some feeling of fullness my first week back, but things settled down pretty quickly.”
Stacey Zimmels: “My son is 16 months-old and no longer wakes in the night. I work and he feeds just twice a day on those days and maybe three times on the days when i am around. He has cow’s milk protein allergy and won't drink any other milk (as demonstrated when I wasn't there for bedtime for the first time recently and he refused to drink oat milk). I have no plans to stop breastfeeding him and will continue to follow his lead.”
Pumping rights in the UK (we don’t have any)
Unfortunately, in the UK, there is no law protecting a breastfeeding mother’s right to pump at work, so what kind of facility is offered is at the discretion of her employer. The more that women request pumping facilities, and insist that the room is clean and can be locked, the more this will become the norm for all breastfeeding mothers when they return to paid employment:
https://www.nhs.uk/conditions/pregnancy-and-baby/breastfeeding-back-to-work/
The NHS on going back to work and pumping: It's up to mothers to decide how long they want to breastfeed. Returning to work doesn't mean a mother has to stop. Before returning to work, she should give her employer written notification that she's breastfeeding. Her employer must then conduct a specific risk assessment. Workplace regulations require employers to provide suitable facilities where pregnant and breastfeeding mothers can rest. The health and safety executive (HSE) recommends that it's good practice for employers to provide a private, healthy and safe environment for breastfeeding mothers to express and store milk. The toilets are not a suitable place to express breast milk.
Breastmilk storage information: https://www.laleche.org.uk/storing-your-milk/
Mothers who pump
Asli Guner: “I went back to work full time with one day working from home when my baby daughter was 8 months old. She has been and is still exclusively breastfed. She used to take a bottle when she was 3 months old as we were topping her up with expressed breastmilk but then she started refusing to take it. I pump twice a day in the office every day for the following day and freeze the excess. I breastfeed her in the morning when I wake up and as soon as I come back home. When I am around, she is being breastfed on demand. But when I am in the office, she doesn’t take much milk (between 100-200ml throughout the day until I get home) from a bottle or sippy cup. We add breastmilk to her porridge/fruit and let her eat by herself. She drinks water with food and catches up mainly in the evenings and at nights. Bedsharing helps me a lot as I don’t fully wake up whilst breastfeeding her and it is the best way for me to catch up with her! Based on my experience mothers do not need to worry as babies set their own routines one way or another and they lead you the best!”
Ellie Gordon: “I went back to work full time when son was 7.5 months. I actually had enough leave to take Thursday off each week, so it was four days a week in reality. But I work early so it was from 6.30am to 5.30pm every day, so long days. By that time, he was roughly feeding once at night and four times per day. I had always ensured he took a bottle of expressed milk. Unlike other babies I’ve heard about, he didn’t suddenly stop having milk when I wasn’t there and pretty much stuck to his “routine”, which was having a bottle at around 10am and around lunchtime. When I got home, he would be having dinner, so I wouldn’t feed him until after bath and before bed (around 7pm). So for him not much changed. But for me it was hard. I had to pump twice a day at work which really cuts into your working day. However understanding colleagues are, it feels like you are “swanning off” twice a day. I often used to work whilst pumping as the mothers’ room has WIFI signal. I would sometimes find myself getting blocked up so I would have to try to nurse him lots those evenings to clear the blockage. It’s pretty tough but worth it. He’s thriving and I am really enjoying being back at work and using my brain. As with anything as a mother there is lots to feel guilty about but overall, I feel I just about manage the right balance.”
Laura Backhouse: “I went back to work 3 days a week when my little girl was 11 months. She’s breastfed and feeds frequently, in addition to eating well and having water. I send her to her childminder with one bottle of expressed milk a day (now a sippy cup, since she turned 1) and she often doesn’t drink all of it - she drinks lots of water and eats well. I have had some long evenings of breastfeeding though, as she makes up for it when I’m home.”
Anonymous: “I went back to work when my baby was 18 months after extended maternity leave. By that time, I wasn’t worried about my supply or his thirst or hunger needs as fortunately he really took to baby led weaning and has always eaten plenty of solids and drank water, though no milk. As I had hoped there was never a problem with eating during the day and thankfully, we found a wonderful nanny who fully got BLW and let him to continue to eat what he wanted. But what i was really worried about was the emotional side of things and how he would cope being away from me given he’d spent every day of his life with me up until that point. The thing that 100% has helped the most, as well as a long and gentle settling in process, was breastfeeding at end of each day and through the night. It helps us to cuddle, chat and reconnect; it gives me 10 minutes chill time when I get in; it gives him a chance to process what’s happened in the day. So often I watch his eyes while he’s feeding, and you can almost see the cogs whirring as he’s working stuff through. He’ll pop his head up and tell me something “we saw the goats this morning”; “had pasta for lunch”; “I got upset on the bus” etc and that’s an entry point for us to talk about things that I’d otherwise have no knowledge of. I cherish that so much, and the cuddles.
I feel conflicted about night weaning now I’m back at work - sometimes I feel it would be a good idea for him / us and then I’m not so sure. He’s always fed a lot at night and this hasn’t changed, and breastfeeding has been a godsend during the illnesses, teething and sleep changes. There have been several weeks of 3 days of 3am starts and back to back meetings and I coped! I honestly wouldn’t have imagined it would be possible to function but somehow you do, you find the stamina and the horror is forgotten the next week. And I know if I hadn’t had the boob those nights would have been a helluva lot more difficult. Slowly I’m aware of his sleep improving - longer first stretch, fewer wake ups. That’s just the way he is, and I’m convinced he’d be the same with or without the boob! Until we reach a tipping point, we won’t night wean, but that’s not to say that won’t be next week. We remain flexible and open. I can’t believe I’m breastfeeding a just turned two-year old. It was only meant to be a year but somehow it just happened!”
When baby won’t take a bottle
It’s not uncommon for breastfeeding mothers to get extremely worried about going back to work because their breastfed baby won’t take a bottle. If a baby won’t take a bottle, from around 4 months, there is the option of giving them expressed milk in an open cup or a sippy cup:
Annick Sawala: “I went back to work at 6 months. From around 4.5 months we tried out various bottles to see if my daughter would be able to drink small amounts of EBM out of them, in preparation for me going back to work, but she never managed anything. We then tried a Doidy cup and a Tommy Tippee Essentials cup and both of these worked more or less. Cup feeding was a bit messy especially in the early days of me going back to work, but my daughter managed to drink about half to two thirds of the 500-600ml I pumped at work (2 sessions). This plus some reverse cycling was plenty to keep her going while she was also slowly starting with BWL from 6.5 months. I stopped pumping altogether at 12 months.
My husband took 6 months of parental leave when I went back to work (so from 6-12 months) and my daughter only started nursery when she turned 1 - so there was no need to do the cup feeding in nursery.”
Mothers who have night weaned
Night weaning is not recommended before 12 months. Dr Jay Gordon has a good explanation of how to night wean in a gentle and kind manner:
http://drjaygordon.com/attachment/sleeppattern.html
Please bear in mind that babies who are night weaned might continue to wake at night.
Rachel Winifred: “I work 8.30am to 4pm three days a week and have done from her being 10 months. I night weaned at 13 months and still feed all day when with her and before and after my work day. My daughter never took a bottle or cow’s milk at nursery and is absolutely fine with just water and solids. It’s working so well! Totally doable and brilliant and rewarding.”
Sophie Lessar: “I am out of the house 8am to 6pm, 4 days a week and I night weaned at 12 months. I feed morning and evening on working days and maybe one other feed a day on days I’m not working. I did this for baby 1 and baby 2. I know others who continue to feed more with that working pattern. It works well for us. Night weaning doesn’t stop night wakes but did mean I’m not the only one managing them (we worked on sleep associations etc - my husband has been heavily involved). Actually my 3 year old (who is no longer breastfed) still wakes up in the night occasionally. My friend’s formula fed baby slept through until she was 1 and then slept atrociously from 1-2! My daughter has some cow’s milk in the day, or balanced healthy snacks. She has yogurt and cheese and of course there are non-dairy sources of all the relevant vitamins etc. I got unnecessarily worried about managing breastfeeding and the return to work first time and the message I’d give to others is don’t waste your energy!”
Rebecca Bryant: “I work 8am to 4:30pm, night weaned at 13 months and still breastfeed morning and bedtime. My daughter is now 20 months old. She will also drink the odd cup of cow’s milk during the day. Night weaning never resulted in sleeping through the night for us. She still wakes once or twice but usually falls back to sleep by herself unless she’s ill or teething.”
Sujatha Krishnan-Barman: “I went back to work when my daughter was 11.5 months old and night weaned just after she turned 12 months. We still breastfeed morning and night (I work 9.30 am to 4.30 pm) and on the days I am home I also feed her usually once more during the day when she wants it. It has meant that my boobs have lost one of their magic powers of being able to put baby to sleep, but they can still miraculously calm her (during teething and jabs and illness and long flights etc) and it’s enabled me to continue breastfeeding while getting some rest and keeping sane. It has worked for us as a family. If the choice is giving up breastfeeding versus night weaning, I’d recommend night weaning and continuing to breastfeed. I never got on with co-sleeping, and 12 months of intense sleep deprivation was having a strong negative impact on my life. We still have the occasional night wake up - usually when she is unwell or teething or jet lagged and we just give loads of cuddles and rock her etc or sometimes just start our day at 4.30 and make up for it with a nap. But by and large we are getting long stretches of sleep most nights.”
How will childcare providers settle your breastfed baby?
Something else that many mothers worry about a lot before going back to work is how someone else is going to manage to settle their baby to sleep. Many breastfed babies will only fall asleep for their mothers if they are being breastfed, pushed in a buggy, or carried in a sling. But the amazing thing is that the vast majority of babies and toddlers will fall asleep pretty easily when others are caring for them.
Maya Freedman: “My youngest is 18 months and at home he won’t fall asleep unless breastfeeding or being in the buggy/car. He has been at nursery since he was 12 months and they lie him down in the cot, rub his back and he drifts off - happy as anything. His key worker was genuinely surprised when I said that doesn’t work at home!”
Jess Steinberg: “I was really concerned about how my daughter who started nursery just before she turned one was going to nap. Straight away the nursery staff were able to get Leah sleeping during nap time. She is now two and I still have to breastfeed her to get her to nap when she is with me at home. She also naps longer at nursery. I don't know how they do it - a mix of magic and peer pressure I think.”
Caroline Plugge: “My nursery were totally unphased when I said he couldn’t sleep without suckling (he started nursery at around 20 months). They said they would try anything to get him to sleep if he was tired: sling, pram, singing, cuddling, stroking, walk outside etc. His key worker ended up cuddling him, then laying him down and stroking him and he felt very calm and peaceful and slept well. On wake up she would cuddle him again. They were so understanding, kind and dedicated.”
Melanie Montanari: “I was also worried about this - Jamie has never slept in a cot in the day - he’s a boob or buggy man. From day 1, Jamie fell asleep at nursery via a cuddle - at first, he would wake when they tried to put him down but he’s started to now sleep on a mattress after a short cuddle. I would say my only advice is to choose a lovely nursery - the main reason I chose mine is because they said they were happy to do whatever Jamie needed to sleep, and they will happily hold him for an hour if that’s what he needs. But to summarise, babies are very pragmatic, and they’ll make do when mum isn’t around!”
Sujatha Kristhnan-Barman: “I was very worried about it, but while spending a month visiting my parents I realised every person gets her to sleep differently. Even my dad managed to get her to sleep by holding her and gently singing ‘twinkle twinkle little star’ for ages until she drifted off. When our nanny started, she was unfazed by it and just gave her lots and lots of cuddles and rocked her and soon she started sleeping well for her. All her caregivers (me, my husband, nanny, my mum) have different strategies and she responds well to all of them when done by that person.
Lan-lan Smith: “I was also really concerned about how he would sleep at nursery since bedtime always involved a lot of boobing, rocking and singing and daytime naps were mostly in the pram. Apparently at nursery they just lay him down and pat his back and he falls asleep, iIm amazed.
Anonymous: “My experience is a bit different...my now 3-year old was challenging with sleep at home. She would only sleep either after nursing for a long time or in the pram; however, once I got her to nap, she would do so for hours. My husband was never successful in getting her to nap and my mum (the only other caregiver) had mixed results so I was very nervous when she started nursery at 12 months. Much to our surprise she responded well to their techniques when done consistently (for example care worker no 1 rubbed her back whereas care worker 2 held her hand), but she would only sleep for very short periods (30 min) and would wake-up screaming. They eventually discovered she slept better in the tee pee alongside a particular friend.”
Francesca Harvey: “Until recently I always fed my son to sleep unless he was in the buggy. My husband managed to get him to sleep by rocking him. He started nursery when he was 14 months old and they have managed to get him to sleep pretty well. My experience is that how my son is with me gives little or no clue as to how he will be with someone else in the same situation. When he's near me and my milk, he behaves totally differently and there's just not that dynamic in a childcare set up, so he sleeps well without me.”
Raksha Raghavan: “My daughter went to nursery at 13 months, and just like many others she would only ever feed to sleep. But I was amazed when on day 1 of me being away during settling week, she was laid down in a cot, patted on the back, and went to sleep in a few minutes. The next day I asked if I could witness this phenomenon as I really didn't believe them. I saw it with my own eyes (stealthily peeking through the door after my daughter thought I've left). By 16-17 months she was putting herself to sleep; she would just go plonk on her mattress at nap time and sleep. No such luck at home even at 3 years now.”
Alexandra: “I’ve always feed my 17-month-old to sleep, including when he wakes during the night. My childminder told me yesterday though that when Patrick is ready for his sleep in the afternoon, she just puts him in the buggy, gives him his rabbit, says "sleepy time Patrick" and he shuts his eyes and goes straight to sleep. Evidence that feeding to sleep definitely does not prevent a child from falling asleep any other way with another caregiver!”
Conclusion
I hope this article will reassure you that it is possible to continue to breastfeed your child when you go back to work, and that challenging as that return can be, breastfeeding is one aspect you don’t need to worry about; both your breasts and your nursling will usually adjust to the new routine more easily that you imagine. In fact, continuing to breastfeed can make the separation easier, as it provides a truly wonderful way of reconnecting at the end of the day. As Mary Keogh says: “she's 15.5 months now, and still likes a big feed as soon as I'm home from work. She pats the sofa to let me know that I need to sit down to feed her.”
Links:
Emma Pickett’s Supporting breastfeeding past the first six months and beyond:
Prof Amy Brown spoke to mothers breastfeeding past infancy: https://sway.office.com/RDNSWWX1oUeUcXDL?fbclid=IwAR3b6RBeVd3wLqEnNSM2PnxGvs6hOA0hPDmkvu3rNIcTOlDsDrb5jUJ3vn0
http://kellymom.com/ages/older-infant/ebf-benefits/
http://kellymom.com/bf/normal/toddlernursing/
Canadian paediatrician Dr Jack Newman: http://whale.to/a/newman.html
Why Would You Breastfeed a Child Who's Old Enough to Ask for It? • Motherhood and More