Multi-part issue...breastfeeding, immunity, cognitive abilities...

[2boyzmama]

**Cross posted in breastfeeding past infancy**

Connor just turned 3. Cognitively he seems to be where Ian was between 18-24 months. Behaviorally he's entered what most people call the "terrible twos" (just recently started telling me "no", has begun hitting his brother, is throwing his version of tantrums, is becoming more demanding in general, etc). His verbal expressive is about 18 months, his signing expressive is about 36 months.

So that's where he is developmentally.

He is still nursing. I love nursing him sometimes, I tolerate nursing him sometimes, and then there's the times when I <not hate, it's such a strong word I dont' like to use it, but something almost as strong as hate> nursing him.

The "don't offer/don't refuse" method of natural weaning is out of the window already, I have declined many times recently, usually because he is using nursing as a bargaining chip (He doesn't want to eat his dinner, he wants to nurse. He doesn't want to go to bed, he wants to nurse. He doesn't like that I said no, he wants to nurse. He doesn't like that I am on the phone, he wants to nurse...you get the idea)

I have no issues with nursing him when he's tired, when he's sick, when he's hurt, when he's scared, whatever. If it's a true *need* then I'm there if I can be. But if it's bratty behavior (because let's face it, sometimes it is) then I tell him no mommy milk, and we discuss his infractions instead.

This is where his delays are so hard! Supposedly his receptive communication is age-appropriate, but sometimes I just don't know! And I sometimes can't tell if his verbal or signed responses are just him parroting, you know? So I'm working so hard with him to outline accepted behaviors and responses (i.e. we do not hit our brother, we use our words or signs, you need to say 'brother I'm sorry I hit you') but I don't know if I'm really getting through or not. (in the above example, Connor would probably refuse to apologize, whining that he wants to nurse instead. I'd insist, he'd finally say/sign sorry to his brother, then continue to whine to be nursed) (another example...he asks for a piece of candy, I say no because I'm making dinner. He starts to throw toys around the kitchen because he's angry. I tell him we don't throw our toys, and I make him help me pick them up. He asks to nurse. I tell him no, first we are going to pick up the toys, then mommy's going to finish making dinner. In this case he doesn't "need" to nurse, he's just angry because he can't have candy.)

[for those of you who dont' know Connor...he has a chromosomal deletion that leads to multiple medical issues. Common in this syndrome is mild mental retardation, severe learning disabilities, severe speech issues, and sometimes severe behavioral issues. We don't see any significant signs of anything other than slight delays right now...]

Okay...so the point of this...if he were a "normal" child, I'd be more steadfast in my boundaries, setting some limits when it comes to nursing (he's responding pretty well to a count-down now, after weeks of us practicing it together). BUT...he's not a normal child. The biggest issue is his immune system (primary immune deficiency). He desperately NEEDS the immunities from my breastmilk. He also really needs the fat/calories (he only weighs 25 pounds).

So what do I do? He's got me stuck between a rock and a hard place. Normally I would be getting more strict about his behavior, but it can't be at the expense of taking away breastmilk. [and I hate pumping, although I am a "good" pumper, so I could give him expressed milk, but honestly don't want to pump any more often than I do when I'm at work]

He needs the immunities, he needs the fat/calories. But I need him to understand boundaries, behavioral expectations, etc. I used to say that if he nurses until he's 5-6 that would be GREAT, but right now I can't fathom continuing to nurse him for that long! I know that some of this behavior will ease, but it's getting through these next 6 months or so, this stage where he is making cognitive leaps, this stage where willful disobedience is abundant, this stage where I want to wring his neck often!!

[queencarr]

I get you on the calories, it was one of the reasons I nursed Jimmy so long (not nightweaning was the alternative to a feeding tube for nightime calorie supplementation until he could eat more normally). But behaviorally, you are setting up a pattern, it sounds like, of food to solve problems and avoid issues, which is probably not so good. He is very concrete, as opposed to abstract, right? Would some kind of nursing schedule work? If you count up the time nursing that you are doing now, so you could approximate the same amount calorie wise, could you do something like a dedicated morning, afterschool, and bedtime nursing time? Then your answer to the avoidant behavior could be "It's not time right now." I would sometimes use that to delay Jimmy a few minutes, during which time he would often forget he wanted to nurse.

[2boyzmama]

I think you're right. I know that I created this...we have been so focussed on everything health-related, behavior took a back seat. And I never said no to nursing--NEVER! It was just too important to his overall health. Same thing with food...there were never any rules about food, if he ate we were thrilled, because his weight has been such a focus. But now we're focussing more on routine and structure, and making sure that the same rules apply to him. Which means that sometimes he goes hungry if he chooses not to eat what I make for him, and no I won't let him just nurse to fill his tummy. It's a really hard transition, because we've been so lax about it all until now. But he's having to learn that household rules apply to him now.

And I don't feel the least bit of guilt about this. It's not like I'm sleep training a 6 week old, he's THREE.

[queencarr]

Oh, I hope that didn't come off as criticizing! My youngest does similar with a bottle, or asking to go potty, to avoid issues I think it is part of toddlerness I am the terrible mother whose almost 3yo is still on a bottle (and at night!!), because I am still operating on the don't ask/don't refuse policy, plus it is still hard to safely swallow enough liquid from a cup or even sippy. I have been recently doing the its not time a little with him (more like--I don't have one made, you have to wait, during which time he moves on) I think at ours kids age, it is perfectly fine to start some reasonable limits and boundaries, health issues or not. One of the things we actually had to do foodwise for my oldest was to intentionally make meals not as friendly to him and let hunger eventually override his dislike for certain textures (this was once we had established to him what hungry was and how to satisfy it at all). I didn't do foods he absolutely hated, but I did do the not favorites. I think we started that about 2 1/2-3y. Good luck on figuring out a way to make it work.

[Linda on the move]

Hello! I'm going to cut and paste and put together different things that you said:

[QUOTE=2boyzmama;15268251He is still nursing. I love nursing him sometimes, I tolerate nursing him sometimes, .....He needs the immunities, he needs the fat/calories. [/QUOTE]

It sounds like you are not interested in really weaning him at this time. You are ok with continuing to nurse and see its importance.

and then there's the times when I <not hate, it's such a strong word I dont' like to use it, but something almost as strong as hate> nursing him. ... I have declined many times recently, usually because he is using nursing as a bargaining chip

It also sounds like you are not OK with the exact way that nursing is going. You are wanting to nurse less (which is totally normal and reasonable!) and you don't want him to use nursing to get out of things like going to bed or because you said "no".

Because of this, you've been setting boundaries. Do you have set times that he always nurses? Like always at bedtime? Or is nursing always a judgment call?

I have no issues with nursing him when he's tired, when he's sick, when he's hurt, when he's scared, whatever. If it's a true *need* then I'm there if I can be. But if it's bratty behavior (because let's face it, sometimes it is) then I tell him no mommy milk, and we discuss his infractions instead.

this all sounds reasonable.

This is where his delays are so hard! Supposedly his receptive communication is age-appropriate, but sometimes I just don't know! And I sometimes can't tell if his verbal or signed responses are just him parroting, you know? So I'm working so hard with him to outline accepted behaviors and responses (i.e. we do not hit our brother, we use our words or signs, you need to say 'brother I'm sorry I hit you') but I don't know if I'm really getting through or not. (in the above example, Connor would probably refuse to apologize, whining that he wants to nurse instead. I'd insist, he'd finally say/sign sorry to his brother, then continue to whine to be nursed) (another example...he asks for a piece of candy, I say no because I'm making dinner. He starts to throw toys around the kitchen because he's angry. I tell him we don't throw our toys, and I make him help me pick them up. He asks to nurse. I tell him no, first we are going to pick up the toys, then mommy's going to finish making dinner. In this case he doesn't "need" to nurse, he's just angry because he can't have candy.)

I understand that his delays make this harder, but I still think that *not nursing* in these situations is the right thing to do in your case. Pretty much all kids get angry/annoyed, and just like any other child he has to learn that he doesn't always get his way and that nursing is the answer to every problem. It may be harder for him to understand that, it may take more time, it may happen at an older age, but he still has to get there.

(in the nursing at dinner time option, giving him a healthy snack would be another option)

The biggest issue is his immune system (primary immune deficiency). He desperately NEEDS the immunities from my breastmilk. He also really needs the fat/calories (he only weighs 25 pounds).

Would it be possible to think through how many times a day would be ideal for him to be nursing, and then schedule them. I know it sounds backwards on Mothering to say to schedule nursing, but since he needs to breastmilk for his health but Bfing on demand is bad for his behavoir, it seems like a reasonable option.

One thing about practicing APing with a sn child that really gets to me is that my ideals about how things *should* go often aren't in line with reality. We have to be really lax about some things some times while working on something else, then we have to go back and play catch up. I have stuff like that my DD, too. It's different stuff since she's 10 years older, but I can really relate to how you feel about this.

[2boyzmama]

Thank goodness you guys understand! I'm actually a LLL leader, it's supposed to be my job to counsel other moms who are having trouble nursing toddlers. But there are facets of this that just aren't typical.

Queencarr, you weren't criticizing at all! In fact it's nice to see that you were in this same boat with Jimmy, and now with your 3yo (I forget his name...Noah?? sorry!)

Linda, you're exactly right that I don't want him to wean, and that I've been trying to set boundaries and reasonable expectations. It's just harder to explain those boundaries and expectations when I'm not sure of his cognitive level. It was relatively easy to set boundaries with Ian, explain it to him, talk him through something, etc. Maybe I don't give Connor enough credit. He's just so much farther behind where Ian was at this age.

[Linda on the move]

Originally Posted by 2boyzmama

It's just harder to explain those boundaries and expectations when I'm not sure of his cognitive level. It was relatively easy to set boundaries with Ian, explain it to him, talk him through something, etc. Maybe I don't give Connor enough credit. He's just so much farther behind where Ian was at this age.

I think that for small children, sometimes they don't totally understand what we are saying. We say (or sign!) it, stuff happens, and the next time the same thing happens and we say the same thing again, it make more sense. I think that process is part of how they figure language out. So, even if he doesn't totally understand right now, going through the motions is how he will learn.

It just sucks. It really, really does. It's really not fair that to learn he is unhappy. It's not fair that it's harder for him.

I think that part of *giving him credit* is having faith that he will figure it out, that this is just an unpleasant phase, that it is temporary. Even though he is behind, he is learning so much and developing so much.

[khaoskat]

Have you thought about when he gets into this behavior, instead of offering it "on tap", giving him a sippy or a cup with it in it. This way, it is not rewarding the negative behavior with your attention and giving into demands to nurse, but he is still getting the milk.

It might give you an alternative.

[christinelin]

I don't have any brilliant answers, but I want to say I know where you are coming from. My DS1 nursed avidly during his third, fourth, and fifth years. He wasn't diagnosed until about the time he was weaned, but it is clear in retrospect that he used nursing as a regulatory tool. He needed it desperately, but I also needed to set limits on his behavior around it. Without the limits I would have had to have weaned much younger. We tried different tricks at different times (nursing until the end of the ABCs, giving him a certain number of popsicle sticks representing the number of times he could nurse each day, etc.) But we don't have cognitive challenges as part of the picture.

I am tempted to say, imagine that he was 18-24 months. What nursing manners would you expect? What limiting tools could you imagine using? I definitely had expectations of decent behavior around nursing even for my younger toddlers. I think you can with Connor, too.

You must be tandeming, right? I was, too, and I think that makes it extra challenging.

I remember years when it was all very hard -- when it felt like I was constantly nursing and I hated it for a chunk of that time. Now everyone is weaned, though, and I am so grateful that I gave my guy that gift for as long as he needed it (5 years, 4 months and 2 days, but who is counting!)

[momtoalexsarah]

Hugs - I understand alot where you are. Megan did the same thing at that age (a few months younger) when we had to wean her from the bottle to open cup in prep for her surgury. We where useing BM in a cup (what little I could still pump) and whole milk with cream - I know this isn't an option for you though. I would bet that he does understand - that kind of manipulation requires logic and reasoning on his part. The launguage barrier is the issue - and the general stubournness (Megan is the same way - she is very verbal now - but man the tantrums she can throw - wow I thought Alex's were interesting -megans step it up one more level)

[askew]

I don't feel like I have any really useful advice, but I did want to add that I weaned my son at just over 2, mama led, as I was pregnant and just could not take it anymore. He understood me completely when I explained to him that it hurt me. For a week he said "mama num nums ouch, no more num nums." He took it so well, and I cried like a baby all week. But my point is, I think that at a 24 month level there can be understanding if you make yourself and your boundaries really clear. I might really try to offer some of his breastmilk in a cup, even though that means more pumping.

[2boyzmama]

Originally Posted by christinelin

I am tempted to say, imagine that he was 18-24 months. What nursing manners would you expect? What limiting tools could you imagine using? I definitely had expectations of decent behavior around nursing even for my younger toddlers. I think you can with Connor, too.

You must be tandeming, right? I was, too, and I think that makes it extra challenging.

I remember years when it was all very hard -- when it felt like I was constantly nursing and I hated it for a chunk of that time. Now everyone is weaned, though, and I am so grateful that I gave my guy that gift for as long as he needed it (5 years, 4 months and 2 days, but who is counting!)

Yes, I'm tandeming, and I think part of this struggle is because the baby doesn't sleep well, so I'm nursing literally the whole night some nights. Then I get up, exhausted, and go to work where I have to pump, and come home and the last thing I want to do is listen to a 3 yo whining at me about wanting to nurse 20 times! I sit down to nurse him (and the baby) as soon as I get home, and I still give him attention all evening long (even as I'm cooking dinner, going through backpacks, cleaning, etc) but when he wants to nurse because he's being whiney...I have very little tolerance for that.

I feel like this would be the point where normally I'd be leading him towards some gentle weaning. I'd be encouraging him to cut back, I'd be instilling more rules, etc. But I can't let him wean.

Originally Posted by momtoalexsarah

Hugs - I understand alot where you are. Megan did the same thing at that age (a few months younger) when we had to wean her from the bottle to open cup in prep for her surgury. We where useing BM in a cup (what little I could still pump) and whole milk with cream - I know this isn't an option for you though. I would bet that he does understand - that kind of manipulation requires logic and reasoning on his part. The launguage barrier is the issue - and the general stubournness (Megan is the same way - she is very verbal now - but man the tantrums she can throw - wow I thought Alex's were interesting -megans step it up one more level)

So far Connor's tantrums are nothing like Ian's were, so at least there's that. And I think you're right, there is a level of manipulation here, which does require logic and reasoning. Like I said before, maybe I'm not giving him enough credit. Maybe he's playing me more than I realize!!

Originally Posted by askew

I don't feel like I have any really useful advice, but I did want to add that I weaned my son at just over 2, mama led, as I was pregnant and just could not take it anymore. He understood me completely when I explained to him that it hurt me. For a week he said "mama num nums ouch, no more num nums." He took it so well, and I cried like a baby all week. But my point is, I think that at a 24 month level there can be understanding if you make yourself and your boundaries really clear. I might really try to offer some of his breastmilk in a cup, even though that means more pumping.

I do have plenty of extra milk pumped that I've been hoarding in case a work trip came up and I needed to be away from the baby. But that's looking like it's an almost non-existent possibility, so I've been giving my milk away to other moms. And when I focus on pumping regularly, I get a bunch extra. So it is an option. But Connor really wants to be held and latched on, he doesn't always care if any milk is coming out or not (for example, he's woken up before right after I finished my morning pumping, so I know that I'm empty, but he'll still latch on and act as if he's nursing, even though he's only getting maybe some drops)

I think part of this is the feeling I have that I'm being almost "forced" into still nursing him...that sounds more harsh than it really is. But here's the reality. With Ian, I could choose when to wean if I wanted to. If I decided suddenly that I was done, then that was it, I was done. I didn't choose, I let him mostly self-wean, but the point is that I had that option. You know? I felt like I had some control over the situation. But with Connor, I feel like I have no control, or less anyway. I have to keep nursing him, it's that important to him. And, in a way, that makes it harder to do.

[2boyzmama]

Here's what happened this morning:

I had already pumped, and was already dressed for work. I was 10 minutes away from walking out the door. Connor woke up, crying as always (he never wakes up happy) He walks up to me asking to nurse.

I sat down and said "We will nurse for 10 seconds, then you're all done and daddy will get you breakfast. Okay? 10 seconds." Then he latched on and I said "okay now, help me count to 10, ready? One....two....three....oops, let me fix your thumb, this is how we do three [ASL three]...four....five...six, no, the other finger, there you go, that's six...seven...eight...nine, oops, let me help you with that thumb again, now we have to use only our thumb for ten, can you show me ten?" You get the idea. So it took obviously much longer than 10 seconds to count to 10, but I was trying to engage him.

Then when we got to ten I said "okay, we counted to ten, great job! Now we're all done with mommy milk, let's go find daddy so he can make you breakfast!!!" At this point he actually willingly let go (sometimes I have to unlatch him forcefully) but then in the 5 minutes before I left, he asked again repeatedly to nurse. I kept saying "no Connor, daddy is making your breakfast, mommy is going to work now, you can nurse when I get home."

He ended up sitting on the floor in front of the door crying and asking to nurse as I was getting my shoes on.

So progress, in that he responded well to the counting, but still frustrating because he ended up throwing a fit because I was leaving. Obviously no child likes to see his mommy leaving, but I've been leaving every day since his maternity leave ended, so this isn't new. I don't think this is any kind of separation issue. I think this is just a toddler control phase.

[moongazer]

I completely understand what you are saying about the "control" part of it. My Dr suggested that it would be best to nurse DS until he was at least 5. I reacted the same way you are feeling. I nursed my other dc until they were each 4, so 5 is not that much longer. But somehow being EXPECTED to nurse that long is totally different.

Wish I had some words of wisdom. You are doing a great thing.

[momtoalexsarah]

just another thought - I wonder if the increased desire to nurse is related to the increased stress of going to school and being in a different environmtnt. When we change something big on Megan we get an increase in sensory stuff (I'm wondering if the nursing is a comfort that he is useing to compensate for a sensory overload) Is he still gettting OT - If not I wonder if it is time for a visit with OT. We do an OT refresh appointment when Megan gets into a stress situation and set up a program to help her with it.

[mrsfru]

This is such a tough one...I nursed ds1 till almost March of this year (he'll be 5 in August), along w/ds2 who's now 19 mos. DS1 only nursed to sleep at night over the last 6 mos, a few times when he was really, really sick, and only for 5 minutes or so. It got to be terribly uncomfortable for me, and I started pushing for him to let it go. We had many months of me bringing up that he really is bigger now and could fall asleep without nursing (and I made it clear that Mommy or Daddy would still snuggle him to sleep AND he can always come to our bed if he wants to). BUT before this time, he was a very difficult kid at times (still is--he probably has Asperger's, amongst physical health issues), and he was a die-hard nurser. He would want to nurse, too, any time his feelings were hurt, he was angry, he didn't get his way, etc. I had to remind myself that this was still a *NEED*, even if it's an emotional one. He has trouble regulating himself (sensory issues, as well), and this was one of the few ways he could do so early on. In some ways, the less he nursed over the last year, the less he could regulate himself! LOL Obviously, all kids need to learn this skill eventually, but it's far tougher w/kids w/problems like ASD. Sometimes, I really would let him nurse until he was "okay" and *then* I would deal w/the behavior. He could deal w/it and learn the lesson if he could get himself together first. And that usually only took 30 secs. Other times, I would explain to him that I understood that he wants to nurse to calm down, but I can't do it right now b/c of (whatever I'm doing at the moment) AND I would sit w/him in 10 minutes (or whatever was practical). That gave him something to look forward to, plus a chance to sometimes figure out how to calm down before he even got to nurse. And then there's the times when there was no waiting or explanations, b/c the meltdown is so large that there's no stopping it....I just had judge each situation individually (ie is he tired, sick, overstimulated, etc). I know that all sounds wishy-washy and was probably easier w/my son than yours, b/c even though he's developmentally delayed, his overall abilities are pretty typical (age appropriate). He has some expressive and receptive language issues, but they are fairly minor.

It may come down to setting some hard and fast boundaries and suffering w/the meltdowns for a little bit. I would suggest trying the "in 10 minutes, after I finish this, or after you eat/go potty/put your shoes on" and stick w/that whenever he is demanding. Obviously, he still has an emotional need, b/c he doesn't have better coping skills yet. Meanwhile, brainstorm some creative alternatives for him to try in the meantime until he can nurse --squishing playdough, chewing a teether, etc. My 4.5 yr old now chews/sucks his fingers (never did that before!), so some of the nursing was his only means of stress relief.

Best wishes--hope it's better soon!

mrsfru