What is tandem nursing and what does it mean for me and my family?
Tandem breastfeeding is nursing or pumping for two children of different ages, at the same time. It is also possible for a mother to breastfeed twins or other multiples if so chooses (1). Many mothers who choose to tandem breastfeed face criticism and social stigma because the practice is not common the US and Europe (2). Broad sweeping statements like, "It's dangerous to breastfeed during pregnancy," and "Your toddler will drink all of the baby's milk," are commonplace. Although not rooted in fact, misconceptions like these leave mothers misinformed and lacking in confidence when it comes to tandem breastfeeding. In reality, myths like these are perpetuated by a lack of understanding. A 2023 study found that mothers cannot get enough information about tandem breastfeeding and this is one of the challenges of the experience (3). So, what are realities of tandem breastfeeding and how does it impact mothers and their children?
Breastfeeding During Pregnancy
Many mothers around the world fall pregnant whilst they are breastfeeding and choose to continue to breastfeed throughout their pregnancy. In the vast majority of cases, lactation during pregnancy is safe and this has been found across multiple studies (4, 5, 6). Exceptions to this include when a mother becomes pregnant whilst she is exclusively breastfeeding (typically up to 6 months postpartum), or if she has experienced one or more premature births or miscarriages. Another risk factor is if a mother has a weakened cervix. Any mother who is unsure about whether or not it is safe to breastfeed through pregnancy should consult her health care provider.
Whilst it is possible for many mothers to conceive again whilst breastfeeding, it may not be possible for all. This is because the hormone associated with breast milk production - prolactin - can also prevent the uterine lining from thickening enough to support an embryo. You can read more about conveiving whilst breastfeeding and breastfeeding through pregnancy, here.
How does Tandem Breastfeeding Affect my Baby and Older Child?
Tandem breastfeeding can be a wonderful way to help an older child bond with their new sibling. It may also create much-needed opportunities for a mother to have quiet time with both children. This will depend of course on the temperament, schedule and energy levels of the older child. Toddler gym-nurse-tics can make nursing both children at the same time more challenging than restful! Nonetheless, continuing to breastfeed an older child can also be a powerful tool for helping them to navigate the transition to being an older sibling. One tip to make tandem nursing easier is to position yourself and your baby first, before allowing your older child to get into a comfortable nursing position afterwards. It is worth noting that some mothers who tandem breastfeed rarely or never nurse both children at the same time.
A toddler or older child may self-wean once a mother's breasts start to produce colostrum again around week 16 of pregnancy. There is no way of knowing in advance if a toddler will self wean when this happens, but it is worth noting in order to prepare for the possibility. If your toddler or older child does continue to nurse throughout pregnancy, remember that colostrum has a laxative effect which could make your child's poos runny. This is not considered to be harmful.
When it comes to nutrition, breast milk has been shown to adapt to the needs of both nurslings until the older child is weaned. At that point, breast milk nutrient levels return to those appropriate for the remaining nursing child. For instance, a 2021 study found that the concentration of fat in breast milk was 25% higher when tandem breastfeeding. This was 14% higher than in samples taken after weaning the older child from the breast. Results were similar with regard to protein content. After weaning, breast milk protein content dropped by 18%. Interestingly, there were no changes in the levels of carbohydrates in samples before and after weaning. This shows how breast milk still meets a newborn's need for higher levels of carbohydrates during tandem breastfeeding. In short, a mother's milk adapts to meet the needs of both her older nursing child and her new baby for as long as she is tandem breastfeeding (4).
Due to tandem breastfeeding being relatively rare in many parts of the world, concerns about not producing enough milk for the new baby - or the older child drinking more than their share are common. However, as long as a mother nurses her newborn on demand, there is no reason to expect that she will have supply issues - even if she has historically. This is because tandem breastfeeding allows for more stimulation of the mammary glands. Moreover, the number of alveoli cells in the breast increases with each pregnancy (7). In order to ensure that the newborn baby gets enough milk in the first few days after birth, it is recommended that a mother nurse her newborn before offering the breast to her older child.
How does Tandem Breastfeeding Affect Mothers?
Tandem breastfeeding can be great for helping mothers to establish and manage their milk supply postpartum. For instance, if a mum has an overactive let-down or an oversupply of milk, nursing a toddler or older child can make breastfeeding more manageable for the new baby, as well as reducing the risk of painful engorgement, clogged ducts or mastitis. This is because nursing another child alongside a newborn mitigates the effects of the temporary increase in supply caused by cluster feeding. Furthermore, tandem breastfeeding mothers report feelings of self-efficacy, pride and enjoyment when describing their experiences (3).
Nonetheless, tandem breastfeeding is a significant commitment and one which can take its toll on a mother's body. A common complaint among tandem nursing mothers is that they begin to experience feelings of aversion (only) when their older child nurses. Breastfeeding aversion is when a mother feels angry, sad or frustrated during or after a feed. This could be a sign of overwhelm and/or nutritional deficiencies, as well a sign that a mum needs more time for wellness and self-care. It may be helpful to know that all nursing and pumping mothers loose the following vitamins and minerals through their milk:
• B Vitamins
• Vitamin C
This means that if a lactating mother is not consuming enough of the aforementioned nutrients in her diet, they will be drawn from her body's reserves to be used in her breast milk. This can trigger feelings of aversion including feeling sad, angry or frustrated whilst nursing. This can be the case whether a mother is nursing one child or more than one.
Stopping Tandem Breastfeeding
There often comes a time when a mother wants to wean her older child off the breast whilst still breastfeeding her younger child. This is entirely possible and in my experience, it helps to link the decision to wean to growing up (without using shaming or coercive tactics). I recommend for instance, focusing on all of the activities that your older child can do as a result of maturing and linking moving away from breastfeeding to that growth. Sharing photographs and videos of your older child and reflecting upon their growth can be a fun and engaging way to do this. Whether a mother allows her children to self wean or initiates parent-lead weaning, empowered and supported has and will always be best.
For personalised, detailed support on stopping breastfeeding gently & responsively, explore my Weaning with Love Guide & Webinar here. Buy the webinar and get the 33 page guide for free using discount code: BOGOF