Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Tuesday, December 31, 2013

Adoptive Nursing: What Are the Reasons?

At the end of the war in Vietnam, there was some publicity about the fact that staff caring for babies who were to be airlifted to the U.S. took medications that caused them to lactate so they could feed infants in the absence of their usual food supplies. Over a number of years, there has been increasing emphasis on the idea that adoptive mothers can breastfeed their babies--  and that if at all possible they ought to do so.  One person who has pressed this idea is Alla Gordina, a Russian physician who practices in New Jersey.  A PowerPoint by Gordina can be seen at http://www.wiziq.com/tutorial/693267-ADAPTIVE-NURSING-APC.

Although she includes in the PPT instances where an adoptive mother was unsuccessful or unhappy with breastfeeding, Gordina stresses the benefits of adoptive nursing and focuses on social and emotional as well as biological factors. She refers to the practice as “adaptive nursing”, followed by “TM”, so it would appear that she has trademarked this term (?). Her PPT lists some of the advantages of adoptive nursing in the following order: promotes secure attachment and trust; augments their sensory and physical development; provides a therapeutic effect on the correction of oral deficits and/or aversions.

Gordina discusses a number of general practical issues about feeding children adopted from institutions where they might have received poor care, including fears they may have if they have been fed roughly or insensitively. These are important considerations, but my concern today is to discuss the statements she makes about the social and emotional aspects of breastfeeding.

  1. Breastfeeding and attachment. Emotional attachment of young children to their caregivers is based not on food but on the sharing of pleasant social interactions and play. For young infants, most of those interactions ordinarily center around physical care routines, including feeding. These are the events that happen most often in the infant’s day and are always a time when another person is present to socialize (except when people prop bottles, but let’s not think about that). They are also times when the caregiver is focused strongly on the infant and is not doing much else, although of course there may well be side activities, conversations with others and so on. Pleasant social interactions often occur during feeding, when the baby eats enthusiastically and the caregiver is pleased to see this.
      However, it makes no difference to social interaction whether the young child is breastfed  or not. Any feeding method or routine can be linked with pleasant shared experiences and communications. These are the real basis of attachment:  attachment is not the    “cupboard love” proposed in the past, but involves satisfaction of a hunger for social  contact. Otherwise, young children would not become attached to their fathers, brothers,    sisters, grandmothers and fathers, nannies, and child care providers--  which they do.

Initially, attachment is shown as a sense of safety and security associated with familiar people, and many authors, including Gordina, have jumped to the conclusion that attachment at all ages is shown by “staying near”. But as children get older, their attachment to adults is expressed in terms of new developmental needs such as needs for autonomy and the ability for independent actions. Pleasurable experiences with adults involve children’s pride in their new abilities, not the sense of happy dependency that was evident earlier. Bowlby’s attachment theory  stresses the growth of a “goal-corrected partnership” in which the maturing child and the parent gradually shift their ways of interacting to satisfy the developing needs of both and to preserve their relationship--  not simply to preserve dependency.
(It’s interesting, by the way, that Gordina refers to the possibility that adopted children will have “Developmental Trauma Disorder”, a diagnostic category that remains poorly defined and “unofficial” in spite of recent attempts to bring it into use. )

  1. Breastfeeding and bonding. The term “bonding” is best used to describe the powerful positive feelings and intense interest of a parent with respect to a young infant. Writing decades ago, Klauss and Kennell originally used the term “maternal-infant bonding” to refrer to this, but for the second edition of their book chose the term “parent-infant bonding”. In that second edition, they also attempted to correct the misunderstanding that bonding occurred instantaneously for all parents or even for mothers alone, or that all aspects of the parent-child relationship were somehow determined by some bonding event soon after birth.
Nevertheless, quite a few people continue to assume that some event pushes a button, which causes bonding, which in turn causes good parenting. The events that push the button are usually expected to be related to “primitive” or “traditional” folkways. They include an emphasis on skin-to-skin contact and of course on breastfeeding immediately after birth (although in fact a number of  “traditional societies” do not let the baby nurse at once and regard colostrum as dirty, and many others have traditionally swaddled the newborn, making skin-to-skin contact minimal).  The actual association of such experiences with parental attitudes and with effective parenting has never been demonstrated.  It seems most unlikely that there are such associations, as human beings care for and feed infants in a wide variety of ways, usually with good outcomes--  just as they feed both children and adults on a wide variety of diets.

 It’s thus improbable that breastfeeding causes bonding. However, if mothers are told that they cannot do a good job caring for their infants unless they breastfeed, wear purple for the first year of the child’s life, or play pinochle regularly throughout the third trimester, they are likely to believe these things because of their strong wish to do well. If they are told that breastfeeding will make them bond, and that without it their feelings for the child will be fragile, they will be distressed by any “failure” they experience.
 Gordina’s presentation notes the needs of adoptive mothers who have been distressed by infertility, miscarriage, or infant death, and suggests that successful adoptive nursing can help them recover from these traumatic experiences. She does not support this statement with evidence, nor does she examine in this PowerPoint the possible effects of lack of success either in lactation or in nursing. Given a mother who has never breastfed or even been pregnant, and a baby who has learned to suck an artificial nipple (a different suck-swallow pattern than is used at the breast), the chances of experienced failure can be pretty large.

  1. Breastfeeding and older children. Gordina’s PowerPoint references Karleen Gribble, an Australian nurse who has apparently recommended breastfeeding for adopted children as old as school age, and who says that it may take as much as a year for breastfeeding to be accomplished (https://www.breastfeeding.asn.au/bf-info/adoption). Curiously, Gribble also notes that a child may need to attach before being abIe to nurse, but that at the same time nursing supports attachment.
I am far from opposing toddler nursing or even culturally-appropriate nursing of older children who have been at the breast since birth, but there are some obvious difficulties for children who were bottle-fed from an early age. One is, as I mentioned in the last paragraph, that these children have learned to suck and swallow differently when using a bottle than they would have if breastfed exclusively. (If the latter, of course, they would not have learned how to nipple-feed and could have a difficult time adapting if suddenly weaned from the breast before they drank from a cup.) A second problem is that most children learn by preschool age that breasts are “private parts” and are not to be touched—most adoptive parents, in fact, would be very concerned and speak of sexualized behavior and even a history of sexual abuse, if a child touched the adoptive mother’s breasts.

Incidentally, Gribble and Gordina both allude to adopted children showing their wish for breastfeeding, but they give no details that I can find, nor does there seem to have been any systematic investigation of this issue.


So, am I saying that there is never any good reason for adoptive nursing? No, indeed. Breastfeeding has some real physical benefits in terms of development of the jaw and resistance to infectious diseases. The breastfeeding mother’s mature immune system serves as an auxiliary support to the immature infant’s reaction to infection, and this can be very important for babies who are poorly nourished, exposed to many infections, or in a dirty environment. When breastfeeding can be established for the young adopted baby, there will be real physical health benefits. It’s also beneficial that a mother enjoys nursing and that families may regard the nursing relationship as a more “real” connection than any other.

But what about attachment, security, and other emotional benefits? No, these are not reasons to do adoptive nursing, because they are not based on breastfeeding in any case.

Tomorrow, I want to go on to talk about some of Gordina’s views on the need for child dependency, and on her connections with other authors like Gribble who propose that older children need to be treated as if they were infants.  






8 comments:

  1. An interesting historical note:

    The German explorer Alexander von Humboldt wrote of his early-19th century travels in South American that he met a widower, age 32, who was breastfeeding his infant child after the death of his wife – and the man claimed to be doing so for several months. Humboldt doesn't have a stellar reputation for accuracy, but he rarely mentioned any indigenous people. This lactating father stands out in his writings.

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    1. Some psychotropic medications can make men lactate, which makes the drugs very unpopular in mental hospitals. And of course endocrine dysfunction could also do this. But perhaps more likely is that the father was messing with the mind of the credulous Humboldt, as later indigenous peoples played jokes on Margaret Mead!

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  2. Hi Jean, You might like to check out some of my papers on adoptive breastfeeding.

    Gribble, K. (2005). Post-institutionalized adopted children who seek breastfeeding from their new mothers. Journal of Prenatal and Perinatal Psychology and Health 19: 217-235.
    Gribble, K. (2005). Breastfeeding a medically fragile foster child. Journal of Human Lactation 21: 42-46.
    Gribble, K. (2006). Mental health, attachment and breastfeeding: implications for adopted children and their mothers. International Breastfeeding Journal 1:5.
    Children seeking breastfeeding from their new adoptive mothers appears to be by far the most common form of adoptive breastfeeding- I have a hundred of so cases now. And btw I'm not a nurse though I am an academic in a school of nursing and midwifery.

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    1. Dear Karleen,

      Thanks for these suggestions. I had already read the later two papers, but could access only the abstract of the first one.

      Perhaps you can help me interpret some of your statements. I remain puzzled at the apparent paradox you put forward-- that getting most adopted children to nurse requires long and careful efforts, but a smaller number signal or request their desire to breastfeed. Why do you think this is? If nursing is seen as a general and expectable wish of human infants, why is it difficult to establish for many? I understand your statement that some of those who signal their desire to nurse may have been breastfed earlier, but considering the circumstances of adoption, I would think this number would be quite small.

      A second question is this: Given your statement that some adopted children seek breastfeeding, what do you make of other situations in which adopted or foster children touch the mother's breasts? As I noted in my post, this behavior is usually interpreted as "sexualized" and as an indication that the child has been sexually abused. Would you say that this interpretation is often wrong, and that the child's behavior may indicate the wish to breastfeed? If you have reason to think that, it would be important to publicize your view, and to prevent the damage that occurs when innocent people are accused of molesting children.

      If you are not a nurse, is your training in midwifery? I am curious as to how different disciplinary backgrounds influence perspectives on early development.

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    2. Hi Jean, If you wish, send me an email karleeng@uws.edu.au and I will send you the first paper, it goes into the possible reasons why children might seek breastfeeding in some detail. It's just speculation but based on what women have observed in their children. As I have heard more stories I have strengthened my view that this is something that often flows from the instinctive feeding behaviours that newborns through to young infants express when placed in skin to skin contact with their mother.
      Yes, it is a paradox. That children who have been traumatised and then abruptly placed in a new family might find it impossible to interact in intimate ways with their caregivers I think is not at all surprising. The idea of children seeking breastfeeding was unexpected to me...but it happens and quite a lot. Certainly in Australia it is discussed in the mandatory adoption education classes that prospective adoptive parents undertake.
      I honestly haven't been contacted by many mothers who have thought that their child's behaviour in wanting to breastfeed really was an indication that the child had been sexually abused. There was just one case where the mum suspected that her son's behaviour might have been related to past sexual abuse. I expect that in such cases women might not be contacting me because I am sure that this also happens and picking between the two might be difficult. Usually when this happens women are very shocked (usually they have not heard of it before) and they were initially worried that it could be an indication of past sexual abuse because breasts are involved but it also does not appear to them to be sexualised behaviour and if they run with what their child asks they are certain that it is not. I have a question for you though, in all your years of working in this area, had you not heard of children seeking breastfeeding before?? Have you worked with families where this breast seeking behaviour has occurred and assumed that it was sexualised behaviour?? Have you heard of parents accused of sexual abuse because they have allowed children to breastfeed (I have not, but I know it is a fear of very many mothers). As I mentioned, this is a recognised behaviour in Australia in newly adopted children. I am certain that it also happens commonly in foster children but of the cases I have collected there is less than a handful where there child was a foster child. I can guess why.

      Nope, not a midwife either. I came from the life sciences across to infant feeding research.

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    3. I sent an e-mail request for the paper-- thanks.

      No, I have never heard of adopted or foster children seeking breastfeeding. This may be just my ignorance, but I don't think it's discussed much in the U.S.-- although adoptive nursing has been around for a long time, here as well as elsewhere.

      Not having heard of breast seeking in these situations at all, I don't think I've ever interpreted such a thing as sexualized behavior. I'm simply aware that adoptive parents do sometimes feel repelled by children seeking breast contact, and may attribute such behavior to abuse by some person in the child's past, or actually accuse some other adult who's in the picture.

      I have heard of a mother who advocated for holding therapy breastfeeding an adopted teenage daughter, but I have no idea whether this story was correct. Much disapproval was expressed by various people, and I don't find that surprising.

      Are you a botanist by training, then? The two articles you've published other than on breastfeeding would seem to suggest that.

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  3. I think that mothers are quite careful with whom they speak about their child seeking breastfeeding but it's not a new thing- one of the cases cited in my paper was a child from Operation Babylift.
    I've not heard of a teenager breastfeeding. Typically the children who seek breastfeeding are in very new to fairly new placements. The oldest child I know of was 12 (and in this case breastfeeding was not permitted by the mother), the oldest child I know of who breastfed was a newly adopted 10yo (and as seems common with these older kids breastfeeding only occurred a few times- almost a claiming behaviour).
    My undergrad was in agriculture and postgrad in plant physiology....a bit of field switch to infant feeding, though I remain very grateful for my broad science background!

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    1. Thanks for sending the paper. I hope to comment on it in a few days--

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