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. )

2. 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.

3. 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.