Monday, January 13, 2014
Do Adopted Children Want to Breastfeed? Karleen Gribble's Report
After I commented on some recent discussions of breastfeeding for adopted children, Karleen Gribble, of the University of Western Sydney , responded and sent me a copy of her paper “Post institutionalized adopted children who seek breastfeeding from their new mothers” (Journal of Pre- and Perinatal Psychology and Health, 19(3), 217-235). I’m going to comment on Gribble’s paper today.
Let me say first that I’m thrilled to see more observational work on care events in infancy and childhood. I consider this to be a much-neglected topic, and exactly what happens during breastfeeding-- including the many variations-- is rarely given systematic attention. I attempted to do some data collection of my own some years ago, but unfortunately La Leche League (it was at one of their functions that I was observing) was not willing to give permission for this. I also vividly recall being roundly scolded by the journal editor Marc Bornstein for submitting a comment that proposed more such work. I confess that I have not been entirely evidence-based or free from speculation about breastfeeding interaction (www.psychologytoday.com/blog/child-myths/200906/breastfeeding-speculating-wildly), but this is an area where knowing what to observe depends partly on thinking through one’s own experiences and other people’s stories. Nonetheless, it’s the observation rather than the speculation that we need to attain.
In considering Gribble’s paper, it’s important to look first at the a priori assumptions it contains. The author refers frequently to breastfeeding as a causal factor in attachment and attunement, but at the same time concludes the paper by noting that attachment may need to precede breastfeeding. (It is not clear whether this implies that newborn infants who breastfeed must already be attached to their mothers.) In addition to Gribble’s statements in the paper, we need to look at the reference section and see what authors she considered to provide appropriate background for her work; these include Deborah Gray, Mary Hopkins-Best, Terry Levy and Michael Orlans, and Nancy Thomas--- all people committed to an alternative theory of attachment rather than to Bowlby’s conventional psychosocial approach. In line with this background, Gribble references the so-called “attachment cycle” as a series of experiences that cause emotional attachment (see http://thestudyofnonsense.blogspot.com/2012/08/parsing-attachment-cycle-fox-terrier-of.html for a discussion of this issue). Like other authors who publish in JPPPH, Gribble also references ideas about children’s memories of birth and early life. All of the assumptions displayed here suggest that Gribble is very ready to accept the belief that unconscious, biologically-driven motives and behavior patterns play powerful roles in children’s development even after the first few months of life have passed. She quotes a mother as saying that her child’s need to suck was ”primal”, exemplifying the belief I have just described, and suggesting strongly that some human maternal and child behaviors are best seen as instinctive.
The assumptions I have just described are in contradiction to established conventional views of early development (and of course such conventional views can turn out to be quite wrong, but it has yet to be shown that they are wrong). Conventionally, feeding modes are not considered to be important to development of parent-child relationships, although a parent’s sensitivity and responsiveness to infant feeding cues are important, just as they are in every other area of parent-child communication. Neither is skin-to-skin experience thought to play a strong role in establishing emotional relationships. Infants are not considered to have an attachment to anyone at the time of birth, nor are they thought to have memories of birth or of early life. Biologically-determined infant social reactions are thought to be paramount in the early months, but after that learning from social interactions begins to take over. While initially biological, modes of communication become a matter of learning and therefore are strongly culturally influenced rather than instinctive.
Understanding the assumptions of Gribble’s paper, and the ways they differ from the foundations of conventional approaches to early development, let’s go on to look at the information reported about adopted children wanting to breastfeed. Gribble reports information about 32 adopted children, of both sexes and a range of ages (ages at placement= 8 months to 12 years) and separation histories, whose adoptive mothers stated that the children asked for breastfeeding or signaled that they wanted to breastfeed. It is not clear how many of the mothers were actually interviewed by Gribble, as some of the cases were said to have been reported by social workers or drawn from published material. In addition, it is unclear what sex ratio was involved; of the five interviews reported by Gribble, four of the children were girls.
Gribble’s paper provides an interesting beginning for discussion of children’s motivation for adoptive nursing, but a much better context is needed before we can interpret this report. For example, the Wikipedia article on adoption in Australia states an average of 330 intercountry adoptions per year (the children in Gribble’s study were adopted from other countries). However, Gribble does not say over how many years her information was collected, so it is impossible to know whether the 32 children discussed were a very large or a very small proportion of similar adopted children.
In addition, Gribble does not state or even speculate upon the number of nonadopted children who, having been bottle-fed from the beginning, or having been weaned from the breast, later communicate to their mothers that they want to breastfeed. This is an important issue because of Gribble’s argument that adoptive breastfeeding facilitates attachment in children who have experienced separations. Nonadopted children have presumably had ideal opportunities to develop attachment and have not experienced serious separations, so if they signal their wish for later nursing in the same proportions as adopted children, it is hard to see what the emotional motivation for this behavior would be. A full understanding of the phenomena reported by Gribble awaits information that would permit this comparison.
Another important unanswered question is the role of the adoptive mother’s beliefs, expectations, and caregiving behavior in creating the child’s interest in breastfeeding. Gribble has pointed out elsewhere that mothers are not likely to provide information about the atypical behavior of adoptive breastfeeding unless they trust their confidant; this suggests that the mothers have a belief system that is not entirely shared by most other people. Gribble states a belief that skin-to-skin contact is important for attachment, and describes a mother who “used skin-to-skin contact via co-bathing and a cuddle time in the evening as a way of promoting attachment”. Mothers who share this belief provide opportunities for breast contact that would not occur in the Western world in most other situations or be presented by mothers who did not share the belief. Adoptive mothers who believe in the “skin-to-skin” and “attachment cycle” system may also accept the idea that breastfeeding is important for the mother-child relationship and therefore be exceptionally ready to read child behavior as a wish to nurse. (Gribble refers to sucking on clothing as such a signal, although mouthing and sucking objects is common childhood behavior, as often seen in school-age boys who like to chew on the necks of their t-shirts.) Interestingly, Gribble also describes children who sought to breastfeed as part of “birth games” played with their adoptive mothers, suggesting that she is focused on a group of adoptive parents who are committed to an alternative theory of early development-- not surprising in light of the journal in which the study was published.
The information Gribble presents is of great interest, and certainly should be kept in mind in cases where breast-touching by adopted children is regarded as “sexualized” behavior indicative of previous sexual abuse. (If Gribble’s reports are accurate, such behavior may not be an indication of sexual experience at all.) However, interpretation of the reported cases must await contextualization by information about other adopted children and about nonadopted children as well. Gribble’s extensive discussion of why adopted children seek breastfeeding is premature, because we have no idea whether they actually do so more than nonadopted children do, or whether their adoptive parents’ belief systems lead them to read child messages differently than they might otherwise do.
As a final comment, I want to turn to two sentences that Gribble places at the end of the article abstract and that she does not actually discuss in the body of the paper. The first sentence states that the “frequency of adopted children seeking breastfeeding is unknown, however adoption professionals should advise adoption applicants of the possibility”. Such advice, if it is being given, is certainly likely to increase the number of cases where mothers interpret ambiguous behavior as bids for breastfeeding.
In a second sentence at the end of the abstract, Gribble makes the following claim: “It may also be appropriate for adoptive mothers to pursue breastfeeding in the event that the child does not.” Nothing in the paper provides grounds for this claim, and it is most concerning to think that a group of parents who have already (as Gribble notes) experienced various disappointments and losses should be offered an additional challenge when there is no evidence that it is necessary.