Tandem breastfeeding is a practice that many families choose for different reasons, although it is rarely visible. Breastfeeding two babies of different ages may raise reluctance in healthcare professionals accompanying the mother and her babies or children. Therefore, we will explore the topic of supporting mothers in this stage a little deeper. When reviewing the published scientific evidence, we find that this is limited and not very robust, as is the case with many other breastfeeding topics.

Definition of tandem breastfeeding

Tandem breastfeeding is defined as the breastfeeding of two or more children of different ages. Depending on which reference is used, it may also include the pregnancy period of the younger baby.

Why do mothers want to tandem breastfeed?

Rodriguez’s team (2023) investigated the reasons for this decision, among which were: “to avoid wasting the effort invested,” “to desire this life experience,” and “to exercise the freedom to decide.” The mere desire to live the experience is important enough to practice this type of breastfeeding.

Breastfeeding in tandem

Pregnancy

As mentioned above, there is little research on breastfeeding two babies of different ages. During the early weeks of pregnancy, pain is often experienced during the feed, as elevated estrogen levels may favor this sensation. It seems that from week 16 of pregnancy onwards, a significant percentage of cases will notice that milk production is lower. This fact, together with a change in the taste of the milk due to the change in composition, can make it more likely that the baby who is being breastfed might wean more easily. Some experts say that 60% of them will wean spontaneously and stop breastfeeding.

Then, during the third trimester of pregnancy, the milk produced has the same properties as the pre-colostrum produced in a non-lactating pregnancy.

Immediate postpartum and mature breastmilk coming in

Once pregnancy has ended, lactogenesis follows as usual. Usually, lactogenesis II occurs before the first 72 hours. In most cases, newborns whose siblings continue to suckle at the breast maintain a stable weight for the first few days and gain weight efficiently thereafter. The fact that there is stimulation by the older brother or sister facilitates the establishment of breastmilk supply. However, remember the laxative properties of colostrum, so it is likely that the older brother or sister will have very liquid stools. In addition, as milk production is established, the amount of solid food consumed may decrease. This does not affect their nutrition, but it is important to provide this information to the family to avoid stressful situations.

Continuation of breastfeeding

It has been demonstrated that the composition of breastmilk and how it is produced adapts to the younger infant. It is also likely that the so-called breastfeeding crises or frequency changes related to growth spurts are reduced in intensity as the breast receives double stimulation. Even so, the control of breastmilk supply will change, just as in a single-child breastfeeding situation, from the 3rd month of lactation onwards, and will be managed in self-regulation.

In general, it is recommended during the first days after birth to offer the breast first to the newborn and then to the older child until breastfeeding with the little one is well established. From then on, mothers can breastfeed first the newborn, then the older child, or both simultaneously.

So, will there be any problems with tandem breastfeeding?

Breastfeeding that is initiated in tandem has certain advantages, such as, first of all, the mother’s experience, self-confidence, and sense of self-efficacy, all of which are related to an increase in the establishment of breastfeeding. In addition, the fact that the mammary gland is stimulated also ensures an ideal initial milk supply.

Even so, breastfeeding difficulties may arise and should be addressed:

• Pain during the feed: latching difficulties, either due to the presence of ankyloglossia, muscular difficulties of the newborn, or structural difficulties
• Difficulties in milk transfer: possibly due to causes similar to the previous point.
• Difficulties in managing the child: a newborn changes the whole family dynamics, and sometimes, it can be difficult to manage the older child who wants to suckle when they see that the younger baby is also suckling. Support and help for the mother and the need for dedicated time with the newborn are very important.
• Prejudice of relatives and professionals: Tandem breastfeeding is still a socially unknown and stigmatized practice. Supporting the mother’s decision and clarifying the myths that come with this situation will help the mother through what can be an intense time.

Breastfeeding aversion and agitation

Breastfeeding aversion is when the mother has feelings of rejection towards the infant who is breastfeeding at this moment. There is little evidence on the subject; even so, it is a fairly common situation during pregnancy and also when breastfeeding older infants. Therefore, it is quite common in tandem breastfeeding. It is usually directed only towards the older brother or sister. This situation can provoke contradictory feelings, sometimes of high complexity, by the mother. She feels rejection towards her older son or daughter, and this makes her feel bad. Being able to talk about it without feeling judged is the first step in being able to deal with it. In situations of fatigue or stress, it is also more common. When a mother feels aversion, if she wants to maintain breastfeeding with her older son or daughter, it can be suggested that she finds time alone with her younger baby, limits the time or frequency of feeds with the older child, or partially weans the older child.

All these strategies should be known to the mother so that she can decide what to do.

Despite the many positive experiences, tandem breastfeeding mothers may also face a number of difficulties. To cope with them, they need a breastfeeding-friendly environment and the support of their family and healthcare professionals.

References

Sinkiewicz-Darol, E., Bernatowicz-Łojko, U., Łubiech, K., Adamczyk, I., Twarużek, M., Baranowska, B., Skowron, K., & Spatz, D. L. (2021). Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child. Nutrients, 13(1), 277. https://doi.org/10.3390/nu13010277

Rosenberg, G., Mangel, L., Mandel, D., Marom, R., & Lubetzky, R. (2021). Tandem Breastfeeding and Human Milk Macronutrients: A Prospective Observational Study. Journal of human lactation : official journal of International Lactation Consultant Association, 37(4), 723–729. https://doi.org/10.1177/08903344211003827

Aker, M. N., Gönenç, I. M., Er Korucu, A., & Çakırer Çalbayram, N. (2023). Mothers’ Experiences of Tandem Breastfeeding: A Phenomenological Study. American journal of perinatology, 10.1055/a-2033-0031. Advance online publication. https://doi.org/10.1055/a-2033-0031

Rodríguez Vázquez, R., García Díaz, A., Jiménez Fernández, R., y Corral Liria, I. (2023). Exploring Tandem Breastfeeding Motivations Via Self-Determination Theory: An Interpretative Phenomenological Study. Journal of human lactation : official journal of International Lactation Consultant Association, 39(3), 468–477. https://doi.org/10.1177/08903344231166910