Tandem breastfeeding is defined as breastfeeding of two or more children of different ages and may also include the time of pregnancy of the younger baby. Some time ago, we discussed this practice, which is not always well-known here, and you can read the previous article in this link.

While this is a common practice in many cultures worldwide, it is still not widely practiced in modern Western culture and is often misunderstood.

Putting tandem breastfeeding into context

In our Western culture, the practice of tandem breastfeeding was very rare until recently. In many cases, it was either considered taboo, or there was a huge burden of misconceptions around it. This meant that the few mothers who decided to breastfeed multiple children at the same time often did so only at home and would not share their experience with healthcare professionals who cared for them, sometimes for fear of being judged or feeling little understood and supported in their decision.

Increasingly, with the arrival of a new pregnancy, more and more breastfeeding families are beginning to consider the possibility of breastfeeding both children at the same time. Other times this is an idea that comes up later, in the last stages of pregnancy. Years ago, this was unusual and not socially accepted, and even today, in some areas, it is still little known or little accepted. Fortunately, perception has gradually changed, making tandem breastfeeding another option for many families.

Challenges

As for healthcare professionals, tandem breastfeeding can bring certain challenges:

• Emotional support: Mothers who decide to breastfeed two or more children need social and emotional support. It is widely known that when women breastfeed a single child, they face attitudes of incomprehension or lack of support from their immediate environment; when breastfeeding more than one child, this may increase.
• Limited information or clinical experience in accompanying tandem breastfeeding: there are myths about tandem breastfeeding, from the beginning of pregnancy to the type of breast milk the children will get.

Special circumstances

• Older child is ill: In most cases, when the older child gets ill, it is not necessary to stop breastfeeding the older one. In the vast majority of cases, tandem breastfeeding can be maintained by following the usual measures of hygiene or, if desired, even by breastfeeding each of the children separately. Extra hygiene of the breast is not usually necessary. However, in the case of illnesses that may pose a high risk to the youngest infant, the situation should be assessed on an individual basis.
• Tritandem: tandem breastfeeding with more than two children. This is possible when several children are born within a short time between pregnancies.

Maternal care during tandem breastfeeding (after the baby is born)

Tandem BF can be even more demanding on the mother’s commitment, especially if the older child is still young and needs care from the mother. That means it can be more difficult to get enough rest and to find time for self-care.

• Getting enough rest: resources for the best possible rest for the family. If the older child still breastfeeds at night, it is important to provide the family with options so that they can safely co-sleep with both children, by assessing the individual situation and preferences of each family.
• Support from family and healthcare professionals: being able to delegate household tasks (shopping, cooking, cleaning, administrative tasks, and so on) to the partner or other people, especially when the second child is only a few days or weeks old or when both children are very young.
• Maternal nutrition supplements during lactation: there do not appear to be any studies on the need for increased iodine supplementation (if relevant for your location, see general health guidelines) in tandem nursing mothers.
• Maternal nutrition: The literature does not tell how much caloric intake needs to increase in the context of tandem breastfeeding. Hunger and fullness will indicate the amount of food that should be consumed.
• Consider the possibility of the appearance of breastfeeding aversion or agitation, provide information about this, and accompany the mother.

How can we accompany a mother who wishes to breastfeed more than one child at a time?

• Consider the wishes of each mother and her individual circumstances.
• Address initial general questions about tandem breastfeeding
• What to expect when the new baby is born: managing both children’s feeds
• Emotional encouragement for the mother and validation of her wishes.
• Family involvement (partner or others)
• Offer resources for safe co-sleeping if this is the mother’s wish, or resources that allow mother and child to get the best possible rest.

Even if all possible resources are offered, and the mother wishes to carry out tandem breastfeeding, there are circumstances when weaning may happen before the birth of the new baby. However, this is a situation that may also require support from the healthcare professional.

Need for support

As professionals who accompany breastfeeding, we should support each mother’s decisions about her breastfeeding journey, whatever those decisions may be, and offer reliable information and resources based on scientific evidence (whether or not we have previous clinical experience).

Tandem breastfeeding, although still a minority practice, needs the support of the professionals who care for the mother and baby during the breastfeeding period, as does any other situation that may arise during breastfeeding.

 

References

1. Lawrence R A La lactancia materna. Una guía para la profesión médica. Madrid. Mosby/Doyma Libros, SA 1996 Edición en español
2. López Fernández, Gemma & Barrios, Maite & Goberna-Tricas, Josefina & Gómez-Benito, Juana. (2017). Breastfeeding during pregnancy: A systematic review. Women and Birth. 30. 10.1016/j.wombi.2017.05.008. 
3. DOĞANCI, Pınar & Özsoy, Sevgi. (2019). Tandem Breastfeeding. 
4. Aker, Menekşe & Gönenç, Ilknur & Er Korucu, Aslı & Çakırer Çalbayram, Nazan. (2023). Mothers’ Experiences of Tandem Breastfeeding: A Phenomenological Study. 10.1055/a-2033-0031. 
5. Rodríguez Vázquez, Rocío & Díaz, Aitana & Raquel, Jimenez & Corral, Inmaculada. (2023). Exploring Tandem Breastfeeding Motivations Via Self-Determination Theory: An Interpretative Phenomenological Study. Journal of Human Lactation. 39. 089033442311669. 10.1177/08903344231166910. 
6. Rosenberg, Gilad & Mangel, Laurence & Mandel, Dror & Marom, Ronella & Lubetzky, Ronit. (2021). Tandem Breastfeeding and Human Milk Macronutrients: A Prospective Observational Study. Journal of Human Lactation. 37. 089033442110038. 10.1177/08903344211003827.
7. Koruk, Fatma & İn, Tayyibe. (2024). Determining Breastfeeding Behaviors During Pregnancy and Opinions on Tandem Breastfeeding among Postpartum Women in a High Fertility Region of Turkey. 
8. 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