J Pediatr Adolesc Gynecol (2006) 19:131132
Perspectives on Pediatric and Adolescent
Gynecology from the Allied Health
Care Professional
Section Editors: Angela Nicoletti, MS, RNC, WHNP, and Margaret Tonelli, MSN, NP
Brigham and Womens Hospital, Boston, Massachusetts, USA
The Breastfeeding Teen
Angela Nicoletti, MS, RNC, WHNP
Brigham and Womens Hospital, Department of Obstetrics and Gynecology, Boston, Massachusetts, USA
The benefits of breastfeeding to the health of infants
and mothers have been well documented.1 A less
quantifiable positive effect of breastfeeding is the
increase in the mothers self-esteem and confidence
as a mother if she has successfully initiated breastfeed-
ing.2 This boost to self-esteem is particularly notice-
able in the teen mom. A common characteristic of
teens who either consciously or unconsciously choose
to become pregnant is a sense of failure, of never hav-
ing achieved something worthwhile. Pregnancy and
childbirth provides them with a sense of accomplish-
ment, but they absolutely beam with pride when they
successfully initiate and persevere with breastfeeding
their baby.
The key factor, of course, is success. The process of
successfully breastfeeding seems to facilitate the teens
ability to reconcile her developmental role as an ado-
lescent and her adult role as a mother. Clearly, teenage
mothers possess the capacity to initiate and continue
breastfeeding; however, they require sensitive and par-
ticular guidance from all involved to help them em-
brace and grow as mothers of their infants and
mature as responsible adults in society.3 On the other
hand, the failure to successfully breastfeed can be as
injurious to the teen psyche as their previous perceived
failures. Therefore, it is critical that sufficient supports
are provided to the pregnant teen as she evolves to
being a new mother to promote breastfeeding initiation
and to help them persevere with the commitment to
continue breastfeeding. The literature indicates that
Address correspondence and reprint requests to: Angela Nicoletti,
Department of Ob/Gyn, 75 Francis St., Boston, Ma. 02115;
E-mail: anicoletti@partners.org
2006 North American Society for Pediatric and Adolescent Gynecology
Published by Elsevier Inc.
teenage mothers value the formal encouragement they
receive from health professionals,3 though other social
influences are equally important.
The support for breastfeeding teens may take many
forms. Prenatal preparation for some initial discom-
fort is helpful as well as instruction for proper latch.
Providers should consider rephrasing the concept of
when your milk comes in. Many teens dont realize
that colostrum is not only important, but that it is ac-
tually first milk. Teens are often heard to worry that
my baby isnt getting enough because my milk
hasnt come in yet. This concern often results in
early formula supplementation.
Baby-Friendly hospitals are another source of
breastfeeding support. Those so designated have
elevated the rates of breastfeeding in the USA, but
in 2001 only 32 hospitals in the USA were Baby-
Friendly designated hospitals.4 Encouragement and
direction about initiating breastfeeding are critical,
beginning in the delivery room and on the postpartum
floors. Every staff nurse should not only be able to ef-
fectively support breastfeeding but should also convey
a belief that the teen mother can do this. Often the be-
lief that teens wont persevere with breastfeeding any-
way, translates to less than enthusiastic assistance.
Breastfeeding competence is closely associated with
the confidence that one can do this.5
Teens, as well as adult women, with low breast-
feeding confidence are more likely to discontinue
breastfeeding within the first postpartum week. A
low level of breastfeeding confidence is also associ-
ated with a perception of insufficient milk supply
and a decrease in breastfeeding level. Teens who
lack the motivation to avoid pregnancy and choose
to become parents so often lack the confidence that
1083-3188/06/$22.00
doi:10.1016/j.jpag.2006.01.010
132 Nicoletti: The Breastfeeding Teen
they are good at anything. They need all providers
to convey the belief that they can breastfeed suc-
cessfully. Reinforcement and praise of new maternal
behaviors that they have mastered, however small,
can be quite effective in raising teen maternal
confidence.
Support at home is the next critical area. Every
teen discharged from the hospital breastfeeding
should have a home visiting referral for nursing
follow-up when possible and a return appointment
in one week. A referral to one of the Healthy Families
America (HFA) programs would insure home visiting
with para-professionals who are trained to support
first-time moms 20 and under. Many of the programs
have supported certification of their staff as lactation
consultants because it has become apparent to them
that early and intensive breastfeeding support is a ma-
jor factor in the continuation of breastfeeding among
teens. Intensive postpartum support in the hospital by
a breastfeeding expert and continuing at home for the
first 6 weeks has also demonstrated increased breast-
feeding duration among teens. The support at home
can be a combination of visits and telephone
availability.6
While the foregoing supports the concept that
many teens have the potential to be successful breast-
feeders, one must keep in mind that many teens for
a variety of reasons are not able or will not want to
breastfeed. These teens need our non-judgmental sup-
port as well in their evolution to the maternal role.
References
1. Hale TW: Medications and Mothers Milk, (10th ed.).
Amarillo, Texas, Pharmasoft Publishing, 2002
2. Labbok MH: Health sequelae of breastfeeding for the
mother. Clin Perinatol 1999; 26:491
3. Nelson A, Sethi S: The breastfeeding experience of Cana-
dian teenage mothers. J Obstet Gynecol Neonatal Nurs
2005; 34:615
4. Merewood A, Mehta SD, Chamberlain LB, et al: Breast-
feeding rates in Baby-Friendly hospitals: results of a na-
tional survey. Pediatrics 2005; 116:628
5. Dennis CL: The breastfeeding self-efficacy scale: psycho-
metric assessment of the short form. J Obstet Gynecol
Neonatal Nurs 2003; 32:734
6. Nicoletti A, Grizzard T, Tonelli M, et al: Intensive postpar-
tum lactation support for adolescent mothers, 2005, not yet
submitted for publication.