I am writing this column after speaking in Germany and the United Kingdom in June and was struck that health care professionals still have a great need to receive education about human milk and breastfeeding. I assumed that all health care professionals knew what tandem breastfeeding was and found that I was incorrect in that assumption. Tandem breastfeeding is when a person breastfeeds both an older and younger child at the same time period. It is possible that many nurses may not have observed this in their day-to-day clinical practice because of the short breastfeeding duration of many families globally. Although many people initiate breastfeeding, few sustain breastfeeding long term (Centers for Disease Control and Prevention, 2022).

In the United States, only a little over one-third (35.9%) of infants are breastfed for their first year of life (Centers for Disease Control and Prevention, 2022). Women who do breastfeed for over 1 year may consider weaning in order to have a return to fertility and conceive another child (Cunniff & Spatz, 2017). Women are also sometimes advised by health care providers that they must wean their child once they become pregnant. There is no research to support this advice if the women is healthy and has no pregnancy complications (such as placenta previa or risk for preterm birth). When someone is breastfeeding and becomes pregnant, milk supply will decrease due to the hormones of pregnancy. The decrease in milk supply and also the change in the composition of milk may cause some children to self-wean.

If the child continues to breastfeed throughout the whole pregnancy, on birth of the new infant and delivery of the placenta, the milk will again come to volume. Sinkiewicz-Darol et al. (2021) studied macronutrients of human milk for mothers who tandem breastfed. They used a human milk analyzer to study the protein, fat, and lactose in human milk from these mothers. Macronutrients were not negatively affected, and the composition of the milk mirrored the needs of the youngest child (Sinkiewicz-Darol et al., 2021).

Families who choose to tandem breastfeed may have strong beliefs about benefits of this practice for familial attachment. In my course at the University of Pennsylvania School of Nursing on human milk and lactation, I have a panel each semester of breastfeeding families who come and share their experiences with the students. One of my long-term panelists was a mother who continuously lactated for 17 years. She tandem breastfeed all of her children (except for the first) and spoke passionately about how tandem breastfeeding was such a positive way to integrate the new baby into the family structure.

It is important for nurses to be aware that 1) tandem breastfeeding exists, 2) support mothers who choose to tandem breastfeed, and 3) provide unbiased and nonjudgmental information and care (O'Rourke & Spatz, 2019). As nurses, we should actively listen to mothers and discuss their personal goals for breastfeeding each child (O'Rourke & Spatz, 2019).

Future research should explore in detail the demographics of families who choose to tandem breastfeed and their experiences. Family-focused research about the experiences of integrating a newborn who is tandem breastfeeding into the family and how this affects bonding and sibling relationships would be interesting. Further research about milk composition during pregnancy and post-birth such as the bioactive components of human milk is warranted.

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