Tandem Nursing: Definition, Benefits, Safety & More

 By Dr. Kenosha Gleaton, OBGYN

Breastfeeding is highly recommended by many organizations, including The American Academy of Pediatrics (AAP) and the World Health Organization (WHO). [1-2] It’s encouraged for most people to breastfeed exclusively for the first six months of life, and continue to breastfeed until at least two years of life [1-2] (read about breastfeeding vs formula feeding). But what if you find out you’re pregnant, or you’re hoping to conceive again within this time frame? Breastfeeding does not have to stop when someone becomes pregnant, and many people choose to continue nursing throughout pregnancy. Some may even be able to nurse two children at once. 

What Is Tandem Nursing?

Tandem breastfeeding, also known as tandem nursing, refers to breastfeeding two children of different ages at the same time. [3] For example, breastfeeding a toddler as well as a newborn at the same time is considered tandem nursing. Someone may also be able to tandem nurse if they adopt a young child into their home while already breastfeeding another child. As you can imagine, tandem nursing isn’t always possible or easy to do. It will likely take some planning, adjusting, and guidance from your healthcare provider. 

The Journey from Pregnancy to Tandem Nursing

Some who become pregnant again soon after having a baby may decide to continue breastfeeding while pregnant. It’s important to note that breastfeeding during pregnancy is not the same thing as tandem breastfeeding, but is often a precursor to tandem nursing. For someone to tandem nurse, they will need to breastfeed two children- meaning both are out of the womb. [3] 

Not everyone will be able to continue breastfeeding during and after pregnancy. For one, many physical symptoms come with pregnancy that may make breastfeeding uncomfortable. [4] For example, the nipples can become very sensitive during pregnancy, and pregnancy can lead to fatigue, making it hard to exclusively breastfeed or stick to a normal schedule. [4] Additionally, those who do breastfeed while pregnant may notice a decrease in milk supply around the fourth to fifth month.[4] It’s also normal for the milk composition to change during this time as a result of hormonal changes- potentially causing your breastfeeding child to lose interest. 

If someone can breastfeed their older child throughout their pregnancy and into the postpartum period, they may be able to successfully tandem nurse. Though there are some factors that should be discussed with a healthcare provider, such as continuing to take prenatal vitamins for women, caloric intake, potential pregnancy complications, etc. 

The Benefits of Tandem Nursing

There are many potential benefits of tandem nursing. Breast milk is extremely nutritious, helping to fuel fetal development as well as boost a child’s immune system. In the case of tandem breastfeeding, two children can receive these benefits. Other reasons for tandem nursing include [3-5]:

• Benefits of colostrum for both the newborn and the older child
• Bonding with both children through skin-to-skin contact
• This may help your older child adjust to their sibling
• Minimizes engorgement 
• Increases or supports milk supply
• Nutritional and immune support

Safety Considerations in Tandem Nursing

There is no evidence to suggest that tandem nursing results in any negative health effects for the parent or either of the children. In fact, one study found that breastfeeding for more than a year and feeding two children did not adversely affect the quality of breast milk. [3] 

Some may be concerned about the health of their fetus if they are breastfeeding while pregnant. The American Academy of Family Physicians (AAFP) states that if a pregnancy is normal and everyone is considered healthy, breastfeeding during a pregnancy is not unusual and is a personal decision. [6] A study also found that there was no risk to the pregnant person or the unborn child for the parent to continue breastfeeding throughout gestation. [7] 

This being said, it’s always best to discuss your breastfeeding plans with a healthcare provider first. 

Ensuring Adequate Nutrition for Both Children

Some parents may be concerned that one or both of their children will not receive adequate nutrition if they practice tandem nursing. Fortunately, most research suggests that this should not be a concern. The composition of breast milk tends to increase after a year of breastfeeding, showing a higher content of fat and energy compared to the mature milk from someone who recently started breastfeeding. [3] Additionally, research found that the composition of colostrum, the nutrient-dense milk that is produced during pregnancy and immediately after childbirth, is no different in those who tandem nurse vs those who were not lactating during pregnancy. [3] This means that the newborn child will still receive all of the important nutrients that colostrum provides. 

Depending on the age of the older child, they are likely also receiving nutrients from other foods and are not relying on breastmilk for all of their nutritional needs. Lastly, lactation tends to work by supply and demand, so if there is a high demand for breastmilk, your body will likely begin to supply more. Of course, if you’re ever concerned you are not making enough milk or that either of your children is not eating enough, you should speak to a healthcare provider. 

Overcoming Challenges in Tandem Nursing

Tandem nursing is an incredible way to nourish two children, but it can cause some difficulties. Not only can breastfeeding become exhausting, but navigating breastfeeding during pregnancy or breastfeeding more than one child can quickly lead to fatigue, sore or cracked nipples, feeling overwhelmed, outside judgment, and more. [4-5] You can overcome some of these challenges by:

• Utilizing nipple balm, cream, or ointments
• Putting boundaries in place for your older child
• Limit their feeds to a certain number of times every day
• Limit the duration of their feeds
• Find time to fulfill your own needs
• Step away for a few minutes if you are feeling overwhelmed
• Schedule some “you” time to get out of the house, take a bath, read, or just nap uninterrupted for an hour

You should also speak with a healthcare provider if you are running into challenges. If needed, you can always begin to wean one or both children- just make sure to do so gradually. (Learn how to wean breastfeeding safely) 

Natalist’s Role in Supporting Tandem Nursing Mothers

If you are hoping, considering, or are currently tandem nursing, it’s important that you are adequately fueling your body. Breastfeeding parents require additional calories and water intake in order to support healthy lactation. [8] You can also support your intake of key vitamins and minerals by taking postnatal vitamins- though you should clear this with your healthcare provider first. [8] Wherever you are on your family planning journey, Natalist is here to support you. Shop our wide range of vitamins, tests, and self-care products. 

References:

1. Breastfeeding. World Health Organization. Accessed December 2023. https://www.who.int/health-topics/breastfeeding#tab=tab_1
2. Joan Younger Meek, Lawrence Noble, Section on  Breastfeeding; Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics July 2022; 150 (1): e2022057988. 10.1542/peds.2022-057988
3. Sinkiewicz-Darol E, Bernatowicz-Łojko U, Łubiech K, et al. Tandem Breastfeeding: A Descriptive Analysis of the Nutritional Value of Milk When Feeding a Younger and Older Child. Nutrients. 2021;13(1):277. Published 2021 Jan 19. doi:10.3390/nu13010277
4. Breastfeeding Info Breastfeeding During Pregnancy and Tandem Nursing. La Leche League International. Accessed December 2023. https://llli.org/breastfeeding-info/breastfeeding-pregnancy-tandem-nursing/
5. Hilary Flower (2003) Adventurers in Tandem Nursing: breastfeeding during pregnancy and beyond. Published by La Leche League International. ISBN: 9780912500973
6. Breastfeeding, Family Physicians Supporting (Position Paper). The American Academy of Family Physicians (AAFP). Accessed December 2023. https://www.aafp.org/about/policies/all/breastfeeding-position-paper.html
7. Al badran, Maysara. (2013). Effect of Breastfeeding during Pregnancy on the Occurrence of Miscarriage and Preterm Labour. IRAQI JOURNAL OF MEDICAL SCIENCES. 11. 285. 
8. Breastfeeding Your Baby. FAQ029. ACOG. July 2023. https://www.acog.org/womens-health/faqs/breastfeeding-your-baby

Dr. Kenosha Gleaton is board-certified in gynecology and obstetrics and is the Medical Advisor of Natalist. She received her MD from MUSC and completed her residency at Carolinas Medical Center in Charlotte, NC.

Dr. Gleaton is passionate about women, health equity, and mentoring. She is the CEO of The EpiCentre, an OBGYN spa-like practice, and is a Clinical faculty member of Charleston Southern University. She is also a member of the American College of Obstetrics & Gynecology, the American Association of Gynecologic Laparoscopists, and the American Association of Professional Women.