La Leche League International
网友：宝宝现在三个月，一直母乳喂养，现在我马上要上班了，一上班就要异地出差三周，这么小就断奶实在于心不忍，有没有什么两全其美的方法？
答：妈妈能不能和公司商量推迟出差时间或者找别人代替新妈妈出差呢？您可以试着和上级申请，请上级理解和支持，并告知公司，支持妈妈们母乳喂养对公司的好处：妈妈们母乳喂养的时间越长，孩子越少生病；妈妈们在工作后将较少请假，妈妈们的歉疚感和分离焦虑程度也会更低。这样能让企业生产效率更高，效益更好。
如果妈妈不可避免出差，经济条件允许的情况下能不能把宝宝一起带去，同时带一个阿姨或者家人随行照料。孩子这么小，非常需要妈妈，宝宝不仅是需要母乳，心理上对妈妈的需求也很大。如果实在带不了宝宝，至少妈妈在出差期间可以每天坚持把奶挤出以便保持产奶量。挤出来的奶有条件的话也可以保存起来，如果出差时间很长，可以用蓝冰将奶保存好，快递回家给宝宝喝。
（本文根据对 Ivy Makelin 的采访内容整理）
网友：我希望能喂宝宝到至少两岁，这样可以吗？一般国际母乳会建议喂到几岁？
周宗蓓：国际母乳会建议最理想的断奶过程是母亲和孩子两个人同时都觉得可以断了，没有一个上限要喂到几岁以上或者必须得几岁就非得断了，没有这样一个说法，因为每个孩子不同每个母亲也不同。有时候是孩子先想断，母亲心理还没准备好，有时候相反，母亲觉得已经喂够了，可是孩子还有需求。因为这是两个人的一种关系，要考虑两方面的需求。
自然断奶信号：
大部分的孩子如果让他自然断奶，可能会在两岁左右或者三四岁甚至有时候更大，到了最后可能白天就不吃了只是夜里吃，或者睡觉前或者刚醒吃的那一顿比较长。
如果一个孩子一岁以前一天吃8—12次，到了一岁左右可能是6—8次，有的时候更少，慢慢就放弃了白天的奶，他要玩，他想学东西，这都会让他转移注意力，他想吃母乳的需求也就自然减少了，白天吃得越来越少，可能睡觉前要吃，醒了以后要吃几口又去玩。
主持人：宝宝出现这种状况是非常好的自然断奶时期？
周宗蓓：是。
网友：宝宝16个月坚持母乳喂养很辛苦，准备春天断奶，怎么样？孩子出牙不是很好，现在只有六颗，您的孩子一直坚持母乳喂养到四岁，这期间喝其它奶制品吗？孩子怎么补钙比较好？
周宗蓓：断奶其实没有什么季节性的考虑，断奶就是考虑家庭的情况，也要考虑孩子的需求。如果给孩子断奶的话，如果强制性断了的话，孩子还接受不了，他会从别的地方表现出来，所以要注意其它的表现怎么样，满足他的需求。
长牙齿跟基因有关系，不一定跟母乳喂养有太大的关系。关于补钙，我们查了国际母乳会出版的《母乳喂养答案书》，没有特别说明一岁以下的孩子要特别补钙。一般母乳喂养的孩子通过母乳就可以得到他身体所需要一切的钙，特别是一岁以内以母乳为主的话不应该缺钙。一岁以上的孩子可以喝新鲜牛奶了。母乳的营养最丰富，坚持母乳喂养的好处之一就是获得活的抗体细胞，而且，当然要比其它的不管是配方奶还是新鲜牛奶会好得多。
Katherine A. Dettwyler, PhD Department of Anthropology Texas A & M University College Station Texas
from Breastfeeding Abstracts, August 1994, Volume 14, Number 1, pp. 3-4.
In the United States, women receive conflicting advice about when to wean their children completely from breastfeeding. The American Academy of Pediatrics recommends one year, while WHO and UNICEF recommend at least two years. Many physicians consider six months to be “extended” breastfeeding, and some health professionals question the motives of women who nurse for more than a year. In turn, women may hide the fact that they are still nursing an older child from disapproving health care professionals or family members. From anthropological research, we know that in many non-Western cultures children are routinely nursed for three to four years. Are they eccentric, or are we? Can we look to other animals to determine what the natural age at weaning would be in modern humans if it was not modified by cultural beliefs?
在美国，妇女得到的关于何时完全断奶的建议是不一致的。美国儿科学会建议至少一年(见附注），而世界卫生组织和联合国儿童基金会建议至少二年。许多医生认为六个月后即进入母乳延长阶段，并且，一些健康专家质疑那些母乳喂养超过一年的母亲的动机。同时，一些母亲可能向持不同意见的保健专家和家人隐瞒自己仍旧为大龄宝宝喂养母乳的事实。通过人类学研究，我们知道在许多非西方文化里，婴幼儿通常会接受三到四年的母乳喂养。是他们太反常还是我们？我们能否在排除文化信仰因素的前提下通过观察其他动物来确定现代人类究竟应该在哪个年龄断奶？
Like all mammals, humans have mammary glands that function to nurture their offspring. Within the class Mammalia, humans are members of the order Primates, and have the basic primate pattern of breastfeeding and weaning activity that has been molded by more than 65 million years of natural selection to ensure the best possible survival rate of primate offspring. This basic pattern is assumed to be primarily genetically based. In addition, a number of life-history variables are also associated with age at weaning in the non-human primates. What do these variables suggest about the “natural” age of weaning in humans?
和所有哺乳动物一样，人类拥有乳腺来喂养后代。在哺乳类动物中，人类属于灵长目，具有灵长目动物经过6500万年自然选择后铸就的哺乳和断奶行为模式，以保证灵长目动物后代能有最强的生存率。这个基本模式被假设为由灵长目遗传基因因素决定。另外，非人类的灵长目动物的断奶年龄同样取决于一些生活史变量因素。这些变量对于人类的“自然”断奶年龄而言意味着什么？
Weaning according to tripling or quadrupling of birth weight. The idea that mammals wean their offspring when they have tripled their birth weight is widely reported in the breastfeeding literature (Lawrence 1989). This rule of thumb holds true for small-bodied mammals, but not for larger ones. Recent research has looked at age at weaning and at growth among large mammals, including primates. The research shows that weaning occurs some months after quadrupling of the birth weight, rather than tripling (Lee, Majluf and Gordon 1991). When do U.S. infants typically quadruple their birth weight? For males, the average age is around 27 months, and for females, around 30 months.
断奶的时间根据宝宝出生体重的三倍或四倍来判定。母乳喂养的文献(Lawrence 1989)普遍报道说，哺乳动物在孩子体重增长到出生体重的三倍时断奶。这说法大抵适用于小型体积的哺乳动物，而不是大型哺乳动物。近期的研究开始观察大型哺乳动物的断奶年龄和发育情况，其中包括灵长类动物。研究表明断奶发生在体重发育到出生时四倍后的数月，而非三倍时(Lee, Majluf and Gordon 1991)。美国的婴儿通常什么时候体重增长四倍呢？对于男婴来说，平均年龄在27个月左右，对于女婴来说，通常是30个月左右。
Weaning according to attainment of one-third adult weight. Other studies suggest that primates are like other mammals in weaning each offspring when they reach about one-third their adult weight (Charnov and Berrigan 1993). Humans come in different sizes, but 4 to 7 years of nursing would be the weaning age for humans using this method of comparison, with boys generally being nursed longer than girls, and large-bodied populations nursing longer than small-bodied groups.
断奶的时间也可以根据达到成人体重的三分之一来判定。其他的研究表明灵长类动物，和其他哺乳动物一样，当其达到约成人体重的三分之一时可以断奶(Charnov and Berrigan 1993)。人类的体型各有差异，但是如果根据这个方法，人类会在4到7年之间断奶，而且男孩的母乳喂养时间通常长于女孩，体型大的种族的母乳喂养时间长于体型小的种族。
Weaning according to adult body size. Harvey and Clutton-Brock (1985) published a study of life-history variables in primates, including a formula for calculating age at weaning based on adult female body weight. The equation predicts an age at weaning for humans at between 2.8 and 3.7 years, depending on average adult female body weight, with larger-bodied populations nursing the longest.
断奶的时间也可以根据成人的体型来判定。Harvey和Clutton-Brock (1985)发表了一个关于灵长类动物生活史变量的研究，介绍了一个基于成年女性体重来计算断奶年龄的公式。这个等式预测人类的断奶年龄在2.8到3.7年之间，并取决于成年女性的平均体重。体型较大的种族母乳喂养时间最长。
Weaning according to gestation length. It is often reported in the literature that, among mammals in general, weaning age is approximately the same as the length of gestation (Lawrence 1989). By this criterion, weaning in humans might be expected to take place after only nine months of breastfeeding. However, this one-to-one relationship is greatly affected by the adult size of the animal. For many small-bodied primates, the duration of breastfeeding is shorter than the length of gestation. Among large-bodied primate species, the duration of breastfeeding far exceeds the average length of gestation. For humankind‘‘s closest relatives, the chimpanzee and the gorilla, the duration of breastfeeding is more than six times the length of gestation. Humans are among the largest of the primates, and share more than 98 percent of their genetic material with chimpanzees and gorillas. Based on these comparisons, an estimated natural age at weaning for humans would be a minimum of six times gestational length, or 4.5 years.
断奶的时间也可以根据怀孕周期来判定。研究文献经常报道，对于哺乳动物而言，通常断奶年龄和怀孕周期大致相同(Lawrence 1989)。根据这个标准，人类断奶的发生或许应该在哺乳仅九个月之后。然而，这种一一对应的关系极度受到动物成年后体型的影响。对于很多体型较小的灵长类动物而言，母乳喂养的时期比怀孕周期要短。而对于体型较大的灵长类动物，母乳喂养的时期比怀孕周期要长得多。对于人类的近亲黑猩猩和大猩猩而言，母乳喂养的时期是怀孕周期的六倍多。人类属于灵长类动物中体型较大的族群，与黑猩猩和大猩猩的基因有百分之九十八相似。根据这个比较，人类自然断奶的年龄预计至少为怀孕周期的六倍长，即4.5岁。
Weaning according to dental eruption. According to the research of Smith (1991), many primates wean their offspring when they are erupting their first permanent molars. First permanent molar eruption occurs around 5.5 to 6.0 years in modern humans. It is interesting to note that achievement of adult immune competence in humans also occurs at approximately six years of age, suggesting that throughout our recent evolutionary past, the active immunities provided by breast milk were normally available to the child until about this age (Fredrickson).
断奶的时间也可以根据牙齿萌出的时间来判定。根据Smith的研究(1991)，许多灵长类动物在萌出第一颗永久的臼齿后断奶。对于现代人类来说，通常第一颗永久的臼齿的萌出在5.5到6岁之间。有趣的是，成人的免疫系统也在大约六岁左右完善，说明在人类近期的进化过程中，母乳提供的主动免疫功能会一直提供到孩子六岁左右(Fredrickson)。
Our evolutionary past has produced an organism that relies on breastfeeding to provide the context for physical, cognitive, and emotional development. The human primate data suggest that human children are designed to receive all of the benefits of breast milk and breastfeeding for an absolute minimum of two and a half years, and an apparent upper limit of around 7 years. Natural selection has favored those infants with a strong, genetically coded blueprint that programs them to expect nursing to continue for a number of years after birth and results in the urge to suckle remaining strong for this entire period. Many societies today are able to meet a child‘‘s nutritional needs with modified adult foods after the age of three or four years. Western, industrialized societies can compensate for some (but not all) of the immunological benefits of breastfeeding with antibiotics, vaccines and improved sanitation. But the physical, cognitive, and emotional needs of the young child persist. Health care professionals, parents, and the general public should be made aware that somewhere between three and seven years may be a reasonable and appropriate age of weaning for humans, however uncommon it may be in the United States to nurse an infant through toddlerhood and beyond.
人类的进化过程产生了依赖于母乳喂养来培养身体、感知和情感发育功能的有机体。人类灵长目数据显示人类幼儿生来需接受母乳和母乳喂养的所有益处的时期最少为两年半，而适当的上限为七年左右。物竞天择的自然规律偏向于那些拥有强劲的基因蓝图的幼儿。这个蓝图使他们在出生后持续数年母乳喂养，并且在整个周期里吮吸母乳的欲望保持强烈。现今人类社会可以通过改善后的成人食物来满足儿童在三到四岁后的营养需求。西方工业化社会可以通过抗生素、疫苗和改进的环境卫生来弥补一些（不是所有）母乳喂养的免疫学益处。但是幼儿在身体、感知和情感发育方面的需求仍在。卫生保健专家、家长以及一般公众应该被告知三岁到七岁之间是人类断奶的合理并合适的时间。然而在美国，母乳喂养到幼儿学步甚至更长通常是罕见的。
(王书睿 翻译 Shiuh-jane、Daisy审稿)
References
附：2012美国儿科学会最新发布的指南内容中关于离乳时间的部分。The AAP reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. 美国儿科学会重申推荐纯母乳喂养时间为六个月，之后添加固体食物并继续母乳喂养至一岁，之后由母婴的意愿决定是否继续。
哺乳期乳腺炎起因于局部乳房的乳汁堵塞，若不加以处理，可能会发展成乳房感染。
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很多妈妈觉得自己感冒生病就不能喂奶，因为妈妈的身体和精力由于需要抵抗疾病而有所消耗，但这只是暂时的，康复之后妈妈的奶量会根据孩子的需求而相应增长。
生病的时候更需要给孩子哺乳，特别是感冒并不影响母乳喂养。妈妈如果感冒时在家里咳嗽打喷嚏，其实家里就已经有这些细菌了，如果不给孩子活的抗体细胞，孩子就没有办法抵抗这些病，他的身体就更有可能会感染妈妈的病。
妈妈可以继续母乳喂养，不用害怕也不用戴口罩。如果妈妈需要吃药，芬必得、布洛芬是安全的，不用断奶。一些抗生素类的药物或者精神方面的药，如果妈妈有问题最好咨询医生，也可以查询《药物与母乳喂养》，或者咨询母乳会的哺乳辅导，我们可以帮助查找相关的信息。
（本文根据对 Ivy Makelin 的采访内容整理）
网友：宝宝四个月了，来例假了，会不会影响到母乳？
周宗蓓：大部分的妈妈没有感到有什么影响，有的妈妈发现例假的那几天乳房不是那么胀了，可是那几天过去也就好了，这时候很重要的还是继续相信你的身体，继续频繁地按照宝宝的需求来喂，你的奶会自己调整起来的，所以不要灰心。 奶量随时可以有变化，也可以随时提高的，不是说一天偏低就永远低了。
主持人：奶量的情况应该不是一种稳定的状况，而是有曲线变化的，有下降也有上升。
周宗蓓：而且不一定是妈妈可以自己控制的，更多的是靠妈妈的身体自己调节。就像你的口水或者你的眼泪，有没有人说过我的口水量太少或者我的眼泪量太少？没有。我们的身体自动就会调节这些液体，包括母乳也是一样的，根据孩子的需求妈妈的身体会调。如果我们用别的东西满足宝宝的需求，不管是奶粉还是钙水还是其它的东西还是加了辅食或者糖水，任何别的东西开始代替孩子吃母乳的需求就会影响妈妈的乳量，妈妈的乳房意识到了孩子这段时间没有吃我的奶，所以下一次就少生产一些。
Sometimes a mother decides to resume breastfeeding, whether due to an emergency when there is a shortage of other food, after a separation, etc. Often a mother can rebuild a milk supply very successfully, with patience and determination (and a cooperative baby). La Leche League‘‘s BREASTFEEDING ANSWER BOOK (p. 52) recommends the following strategies for relactation and induced lactation, to stimulate milk production:
有时候妈妈们会因某一意外情形比如缺乏其他食物或与宝宝分离后重聚，想恢复母乳喂养。只要有足够的耐心和决心，再加上宝宝的配合，妈妈们通常都能成功的恢复产奶。国际母乳会的母乳喂养问答手册第52页推荐了以下几种刺激泌乳的方法（适用于重新泌乳和诱导泌乳）：
Putting baby to breast to suck at each feeding and for comfort between feedings as often as possible. 每次哺乳时让宝宝吸吮两边乳房，哺乳间隙尽可能频繁的让宝宝进行安抚吸吮。
Using a nursing supplementer (if available and if conditions are sanitary enough to make its use safe) to provide expressed milk at the breast while baby sucks at the breast.在宝宝吸吮乳房时,用哺乳辅助器（如果有并且卫生条件有保障时）提供给孩子事先挤出的乳汁。
Taking herbs/medication that increase milk supply. 用草药或其他药物增奶。请遵医嘱。
If you do use herbs or medications to increase your supply, be sure to put the baby to the breast frequently, to remove as much milk as possible. This will help avoid breast infections or plugged ducts.
如果服用草药或药物增奶，要确保让宝宝频繁吸吮乳房，尽可能多地排空乳房。这有助于预防乳房发炎或乳腺堵塞。
你在考虑是否应该服用医生给你开的药。如果你已经掌握了哺乳和药物的相关信息，你会很容易地作出决定。母乳喂养对你和你的宝宝来说都是重要的。审慎地研究要服用的药，甚至非处方药。（草药疗法也应该要研究）国际母乳会的《母乳喂养的女性艺术》一书第312页写道：“在为一个哺乳妈妈开药方时，有些医生出于安全，例行公事——坚决要求（患者）断奶。实际上，很少药物被证明对哺乳婴儿是有害的。”突然断奶对母乳妈妈和婴儿都会造成伤害并且导致额外的健康问题和双方的情感危机。你的医疗保健提供者需要知道你正在哺乳并且你想继续哺乳。
You are wondering if you should take the medication that your doctor has prescribed. It‘‘s easier to make that decision when you have information on breastfeeding and medications. Breastfeeding is important to you and your baby. It is prudent to investigate taking any medications, even ones available without a prescription. (Herbal remedies should also be researched.) LLLI WOMANLY ART OF BREASTFEEDING, says on page 312, “When prescribing a medication for a nursing mother, some physicians routinely insist on weaning as a precaution. In reality, few drugs have been proven to be harmful to the nursing infant.” Sudden weaning is traumatic for mother and baby and can lead to additional health and emotional risks for both. Your health care provider needs to know that you are breastfeeding and that you want to continue doing so.
当为哺乳妈妈开药方时要考虑到很多因素。比如，宝宝的年龄需要考虑。一个较大的母乳宝宝，他吃母乳已经不那么频繁了，所吃的母奶量也会小一些，因此通过妈妈的奶吃到的含在母乳里的药也会相应的少一些。以下有一些问题可供你在和你的医疗保健提供者进行会话时使用。（这些问题来源于LEAVEN文章“药物和母乳喂养”）
There are many variables to consider when a breastfeeding mother is prescribed a medication. For example, the baby‘‘s age needs to be taken into consideration. An older baby who is breastfeeding less frequently would consume smaller amounts of breastmilk and thus have less exposure to medication through mother‘‘s milk. Here are some questions to begin a dialogue with your health care provider. (They are from the LEAVEN article “Medications and Breastfeeding”.)
– Has the drug been given to infants? A drug commonly prescribed for infants is usually a good choice for a breastfeeding mother.
– Has the drug been given to other breastfeeding mothers? A drug that has a history of use by breastfeeding mothers is a better choice than a new, possibly untested drug.
– What is the duration of the drug therapy? The duration of the drug therapy can affect its compatibility with breastfeeding. A drug considered compatible with breastfeeding when taken for a few days might not be compatible when taken over a long period of time.
– Is the drug short-acting? A short-acting form of the drug may be a better choice for a breastfeeding mother than a longer-acting form that stays in the mother‘‘s system for a longer period.
– How is the medication being given? A drug given by injection or by mouth is less concentrated than one given intravenously. However, a drug may be given intravenously because it is inactivated or not absorbed by the digestive system, so the baby‘‘s digestive system would also inactivate or not absorb the drug.
– How well can the baby excrete the drug? Some drugs accumulate in a baby‘‘s system and can potentially build to toxic levels. A drug that is quickly eliminated by the baby is more compatible with breastfeeding.
– Does the drug interfere with lactation? Some drugs should be avoided by breastfeeding mothers because they affect breastfeeding itself (the let-down or milk supply).
参考资料：
药物与母乳，Thomas Hale, Ph.D著，每年都校订和更新，这种常见的参考资料是完整的，易于阅读，易于携带。包含药物报告、疫苗、病毒和草药的配制。这些报告包括美国儿科学会推荐的药品，此外，还包含有成人的和儿科的相关药品的副作用的说明。
Resources for Additional Information
Medications and Mothers‘‘ Milk, by Thomas Hale, Ph.D. Revised and updated every year, this popular reference is complete, easy to read, easily portable, and affordable. Contains reviews of medications, vaccines, viruses, and herbal preparations. The reviews include AAP recommendations as well as adult and pediatric concerns and side effects.
下图是美国卫生部公开建立的针对医护人员的药物与母乳喂养的英文数据库的链接。妈妈们可以将药物的英文名输入搜索，搜索结果包含孕产妇和婴幼儿的用药量，药物对母乳喂养的婴儿及对妈妈泌乳的影响，以及可替代的更安全的药物。建议妈妈们可以将相关信息提供给医生进行参考。
Can breastfeeding mothers get mammograms?
Yes, breastfeeding mothers can have mammograms.
母乳妈妈可以做乳房X射线检查吗？
是的，正在母乳喂养的妈妈可以做乳房X射线检查。
Mothers asking this question may have two concerns:
提出这个问题的妈妈们通常有以下两方面的疑虑：
1. Will the radiation affect my milk and harm my baby?
2. Is it possible to read the mammogram of a lactating breast?
1.X射线会影响母乳质量进而影响宝宝健康吗？
2.对正在授乳的乳房做X射线检查结果能准确吗？
X-rays do not affect mother‘‘s milk, so you can safely resume breastfeeding immediately after the mammogram. In fact, according to the LLLI WOMANLY ART OF BREASTFEEDING, page 134, “Mammograms, x-rays and ultrasound tests will not interfere with breastfeeding.”
X射线对妈妈的奶水没有影响，所以在做完乳房X射线之后可以立即喂养宝宝。实际上，在国际母乳会出版的《母乳喂养的女性艺术》第134页上有说明: 乳房X射线检查、X射线检查、超声波检查都不会影响母乳喂养。
The second question has a longer answer. It is possible to read a mammogram of a lactating breast. Breasts that produce milk are called lactating breasts. Due to milk production, there is more dense tissue present in the lactating breast than in a non-lactating one. This normal density may make it harder to read the results. The amount of tissue in your breast depends on the frequency that your baby is breastfeeding. If breastfeeding occurs infrequently, there will be less milk and tissue so the mammogram would be easier to read. To help reduce the amount of milk prior to a mammogram, you could bring your baby and breastfeed immediately prior to the procedure. Finding a radiologist experienced in reading mammograms of lactating breasts would produce more reliable results.
第二个问题需要详细解释。对正在授乳的乳房做X射线检查是有可能的。正在产奶的乳房称为授乳乳房。从泌乳的原理来看，授乳乳房比不授乳的乳房有更密集的腺体组织。这种密集的腺体组织会影响检查结果。腺体组织的数量取决于你授乳的频率。如果频率不高，存奶和腺体组织就会相对少一些，检查时就能看得更清楚。为了在检查之前减少乳房里的存奶，你可以带上宝宝，喂奶之后马上做检查。如果能找到一个对授乳乳房做检查比较有经验的放射科专家，那么他提供的结果可能会更准确。