Special Dietary Guidelines for Teenage
There are Recommended Dietary Allowances, or RDAs, for teenagers and for
women nursing a baby. But should there be special nutritional guidelines for
teenage mothers who are nursing? Some preliminary research suggests it might be
a good idea.
Pediatrician Kathleen Motil, who is with the
Agricultural Research Service's
Children's Nutrition Research Center in Houston, Texas, compared the milk
production of 22 mothers--half teens, half adults. The nutrient compositions
were similar, but the teens produced 37 to 54 percent less milk than adults.
Motil's findings were published last summer in the Journal of Adolescent
Motil said the differences between adult and teen milk production remained
statistically significant, even after she adjusted the data for differences in
feeding time and daily nursing frequency. Why should the milk volume be
different? Motil has a theory.
"Our preliminary observations suggest that teenage mothers are facing a
dual metabolic challenge," said Motil. "It may be they are still
growing, themselves, which may cause an extra nutritional demand."
Motil and her colleagues wanted to find out more about teen nutrition during
lactation. They measured body composition, dietary intakes, and milk
production. The participants: 24 teenage mothers, half of whom breast-fed their
infants. Eleven additional teens who had never been pregnant served as a
control group. Barbara Kertz, patient service coordinator at the nutrition
research center, organized the study.
Preliminary findings suggest that teenagers who nurse their infants continue
to add muscle mass to their bodies, indicating ongoing growth.
"We found that nursing teens consumed more energy (calories), protein,
and vitamin B6 than teen mothers who bottle-fed or teens who never
had children," says Kertz. "They were taking in 23 percent more
calories and vitamin B6 and 40 percent more protein." The
teens' intake returned to regular levels after weaning. This research team also
included nutritionist Corinne Montandon, who helped the girls keep a food
journal to track the amounts and kinds of foods they ate. Montandon reviewed
the journals for accuracy and sometimes provided a little advice. She cautioned
one mother, for example, against trying to crash diet her way back to a
Knowing about teenagers' nutritional demands during breast-feeding fits into
a bigger plan of encouraging all mothers to breast-feed--regardless of age. In
fact, USDA's Food and Nutrition Service (FNS) has started a nationwide campaign
to encourage breast-feeding.
The number of U.S. teenagers becoming pregnant has been declining, but many
groups estimate half a million girls under 20 do give birth annually. For those
who choose to raise their infants, breast-feeding can offer advantages such as
protection against a broad range of infections and enhanced bonding.
Teenagers are less likely to chose breast-feeding than adults, however.
During an FNS focus group on breast-feeding, women of all ages cited
embarrassment and lack of family support as barriers to breast-feeding.
But teens face special problems, according to a survey by Alain Joffe, M.D.,
of the Department of Pediatrics at Johns Hopkins University Hospital. Joffe has
studied breast-feeding among 250 inner city teens in Baltimore, Maryland. Susan
Radius, a sociologist at nearby Towson University, was a co-author.
The researchers found teenage mothers who returned to high school had a hard
time working nursing into their schedule.
Joffe said in his survey the best indicator of whether a teen would
breast-feed successfully was having a breast-feeding mentor. That person could
be her mother, aunt, or other older friend who had breast-fed successfully and
could provide advice.
He added that for teens to accept breast-feeding they must know the benefits
and feel confident about ways of dealing with obstacles. Some high schools, for
example, allow new mothers special time to breast-feed.
Breast-feeding advice and public acceptance seem a long way from research.
But these outside factors can have very real effects on the science. If fact,
the researchers have to account for the extent of their teenage subjects'
breast-feeding knowledge. That's why Kertz, a lactational consultant, met with
the girls in their study from delivery onward, to provide breast-feeding
Still, the researchers at the Houston center don't know exactly how the
teens handled their breast-feeding before their study began. Theresa O. Scholl,
who is with the University of Medicine and Dentistry of New Jersey, read
Motil's paper on breast milk production. Scholl's career has focused on the
effects of teen pregnancy and lactation on the health of girls and their
"The differences between the growing teens and adult women in this
study are huge. It's really impressive," says Scholl. "It might be
good to do a follow-up study of the infants from birth to the first 6 months.
That way, you could find out if the teen mothers were offering to nurse less
often from the start and if that contributed to a reduction in milk flow."
Kertz agrees that the study's findings, like all scientific research, open
the door to new questions.
"Breast-feeding is an issue of supply and demand," she says.
"The more a mother breast-feeds, the more milk she'll have and the longer
she'll be able to nurse. Most of the girls weaned their infants at 3 to 4
months. Was this an arbitrary decision to stop nursing, or did the young
mothers lack the nutrients to continue?"
There are bigger questions, however--the most basic one being how real is
the competition between growing teens and their infants for nutrients? Another
is: Do the girls really continue to grow during their childbearing and nursing?
Medical textbooks once said no; now the question is being revisited.
Scholl points to her studies of pregnant teens that measured growth of the
lower leg only, rather than from head to foot. Lordosis, a natural bending of
the spine during pregnancy, can cause errors in a head-to-foot measurement.
These studies suggested strongly that growth continues during pregnancy.
Does it follow that continued growth in teens could affect breast milk
volume? Scholl points out that, during pregnancy at least, nature often favors
the mother during nutrient stress. Studies on famine and infant birth weight
have suggested this natural advantage may have contributed to the survival of
the human species.
"Nature wouldn't allow the mother to deplete all her resources,"
says Scholl. "If it did, she couldn't live to bear more offspring.
Moreover, if the mother died, what would happen to her baby?"
More research will need to be done to say with certainty that teen growth
causes nutrient competition that results in lower birth weights in newborns and
less milk during lactation. But Scholl's work on teen births and Motil's work
on teen nursing lend support to the theory that the body puts some of its
nutrients on reserve to benefit the teenage mother.
If this proves to be true, physicians will want to be sure that teenage
mothers are getting the extra nutrition they and their infants need to ensure
Lee, Agricultural Research Service Information Staff, 6303 Ivy Lane,
Greenbelt, Maryland 20770, phone (301) 344-2781.
Kathleen Motil is at the USDA-ARS
Children's Nutrition Research
Center, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030;
phone (713) 798-7180, fax (713) 798-7187.
"Special Dietary Guidelines for Teenage Mothers " was
published in the March 1998 issue of Agricultural Research magazine.
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