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Ποια είναι η σωστή ηλικία αποθηλασμού;

Το παρακάτω κείμενο είναι απόσπασμα από το βιβλίο της ανθρωπολόγου Katherine Dettwyler, PhD, “Breastfeeding: Biocultural Perspectives”. Αν και το βιβλίο γράφτηκε από το 1995-1997, πολλά από τα παρακάτω στοιχεία είναι εντυπωσιακά και δίνουν μια καλή εικόνα του “φυσικού χρόνου αποθηλασμού” και του τι σημαίνει αυτό.

Στην έρευνά μου μελέτησα πρωτεύοντα θηλαστικά, λαμβάνοντας υπόψη διάφορους παράγοντες της ζωής τους όπως τη διάρκεια της εγκυμοσύνης, το βάρος γέννησης του μωρού, τον ρυθμό ανάπτυξής του, την ηλικία ανατολής των πρώτων δοντιών, την ηλικία της σεξουαλικής ωρίμανσης, κλπ. Μετά μελέτησα το πώς αυτοί οι παράγοντες σχετίζονται με την ηλικία του αποθηλασμού σ’ αυτά τα θηλαστικά. Τα ζώα αυτά είναι οι πιο κοντινοί μας συγγενείς στο ζωικό βασίλειο, ειδικά οι γορίλες και οι χιμπαντζήδες, οι οποίοι έχουν περισσότερα από 98% κοινά γονίδια με τον άνθρωπο.
Κατέληξα σε διάφορα συμπεράσματα όσον αφορά το πότε θα αποθήλαζε «φυσικά» ο άνθρωπος, εάν δεν υπήρχαν όλοι αυτοί οι κανόνες που επιβάλει η κουλτούρα. Το ενδιαφέρον μου ξεκίνησε από την μελέτη της βιβλιογραφίας για τον χρόνο αποθηλασμού, η οποία έδειξε ότι οι διάφορες κουλτούρες έχουν πολύ διαφορετική αντίληψη για το πότε πρέπει να αποθηλάζουν τα παιδιά, από πολύ νωρίς στις ΗΠΑ έως πολύ αργά σε άλλες περιοχές του κόσμου.
Ακούμε συχνά ότι παγκοσμίως ο μέσος χρόνος αποθηλασμού είναι τα 4,2 χρόνια, αλλά αυτό το νούμερο δεν είναι ούτε σωστό, ούτε έχει κανένα νόημα. Η μελέτη 64 «κλασικών» ερευνών οι οποίες έγιναν πριν το 1940, έδειξαν μέσο χρόνο αποθηλασμού τα 2,8 χρόνια, αλλά σε κάποιες κοινωνίες ο θηλασμός κρατούσε πολύ λιγότερο και σε κάποιες άλλες πολύ περισσότερο.
Με στατιστικούς όρους δεν έχει κανένα νόημα να μιλάμε για μέσο χρόνο αποθηλασμού παγκοσμίως, αφού τα περισσότερα παιδιά δεν θηλάζουν καθόλου, ή οι μητέρες εγκαταλείπουν το θηλασμό τις πρώτες μέρες ή τις πρώτες εβδομάδες μετά τον τοκετό. Ωστόσο είναι αλήθεια ότι υπάρχουν ακόμα κοινωνίες όπου τα παιδιά θηλάζουν ως τα 4 ή τα 5 χρόνια τους κι ακόμα και στις ΗΠΑ κάποια παιδιά θηλάζουν τόσο ή και περισσότερο.
Στις κοινωνίες στις οποίες τα παιδιά επιτρέπεται να θηλάζουν για όσο καιρό θέλουν, συνήθως αποθηλάζουν χωρίς φασαρίες και ψυχολογικά τραύματα κάπου ανάμεσα στα 3 και στα 4 χρόνια τους. Το ενδιαφέρον μου επίσης ξεκίνησε από την συνειδητοποίηση ότι για κάποια άλλα θηλαστικά υπάρχει «φυσική ηλικία αποθηλασμού», η οποία είναι περίπου οι 8 εβδομάδες για τους σκύλους, οι 8-12 μήνες για τα άλογα, κλπ. Προφανώς, τα ζώα αυτά δεν έχουν κοινωνικούς περιορισμούς για το ποια είναι η κατάλληλη ηλικία αποθηλασμού.
Κάποια από τα αποτελέσματα των ερευνών είναι τα ακόλουθα:
1. Σε μια ομάδα 21 πρωτευόντων θηλαστικών που μελετήθηκαν από την Holly Smith (κυρίως μαϊμούδες και πίθηκοι), προέκυψε ότι τα μωρά τους αποθήλαζαν την χρονική στιγμή κατά την οποία ανέτειλαν οι πρώτοι τους μόνιμοι τραπεζίτες. Στους ανθρώπους αυτό σημαίνει γύρω στα 5,5-6 χρόνια.

2. Είναι σύνηθες να ακούμε τους παιδίατρους να ισχυρίζονται ότι σε πολλά είδη ζώων η διάρκεια της κύησης ισοδυναμεί με την διάρκεια του θηλασμού, θέτοντας την ηλικία αποθηλασμού στους 9 μήνες για τον άνθρωπο. Ωστόσο, η σχέση αυτή φαίνεται να εξαρτάται από το μέγεθος του ζώου – όσο πιο μεγάλο το ζώο, τόσο πιο μεγάλο διάστημα θηλάζει. Για τους χιμπαντζήδες και τους γορίλλες, τα δύο πιο κοντινά στον άνθρωπο πρωτεύοντα θηλαστικά, η σχέση αυτή είναι 6 προς 1. Δηλαδή, θηλάζουν τα μικρά τους ΈΞΙ φορές περισσότερο από την διάρκεια της κύησης. Στον άνθρωπο αυτό σημαίνει 4,5 χρόνια (έξι φορές οι 9 μήνες της εγκυμοσύνης).

3. Είναι επίσης σύνηθες οι παιδίατροι να ισχυρίζονται ότι τα περισσότερα θηλαστικά αποθηλάζουν όταν έχουν τριπλασιάσει το βάρος γέννησης, θέτοντας την ηλικία αποθηλασμού στον 1 χρόνο για τον άνθρωπο. Και πάλι ωστόσο, αυτό επηρεάζεται από το μέγεθος, με τα μεγαλύτερα θηλαστικά να θηλάζουν τα μικρά τους μέχρι να τετραπλασιάσουν το βάρος γέννησης. Στον άνθρωπο, ο τετραπλασιασμός του βάρους γέννησης συμβαίνει ανάμεσα στα 2,5 έως 3,5 χρόνια συνήθως.
4. Μια άλλη μελέτη σε πρωτεύοντα θηλαστικά έδειξε ότι αποθήλαζαν τα μικρά τους όταν είχαν φτάσει το 1/3 το βάρος ενός ενήλικα. Αυτό στον άνθρωπο συμβαίνει περίπου στα 5-7 χρόνια.
5. Μια σύγκριση της ηλικίας αποθηλασμού και της ηλικίας σεξουαλικής ωριμότητας στα πρωτεύοντα θηλαστικά, έδειξε τον χρόνο αποθηλασμού στα 6-7 χρόνια για τον άνθρωπο (περίπου στα μισά της ηλικίας της σεξουαλικής ωρίμανσης).
6. Κάποιες μελέτες έδειξαν ότι το ανοσοποιητικό σύστημα του παιδιού ωριμάζει πλήρως γύρω στα 6 χρόνια της ζωής του και είναι επαρκώς τεκμηριωμένο το γεγονός ότι το μητρικό γάλα βοηθάει στην ωρίμανση του ανοσοποιητικού και το υποβοηθά με τα αντισώματα της μητέρας για όσο καιρό αυτή παράγει γάλα (μέχρι τα δύο χρόνια. Δεν έχει γίνει καμία μελέτη για την σύσταση του μητρικού γάλακτος μετά τα δύο έτη).
Άρα, η μικρότερη ηλικία φυσικού αποθηλασμού στον άνθρωπο φαίνεται να είναι τα 2,5 χρόνια και η μεγαλύτερη τα 7.
Όσον αφορά τα οφέλη του μακροχρόνιου θηλασμού, έχουν γίνει πολλές συγκριτικές μελέτες ανάμεσα σε μωρά που θηλάζουν και σε μωρά που τρέφονται με υποκατάστατο, όσον αφορά την συχνότητα κάποιων ασθενειών αλλά και τον δείκτη ευφυΐας. Σε κάθε περίπτωση, τα θηλάζοντα βρέφη είχαν μικρότερο κίνδυνο ασθενειών και υψηλότερο IQ απ’ ότι τα βρέφη που έπαιρναν υποκατάστατο. Στις μελέτες οι οποίες ξεχώριζαν τα θηλάζοντα βρέφη ανάλογα με το πόσο καιρό θήλασαν, τα βρέφη που θήλασαν περισσότερο καιρό είχαν ακόμα χαμηλότερο κίνδυνο για κάποιες ασθένειες και ακόμα υψηλότερο δείκτη ευφυΐας. Με άλλα λόγια, αν οι κατηγορίες ήταν 0-6 μήνες θηλασμού, 6-12, 12-18, 18-24+, τα μωρά που θήλασαν από 18 έως 24+ μήνες είχαν τα καλύτερα αποτελέσματα, αυτά που θήλασαν 12 έως 18 μήνες είχαν τα αμέσως επόμενα καλύτερα αποτελέσματα, τα μωρά που θήλασαν 0-6 μήνες είχαν τα χειρότερα αποτελέσματα, αλλά και πάλι πολύ καλύτερα απ’ ότι τα μωρά που έπιναν υποκατάστατο.
Η έρευνα έδειξε τα παραπάνω αποτελέσματα για τις ασθένειες του γαστρεντερικού, του ανώτερου αναπνευστικού, την σκλήρυνση κατά πλάκας, τον διαβήτη, τις παθήσεις της καρδιάς, κλπ, κλπ. Παρόμοια, τα μωρά που θήλασαν περισσότερο είχαν τα καλύτερα αποτελέσματα στα τεστ ευφυΐας. Ένα σημαντικό σημείο που πρέπει να τονίσουμε είναι ότι καμία από αυτές τις μελέτες δεν μελέτησε παιδιά που θήλασαν περισσότερο από δύο χρόνια. Προφανώς, τα οφέλη συνεχίζουν και αργότερα, καθώς το σώμα μας δεν γνωρίζει ότι το μωρό μας είχε γενέθλια και δεν αρχίζει ξαφνικά να παράγει γάλα που δεν έχει κανένα όφελος.

Ωστόσο, κανείς ως τώρα δεν έχει αποδείξει ότι τα οφέλη του θηλασμού είτε συνεχίζονται είτε σταματούν μετά τα δύο χρόνια, γιατί δεν έχουν γίνει οι απαραίτητες μελέτες. Είναι ξεκάθαρο φυσικά ότι μετά τα δύο χρόνια το γάλα είναι μειωμένο και σίγουρα οι πρώτοι έξι μήνες θηλασμού είναι πολύ πιο σημαντικοί όσον αφορά τη διατροφή και την ανοσολογική ανάπτυξη του μωρού, απ’ ότι οι έξι μήνες από τα 3,5 ως τα 4 χρόνια. Όμως αυτό δεν σημαίνει ότι πρέπει να σταματήσετε να θηλάζετε εάν ακόμα θέλει το μωρό σας κι εσάς δεν σας πειράζει.

Είναι ξεκάθαρο επίσης ότι τα μωρά στις δυτικές κοινωνίες δεν χρειάζεται να αντιμετωπίσουν όλες αυτές τις ασθένειες και το μολυσμένο νερό που αντιμετωπίζουν τα μωρά στις χώρες του τρίτου κόσμου. Έχουμε υποκατάστατα τα οποία γενικά μπορούμε να εμπιστευτούμε ότι είναι καθαρά και ασφαλή. Μπορούμε να εμβολιάσουμε τα παιδιά μας και να τους δώσουμε αντιβιοτικά όταν είναι απαραίτητο. Όμως το γεγονός ότι «μπορούμε» να κάνουμε όλα αυτά τα πράγματα, δεν σημαίνει ότι ο θηλασμός δεν είναι σημαντικός. Τα μωρά που θηλάζουν έχουν περισσότερα πλεονεκτήματα από τα μωρά που πίνουν υποκατάστατο, ακόμα και στο ασφαλές περιβάλλον που μεγαλώνουν, με την καλύτερη ιατρική περίθαλψη.
Μια άλλη διάσταση του θηλασμού ενός μεγαλύτερου παιδιού είναι ότι, μέσω της σχέσης που δημιουργεί ο θηλασμός, μπορούν να διατηρήσουν την συναισθηματική τους εξάρτηση από ένα άλλο πρόσωπο, αντί να ψάχνουν υποκατάστατα σε άλλα αντικείμενα όπως αρκουδάκια ή κουβερτούλες. Πιστεύω ότι αυτό θέτει τις βάσεις για μια ζωή περισσότερο ανθρωποκεντρική και λιγότερο υλιστική και νομίζω ότι αυτό είναι καλό πράγμα.
Επίσης, δεν μπορώ να σκεφτώ τη ζωή ενός νηπίου, το οποίο είναι σε φάση μεγάλων αλλαγών, κάποιες από τις οποίες μπορούν να φέρουν μεγάλη αναστάτωση στον ψυχισμό του, χωρίς αυτή την στενή προσωπική επαφή που επιφέρει ο θηλασμός. Θα μπορούσα να συνεχίσω για πάντα, αλλά καλύτερα να σταματήσω εδώ.
Ελπίζω όλα τα παραπάνω να σας βοήθησαν. Αυτά και άλλα πολλά ακόμα, βρίσκονται στο κεφάλαιο “A time to wean” στο βιβλίο μου “Breastfeeding: Biocultural Perspectives”.

by Katherine Dettwyler, PhD
Department of Anthropology,
Texas A and M University

Μετάφραση: Βίκυ Φαρδογιάννη – Πιστοποιημένη Σύμβουλος Θηλασμού IBCLC

Πηγή: http://www.whale.to/a/dettwyler.html

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