I recently went to see the doctor because of a mild skin allergy I seemed to have picked up from somewhere.  When I was still itching after eliminating my body wash and body butter from the list of possible allergens, I figured it was time to seek some professional advice.  Ah well, looks like it wasn’t the Body Shop products I bought after all - at least I don’t think so. 

Although I sort of guessed that the professional advice wouldn’t have been able to come up with any definitive allergen without testing, at least I got some more potent drugs to help suppress the itch which was starting to become rather annoying.  Just to make sure that the drugs weren’t affect Gavin through my breastmilk, I told the doctor I was still nursing.

The conversation went something like this:

Doctor: We’ll just give you some antihistamines.
Me: Oh, by the way, I’m still nursing - the drugs aren’t going to affect that are they?
Doctor: Oh no, no.  How old is your baby?
Me: 17 months.
Doctor: (eyes widened) 17 months?  You’re still breastfeeding?? (There was an incredulous tone in his voice, which he tried to cover up by adding)  That’s great, of course!

It made me wonder - is it so unusual to still be nursing a toddler at 17 months?

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…or rather, it’s “nen nen” (which literally means “milk” in Chinese).

Gavin’s first words were “ai yah” and “yeah yeah” (taught to him by his Dad).  You would have thought it might be Mama, or Mummy, or even Dada, or Daddy.

When he finally learned to say Mummy, he used to address me as such ONLY when he wanted to nurse.  So he would say, “Mummy milk,” or “Mummy nen nen”.

He must have figured we were too familiar for formalities because he decided to dispense with addressing me as “Mummy”.  Now, it’s, “Nen nen nen nen nen nen,” until I give him what he wants.

It might have been fine if that was what he said only when he wanted to nurse, except that he always says, “Nen nen,” when he wants me.  Even when he doesn’t want to nurse, he’ll say, “Nen nen.”

So it would appear that my name is no longer “Mummy”, but “nen nen”.  I used to think he would call for “nen nen” when he wanted me because he knew that he could always get Mummy if he asked for “milk”, but now I occasionally catch him saying, “Nen nen,” crawling into my lap and then crawling out of it again even before I can get my shirt up.

Is this one of those sociological side effects of nursing or is my child unique unto himself?  Are there any breastfeeding mothers out there also known as “milk” to their toddler? 

Perhaps I should just put it down to one of those dreadful terms of endearment that one gets stuck with, like “chubby-wubby”.

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Do babies have a preferred breast? 

The hubby asked me this question the other night when Gavin was busy switching between breasts like a connoisseur sampling various food on a buffet spread.  I believed he remarked to Gavin, “Left breast, right breast, what’s the difference.  Both the same!”

Evidently, to Gavin, they are NOT both the same.

Since Gavin was born, he has always shown a preference for one breast over the other.  I suspect this has something to do with the fact that one of my nipples is partially inverted and it affects the rate of flow of milk.  Although the book suggests that another possible reason might be due to the fact that we all have a hand preference which affects the way we hold the baby during nursing.  Babies prefer the way they are held on one side and not the other, which then leads to an apparent preference for one breast over the other.  This doesn’t appear to be the case with Gavin, however.

As Gavin has grown, his preference for each breast has changed over time to accommodate his own changing needs.  For instance, when he was born, he only liked my left breast.  Because the nipple on my right breast is partially inverted, I guess it made it harder for him to get a proper latch.  I also suspect that the partial inversion of the nipple is responsible for the flow rate being increased.  Since he was still learning how to suckle, the rapid flow of milk often caused him to choke, which upset him.

As he grew older and became more adept at suckling, his breast preference switched to the right side.  I guess he decided the flow on the left was now too slow for him.  As a result, I suffered two episodes of engorgement in the left breast at a time when I thought engorgement was a problem that no longer applied to me.

Now, he likes both breasts, but it appears that there is a time and place for each breast.  For instance, when he’s hungry, he prefers the right breast.  When he’s upset and needs a bit of pacifying, he only wants to suckle from the left breast.

Sometimes I wonder if he would have such a marked preference if both my breasts were the same, or whether Gavin would still have developed his preferences…

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Did I say I didn’t have any problems nursing Gavin even after his teeth erupted?  Let me rephrase that - I didn’t have any problems nursing him after his lower teeth erupted.  But since his tongue covers his lower teeth as he nurses, it is no wonder I hardly ever felt them unless he decided to take a nibble.  Now that his upper central incisor has erupted, nursing sessions are starting to get a little sensitive again - similarly to the times when he suckles too enthusiastically - and I think it is because his upper tooth is rubbing against my nipple.

I did a search online for some suggestions to manage this problem and found some help from Parenting iVillage who suggested:

1. Getting a dentist to file down the rough edge on your baby’s tooth (a newly erupted incisor will have these bumps on them called mamelons which usually wear away over time and with use of the teeth).  Since it doesn’t hurt terribly, I’m foregoing this suggestion.  Besides, if I can’t get in to clean Gavin’s teeth, I’d like to see a dentist get in to file down those mamelons!

2. Checking your toddler’s attachment position because nursing toddlers tend to wiggle around a lot and can easily slip from a proper attachment to an improper attachment.

Other possible causes of nipple pain arising from nursing a toddler might be due to:

• allergies to food particles trapped in baby’s mouth
• thrush
• pregnancy

Personally, I think I might just leave it for a bit and see how Gavin and I adapt to his emerging teeth. 

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At age 1 year and 1 month, Gavin is still nursing strong.  It has always been my intention to nurse him until he turns two or until he is ready to wean on his own.  But recently, I have discovered the extra benefits of nursing him into toddlerhood (which I presume begins when a child turns one). 

Since he became mobile, Gavin’s been climbing more things, getting into drawers, and squeezing into all sorts of nooks and crannies.  It also means he’s been bumping his head, falling down, and hurting his fingers a lot more.  More often than not, he usually doesn’t notice when he’s bumped his head, or slammed his fingers in the drawer, unless it really, really hurts, or he’s already feeling tired and irritable.  If he doesn’t react, I’ll usually pretend I didn’t see anything.  But if he starts howling, I’ll try to comfort him as best I can.  One of the biggest benefits of extended nursing is that when I can’t console him with hugs and kisses, offering him the breast is great for soothing those inconsolable tears.

Another benefit of extended nursing is something I’ve only recently really started to comprehend.  Since around about the nine month mark, Gavin has been extremely difficult to feed and we’ve had to employ all sorts of creative tactics to get him to eat his solids.  Until now, he’s only really eating one to two real meals a day - the rest of the time, he’s just nibbling.  Even then, the food he usually eats is mostly bread, cheese, teething biscuits and noodles.  We’ll try to feed him anything else that he’ll take but once he’s happy eating a particular food during a meal, we are usually hesitant to introduce a new flavour because he has a tendency to stop eating altogether if he doesn’t like the new taste.  Extremely temperamental, he’ll stop eating if he gets angry, bored, restless or if you try to do something he doesn’t agree with (e.g. feed him fish when he was already happy eating chicken).

This disinterest in food has gotten many of the family members concerned, and we’ve done everything from offering him everything that he is remotely interested in to formula.  Yeah, I don’t know what I was thinking.  Although breastmilk contains all the nutrients a baby needs, by about 6 months, the only mineral lacking is iron.  This is because the iron stores that Mummy transferred to baby have been depleted, meaning that baby now needs to get his own supply. 

Since formula is fortified with iron, we thought of giving him a bottle so his diet would be nutritionally balanced, but it seemed ridiculous to encourage him to take the bottle when he was already one year old and he has been happy with a sippy cup since he was nine months old.  Additionally, age one is when most babies are encouraged to start drinking from cups and from a dental perspective, the prevention of bottle caries meant that bottles were no longer a suitable medium to be feeding liquids to babies.  At any rate, Gavin displayed no interest in formula milk, probably since he was already getting the good stuff at night.

Despite Gavin’s apparent “lack of interest in food”, my MIL has been amazed that he still manages to maintain his generous baby padding and that his weight remains above average for his age. 

Even I, who feel that his current solid food consumption is acceptable, also wonder about how he’s managed to keep the weight up.  Until the hubby pointed out that Gavin was a heavy nurser during the night when he said, “He’s practically stuck to your breast for half the night!”  Well, “half the night” seems to me to be a tad exaggerated, but even I can’t deny that Gavin does nurse quite a lot at night.

And if I was at all worried about Gavin meeting his daily nutritional requirements, an article on extended breastfeeding from KellyMom has laid to rest my concerns with the following:

• “Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant.”
  – Mandel 2005

• “Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.”
  – Dewey 2001

• In the second year (12-23 months), 448 mL of breastmilk provides:
  • 29% of energy requirements
  • 43% of protein requirements
  • 36% of calcium requirements
  • 75% of vitamin A requirements
  • 76% of folate requirements
  • 94% of vitamin B₁₂ requirements
  • 60% of vitamin C requirements

  – Dewey 2001

I have heard that a common recommendation to mothers whose nursing toddlers are fussy eaters that it is advisable to reduce their breastmilk intake to help increase their appetite.  I would like to set the facts straight on this matter. 

Sally Kneidel in “Nursing Beyond One Year” (New Beginnings, Vol. 6 No. 4, July-August 1990, pp. 99-103.) wrote:

Some doctors may feel that nursing will interfere with a child’s appetite for other foods. Yet there has been no documentation that nursing children are more likely than weaned children to refuse supplementary foods. In fact, most researchers in Third World countries, where a malnourished toddler’s appetite may be of critical importance, recommend continued nursing for even the severely malnourished (Briend et al, 1988; Rhode, 1988; Shattock and Stephens, 1975; Whitehead, 1985). Most suggest helping the malnourished older nursing child not by weaning but by supplementing the mother’s diet to improve the nutritional quality of her milk (Ahn and MacLean. 1980; Jelliffe and Jelliffe, 1978) and by offering the child more varied and more palatable foods to improve his or her appetite (Rohde, 1988; Tangermann, 1988; Underwood, 1985).

I have also heard the comment from others that nursing babies seem more clingy and dependent than bottle-fed babies.  I tend to think that the clinginess isn’t due to the fact that the child is nursing, but that bottle-fed babies are forced into independence far too early.  The clinginess that is displayed is a normal part of childhood and it displays the strength of a child’s survival instincts to cling to Mummy.  If you follow the theory that evolution is recapitulated in infancy and realise that a child’s higher brain function does not kick in until they are much older, it stands to good reason that they would want to stay close to Mummy.  An infant in the wild who loses his mother often spells a death sentence because nothing swoops in faster on an unprotected infant than the predators.

From KellyMom:

“Breastfeeding is a warm and loving way to meet the needs of toddlers and young children. It not only perks them up and energizes them; it also soothes the frustrations, bumps and bruises, and daily stresses of early childhood. In addition, nursing past infancy helps little ones make a gradual transition to childhood. Meeting a child’s dependency needs is the key to helping that child achieve independence. And children outgrow these needs according to their own unique timetable (Baldwin 1993).” Children who achieve independence at their own pace are more secure in that independence then children forced into independence prematurely.

Another common belief going around is that breastfeeding Mums are at higher risk of developing osteoporosis because their babies leech their calcium stores through breastmilk.  Although I had read before that breastfeeding actually protects breastfeeding Mums from osteoporosis, I wasn’t sure about the mechanics of it.  According to KellyMom, although a breastfeeding Mum experiences a decrease in bone mineral during the period she is nursing, this is gained back once the baby is weaned.  In some cases, her bone density may even increase irrespective of additional calcium supplementation in her diet.  So if you’re at risk of osteoporosis (my mother has it and her mother before her), then you certainly should be breastfeeding, not avoiding it!

For the full benefits of extended breastfeeding, you can read all about it from KellyMom’s fact sheet.

A common concern I have heard about breastfeeding toddlers it that it will be harder to wean them past one year.  According to toddler nursing from KellyMom, “nursing past a year does NOT make it impossible or even necessarily more difficult to wean later on… Age has much less to do with ease of weaning than does your child’s developmental readiness for weaning… the age that a child is ready to self-wean varies greatly from child to child and commonly ranges from age 2 through age 4.”

Children generally self-wean when they no longer have a need for it either nutritionally or emotionally.  Weaning occurs over a period of time, with your child decreasing the number of nursing sessions one at a time.  Anything more rapid than this is usually indicative of a nursing strike.  Things like Mummy’s pregnancy can affect weaning, too.  Some children self-wean partway through the pregnancy as the taste of breastmilk changes due to the pregnancy hormones.  Others may continue tandem breastfeeding with a younger sibling.  Whatever it is, you can be sure that your child will self-wean when he is good and ready.  Until that time, rest assured that you and your child will be reaping the benefits of nursing past one year.

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I’ve just realised that I haven’t written a single post about Gavin’s teeth and I’m a dentist!  Or rather, was. 

Well, Gavin is now 1 year and 1 month old and he still only has two lower central incisors (they are the two front teeth on the bottom), although the two upper central incisors look like they are about to pop through his gums any day now.  His teeth are erupting a little on the slow side considering the average age of eruption for the central incisors are around 6-10 months for the lower and 8-12 months for the upper.  I had to memorise eruption dates in first year for an oral anatomy exam but heck if I can remember them all now.  I had to be told by my paediatrician that eruption of the first tooth can be as late as 18 months and that is still completely normal.

Well, there are benefits to having Gavin cut his teeth late - at least he has less teeth to bite me with when he’s nursing.  That said, I have a number of Mummy friends who’ve asked me about biting and nursing so I guess this is a common concern among mothers who intend to nurse their babies beyond six months.  Well, I was worried about it too and I asked my BFF - who had more experience than I (her son is soon to be turning two years old) - and she gave me this piece of advice:

When baby bites, just remove your nipple and tell him, “Ouch!  That hurt!  No more milk.”  He’ll soon get the message that he shouldn’t bite Mummy’s nipple. 

Gavin’s been quite good with the biting.  He hardly ever bites and when he does, it’s usually a gentle nibble.  Biting is also a sign that baby is playing and has either lost concentration for nursing or is only pacifying because in order to suckle, baby tongue thrusts forwards and that would mean that he would end up biting his own tongue.  So if baby is biting, he is no longer nursing.

When I was in dental school, we were taught to recommend to patients to bring their babies in for their first dental check up at about 6 months.  This is because the first tooth is expected to erupt about 6 months and it is a good time to advise parents about how to take care of their baby’s teeth.  It also ensures that baby’s first experience at the dentist is a positive one (which makes it easier for subsequent follow up appointments). 

I find that the number one reason why children are afraid of the dentist is because their first visit to the dentist is because they already have problems with their teeth.  A lot of people have the misconception that they only need to visit the dentist when their teeth hurt, but the problem is, when your teeth hurt, it usually means that the problem has escalated to something really big. 

It’s a catch 22 really.  Whenever a friend tells me about a dental problem they have, I’ll ask, “Why don’t you see a dentist?”  The reply inevitably will be, “I’m afraid to see the dentist because it’ll hurt.”  It really doesn’t make sense because their teeth is hurting now but they are afraid of going to see the dentist because it’ll hurt?  I’m sorry, I fail to comprehend the logic behind that statement.  The second point is that if you only visit the dentist when the pain has kicked in, it means the problem you have in your mouth is a big one and that means a big procedure will be necessary and big procedures, being more complex and more involved, can be painful (although I should add that in this day and age, most dental treatments can be done painlessly).  If you make regular trips to the dentist, your dentist will be able to fix the problems in your mouth while they are still little ones - these involve small procedures that are simple and painless.

I digress… I’m supposed to be talking about baby teeth.  Sorry.  I can’t help lecturing when I get on this topic… 

Cleaning Baby’s Teeth

You can get finger brushes that you can wear over your finger and use that to brush baby’s teeth.  It’s easier to use when compared to a toothbrush but it really depends on your child’s compliance.  In theory it sounds great but when I got one for Gavin, he refused to let me clean his teeth.  In the end, I ended up using a wet washcloth to rub his teeth, which he seemed to like.

Young children don’t need fluoride toothpaste, especially if you live in an area where the water is fluoridated.  Because of their small stature, it is easy for children to get too much fluoride which can cause a condition called fluorosis.  Mild fluorosis appears like small white spots on the teeth.  In severe fluorosis, the teeth can become brown and mottled - although there is nothing wrong with the teeth, it is aesthetically rather unpleasing.

When you start introducing fluoridated toothpaste to a child, make sure you use children’s toothpaste which usually only has about 500ppm of fluoride (compared to regular adult’s toothpaste which has 1000ppm of fluoride).  Make sure you put only a pea size amount on your child’s brush and mash it into the bristles so that your child doesn’t end up swallowing the toothpaste.  Young children have difficulties spitting so often they end up swallowing most of the toothpaste which increases their fluoride exposure.

There are really only two major diseases that affect the teeth and gums - dental caries (tooth decay) and gum disease.  When you brush your teeth, the fluoride in your toothpaste protects your teeth from dental caries and the brushing action of your toothbrush protects your gums from gum disease.  It really is as simple as that.  The fluoride in toothpaste attaches itself to the tooth surface forming a new harder structure that is more resistance to dental caries.  The action of toothbrushing removes plaque bacteria that accumulate around the teeth and irritate the gums, causing gum disease. 

In Uni, one of my lecturers explained to us that for some reason currently unknown to us at that time, children have a natural protection against gum disease.  They are immune to gum disease - perhaps it is just mother nature’s way of protecting our children, who knows? Once they turn 6, they are no longer protected, because at 6 years, the first adult molars will erupt into the mouth. 

So when it comes to your baby’s teeth, all you really need to concern yourself with is dental caries.  Which leads me to another concern that I had earlier when I had decided I was going to try to continue nursing Gavin at least until he turns 2 (as recommended by WHO, 2002).  Since Gavin is so active during the day, he tends to nurse a lot at night and since the flow of saliva is reduced when we sleep, I was concerned that the milk sugars left in his mouth might lead to tooth decay.  During the day, the constant flow of saliva washing over the teeth helps to protect the teeth from decay.  Since it would be impractical to clean Gavin’s teeth after each time he nursed, I wasn’t sure what to do about it until I read the chapter on nursing toddlers in The Womanly Art of Breastfeeding.

It appears that the milk sugars in breastmilk seem to have a lesser effect on causing tooth decay compared with formula milk and that “prolonged demand breast-feeding does not lead to a higher caries prevalence” (Weerheijm et al, 1998).  From the study, only 9% of the children who received prolonged demand breast feeding suffered from nursing caries and this was due to their low exposure to fluoridated toothpastes.  For mothers whose babies are more proned to tooth decay, it was recommended that they clean their toddlers’ teeth more frequently during the day time, especially if their toddlers are night nursers. 

Now I can continue nursing Gavin at night without feeling guilty…

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I’m spotting - does that mean my period is back?  Gavin’s ten months old.  I was sort of hoping my period wouldn’t come back until he was at least a year old.  Not having my period is another one of those additional benefits of breastfeeding - most women who do not breastfeed start menstruating again around two months post delivery, although this can vary between four weeks to six months.  I suppose ten months is still pretty good considering some women who breastfeed can still end up menstruating by six weeks post delivery.  The majority of women who breastfeed generally take longer, some even longer than a year and a half - I wish I were one of those women.  Well, it was nice while it lasted…

In terms of getting pregnant, pregnancy before menstruation has resumed is usually rare.  In most cases the first period is usually anovular (no egg is released), although the longer it takes for menstruation to resume, the more likely it is for ovulation to occur during the first period. 

When I first told the hubby I was spotting, he asked, “Are you pregnant?”  (In case you’re wondering, spotting can also be a sign of implantation, as in when the fertilised egg implants into the wall of the uterus - a sign I somehow missed when I first got pregnant thinking it was an irregular period)  Well, although I think it highly improbable, based on what I’ve just written, it looks like it could be possible.  Now that it’s dawning upon me just how much effort goes into raising a child, I don’t think I’m quite as gung ho about my original plan of having number two when Gavin turns one - try when Gavin turns two or three.

The plan for having two children in close succession was more for the benefit of the kids.  I’ve always thought it was nice growing up with an older brother who was relatively close in age to me.  And if you think number two is a great idea for keeping number one happy, I think the following cartoon that I received from my weekly Baby Center newsletter says it all…

Hope it brought a smile to your face like it did mine…

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On Sunday, I developed a blocked duct in my right breast and my breast became engorged.  At least I think it was a blocked duct because the last time I had one was when I first started nursing Gavin.  Back then, everything hurt so I guess I was more tolerant of the pain.  When I palpated my nipple, I could feel small lumps in the aveolar area - which are indicative of a block duct or three.  

It all started on Saturday night when I avoided nursing Gavin on the right breast because of a sore nipple (I think it was cracked).  Over the entire night, I kept giving Gavin the left breast - that was my first mistake.  On Sunday morning when I woke up, not only was my right nipple still sore it felt like I had rocks in my right breast. 

Realising the problem, I wasted no time putting Gavin on the right breast but it hurt so much my eyes were smarting from the pain.  It seemed that Gavin wasn’t really interested in the breast either because he kept pulling away, which hurt even more.  So I went through everything I remember from the books about engorgement (I tried to express the milk, I tried hot and cold compresses) and took a warm shower as suggested by my BFF.  They all worked to a limited extent but I would feel the ache coming back again after a while. 

I was feeling desperate enough to take painkillers, but I’m glad I held off.  I waited until I knew Gavin would be eager for a feed before putting him on the breast.  He managed to drain most of the breast except for one lump at the top.  I’m sure he would have drained that one, too, if it weren’t for the Dad who was singing to his daughter in the baby room that I was trying to feed Gavin in.  My keipo (read: nosey) boy kept pulling off to see where the voice was coming from. 

For the rest of the day, I would nurse Gavin twice on the right side for every nursing on the left.  By Sunday night, my right breast was returning to some semblance of normality.  By Monday morning, me, my breasts and I were all hunky dory.

My take-out from this experience:

• If I ever have a cracked or sore nipple again, I will persist with feeding baby.  If I had forgotten how good Bepanthen is fantastic for helping the healing process for cracked/sore nipples, I certainly remember now (and I’m not saying this because I used to work for Roche - Bepanthen is now manufactured by Bayer anyway).

• Nothing beats baby when it comes to resolving a blocked duct and an engorged breast.
• If I am ever in charge of building a shopping mall, I will design a baby room with sound-proof nursing cubicles.

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What’s the association? 

Recently, I’ve frequently been having letdowns in the shower or just straight after.  I wonder what that means?  Perhaps it is a misconception on my part to assume that after ten months of breastfeeding, spontaneous letdowns shouldn’t really be happening any more. 

Just an odd observation that had me somewhat perplexed.

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If only we had these in Malaysia…

You push the button and the door automatically opens for you.  Very handy if you’re a Mum trying to handle a pram and a wriggly baby.  I didn’t get a picture of the inside but it is like a lounge with changing stations, a toilet and cubicles for mothers who want more privacy while breastfeeding.  Nearly all the nursing rooms I saw in Australia had automatic doors, private nursing cubicles, and changing stations with special diaper bins.

That said, I paid a visit to the new development at Midvalley Megamall today and the nursing room in Isetan is quite impressive.  Let’s see how nice it stays after about six months or so…

A real let down was the nursing room at the new Parkson in the Pavilion.  After doing so much to improve their image (and I might add that I was very impressed with their new store and the hubby even equated it to David Jones in Australia), it was extremely disappointing to see the nursing room they had set up.  With only one changing station and one chair for breastfeeding, only one family can use the room at a time. 

So far, the nicest nursing rooms I’ve seen in Malaysia are:

• the one in the Curve
• the one in the new Isetan at Midvalley

Shopping complexes in Klang Valley with nursing rooms that I am aware of:

• The Curve - on Level 1 near the baby shops.
• Ikano - there are two in Ikea, and one on ground, Level 1 and Level 2 at the end opposite to Ikea near the toilets. 
• Isetan at Midvalley - on Level 2.
• KLCC - Isetan Level 2, and Parkson Level 2.
• Bangsar Village - Level 1, old wing.  I’m surprised they never made one in the new wing.
• Great Eastern Mall - Ground floor.  The inconvenience is that they occasionally lock the door and you have to get the keys from the information desk.  If you’re unlucky, the person at information will be on a break somewhere and no one will be able to locate the keys.  Other than that, I think it is one of the better thought out nursing rooms.
• 1Utama - recently added a screen to seal off a section of the ladies toilets.  Personally, I don’t like the idea of a nursing room in the toilets so I never use these.  It is one of the worst efforts at creating a nursing room I have seen.  I’m also rather surprised that there is no nursing room in Parkson.
• The Alpha Angle - inside Jaya Jusco department store on Level 1 near the baby section.

The biggest surprise is Bangsar Shopping Complex which doesn’t have a nursing room at all.

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