Breastfeeding is not motherhood, and motherhood is not breastfeeding. Attachment does not spontaneously form by nursing. It is responding in the right emotional manner to the child’s needs.

Time magazine’s cover recently pictured an attractive, blonde woman nursing her 3-year-old son. There are several reasons why people could find that objectionable not least of which is that the premise behind the photo is incomplete.

The photo introduced attachment parenting. Please, know I am a total believer in attachment principles. The work of Drs. John Bowlby and Mary Ainsworth has transformed the understanding of mother and child relationships. Current neurodevelopmental science has only endorsed their conclusions. For this, pediatricians should be instructors in the school of attachment.

Where the train derails is if parents feel that the mainstay of attachment and hence security is only co-sleeping, persisting nursing and kangaroo carrying. These are means to an end, but not the end itself. The main feature of attachment is the emotional brain-to-brain connection of the mother and child. Of course this cannot happen when the parent is not present, hence the understandable emphasis on proximity of mother and child.

Bowlby, a British pediatrician and psychoanalyst, studied the behavior of delinquents in England after World War II. These children were reared both away from the Blitzkrieg but also away from their parents. He further observed other children separated from their parents. Bowlby was also familiar with the pioneering work of Harry Harlow with baby monkeys and terry cloth surrogate mothers.

He concluded that the principle drive for all humans and primates is security. It is not food or sex; it is to regulate our inner emotions and energies in order to feel peace. The outcome, when all of this goes right, is a feeling that becomes intuitive. It is as if the safe presence of the mother or father is forever engraved into the psychic, reassuring children for the rest of their lives.

This internal unspoken sensation of security is the foundation of human action. When this force of peace is internalized, the child is able to explore the world and better tooled to cope with daily stresses.

The consequences of a child reared in an insecure way are also evident beyond the nursery. Adults with insecurity struggle continuously attempting to reach security and acceptance. At times their behavior and attitudes can be maladaptive; read Steve Job’s biography. Either style is taught transgenerationally from parent to child to its child and beyond.

Ainsworth showed in experiments that the security a mother teaches the newborn can be tested. It is a monitored situation of separation.

We now understand the biology behind the theory. Mirror cells within the infant duplicate and imprint the mother’s emotional messages to the child’s nervous system. When there is a spike in energy as in separation, there is a recording in a frightened child’s brain. If the mother correctly recognizes the signal then modulates the surge, it won’t zoom too high. Next, the mother down-regulates the energy to a new state of calm.

Likewise, the mother energizes her child when she notices the facial and body language of sadness or loneliness. Laughing and smiling give a resilience that will be life sustaining.

To begin attachment parenting, a woman and man benefit knowing their own working models of stress regulation. Accessing their memories permits a glimpse into their own intuitions. The urge of a parent to do too much may be an overcompensation for the parents’ own loss.

Breastfeeding is not motherhood, and motherhood is not breastfeeding. Attachment does not spontaneously form by nursing. It is responding in the right emotional manner to the child’s needs. Every mother who can and wants to nurse should for many wonderful reasons. But it is nursing and sensitive interaction, or bottle-feeding and sensitive interaction, that build attachment parenting.

Parenting styles of attention to the child’s signals, aligning feelings and providing security build attachment. To do it best, mothers need to feel their own security and the emotional availability of others, family and friends. Appearing on a magazine cover isn’t necessary.

Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for 30 years and an adjunct professor of pediatrics at the University of Utah. He can be reached at [email protected].