Extended Breastfeeding

While there is much important information out there about nursing in the early days, weeks, and months of your child’s life, we hear less about the nursing relationship after a child’s first birthday and beyond.  Nursing beyond the first year of life is often referred to as extended breastfeeding here in the US, though other cultures don’t consider breastfeeding to be “extended” until after a child’s third birthday, as longer nursing relationships are more common.

Rates of Extended Breastfeeding

According to the CDC’s 2011 Breastfeeding Report Card, approximately three-quarters of mama-baby pairs initiate a breastfeeding relationship after birth.  At six months, about half of all mama-baby pairs are breastfeeding and at baby’s first birthday, about one quarter of all mama-baby pairs still enjoys a breastfeeding relationship. In Minnesota, about 23% are nursing by the child’s first birthday.

In many nations, the rates of breastfeeding at one year are much higher; for example, India, Iran, and the majority of countries in Africa have breastfeeding rates at one year at or above 90%.

Extended breastfeeding in the US

A 1994 study in the journal Birth looked at the characteristics of women and their children when breastfeeding continued beyond a year.  This study found that:

• Longer duration of breastfeeding was associated with greater maternal age and education and longer rates of exclusive breastfeeding
• Nearly 70% of women who continued to nurse beyond 1 year had returned to work before the child’s first birthday.
• About half of the women reported nursing on demand.
• At 12 to 15 months, 54% of children were sleeping separate from their mothers (in cribs) and 37% were co-sleeping
• The most frequently cited reason for continuing the breastfeeding relationship was the perception that it was a special way to nurture and bond with baby.

Another study of 179 women who nursed beyond one year found that the average age of weaning among this group was 2.5 to 3 years of age, with a span ranging from one month to 7 years.  Most of the women in this group described weaning as gradual and child-led.  Some also cited a subsequent pregnancy as the reason for weaning.

Support for extended breastfeeding

Most major health organizations both in the US and internationally recommend extended breastfeeding, citing significant health benefits to both mother and child.

• The World Health Organization recommends breastfeeding for at least 2 years.

• The American Academy of Pediatrics recommends that “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child… Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother… There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.”(AAP 2012, AAP 2005)

• The American Academy of Family Physicians recommends that breastfeeding continue throughout the first year of life and “should ideally continue beyond infancy,” though not the cultural norm in the United States. They cite that the natural weaning age for humans is between two and seven years. They also recognize that continued breastfeeding offers a child immune protection, better social adjustment, and a sustainable food source in times of emergency and offers the mother a reduced risk of breast cancer and other illnesses. They also note that, “If the child is younger than two years of age, the child is at increased risk of illness if weaned.” (AAFP 2008)

• The Academy of Breastfeeding Medicine affirms breastfeeding beyond infancy as the biological norm, with average age of weaning between six months to five years.  The president of The Academy says idea that breastfeeding beyond infancy is harmful to mother or infant has absolutely no medical or scientific basis.   He notes the more salient issue is the damage caused by modern practices of premature weaning.”  The Academy further notes that increased breastfeeding duration is associated with reduced maternal risks of breast cancer, ovarian cancer, diabetes, hypertension, obesity, and heart attack.” (ABM 2012)

Benefits of extended breastfeeding for children

Evidence shows that breastfeeding continues to be a valuable source of nutrition and disease protection for as long as breastfeeding continues.  A 2005 study noted that human milk expressed beyond the first year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods.  A 2001 study noted that, “Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.”

Some argue that breast milk doesn’t provide the same benefits after the first year.  However, some of the immune factors in breast milk increase in concentration during the second year and also during the weaning process. In several studies, breastfeeding toddlers between the ages of one and three have been found to have fewer illnesses, illnesses of shorter duration, and lower mortality rates.  The World Health Organization notes the importance of breastfeeding in the treatment and prevention of childhood illness, and states that “a modest increase in breastfeeding rates could prevent up to 10% of all deaths of children under five.

The benefits of extended breastfeeding continue beyond the body.  Research shows the longer a child nurses, the greater their cognitive development (as measured by IQ scores and grades in school later on).  Other studies show that children breastfed longer are more socially developed and have lower rates of mental health problems throughout childhood and adolescence.

Benefits of extended breastfeeding for mothers

Studies show the following benefits of extended breastfeeding for mothers:

• Delayed return of fertility
• Easier ability to lose weight if desired
• Lowered risk of:
  • breast cancer
  • ovarian cancer
  • uterine cancer
  • endometrial cancer
  • osteoporosis
  • rheumatoid arthritis
  • cardiovascular disease
  • Type 2 diabetes mellitus in mothers who do not have a history of gestational diabetes

Beyond the measurable

Elizabeth Baldwin, attorney and author of “Extended Breastfeeding and the Law” notes the following:

“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.”

Sources:

http://www.cdc.gov/breastfeeding/pdf/2013breastfeedingreportcard.pdf

http://kellymom.com/ages/older-infant/ebf-benefits/

http://kellymom.com/fun/trivia/bf-numbers/