Breastfeeding: How Long Is Too Long?

Mothers from Eastern Ukraine attend training on breastfeeding

Brooke A. Perry

MPH, RD, CLC

It was a cool September morning. Flipping the radio station on my drive into work, I happened across a talk show—on a local hip hop station of all places—and something caught my ear. As I listened, I realized they were discussing breastfeeding—more specifically breastfeeding into toddlerhood.

I listened for the rest of my commute and it got me thinking. I'm a huge advocate for breastfeeding during infancy until 12 months of age and understand the benefits of continued nursing until the age of 2, but I had no opinion or even background education about extended nursing. What are the benefits of extended breastfeeding?

Most of us have heard that "breast is best." Breast milk is a great source of nutrition, but it is so much more than just a food. Breast milk contains water, fat, proteins, carbohydrates, vitamins, minerals, and other necessary elements1. These nutrients double as anticancer agents, antibacterials, antivirals, as well as immune-boosters1.

Breast milk adapts to the needs of the baby and can provide immunoglobulins specific to the illness the baby has1. Due to these components of breast milk, there are several benefits to the infant and child. These include reduced risk for infections, childhood cancers, cardiovascular diseases, type 1 and 2 diabetes, obesity, dermatitis, asthma, sudden infant death syndrome (SIDS), and infant mortality2. Studies have shown that mothers who breastfeed also have a reduced risk for breast and ovarian cancer, type 2 diabetes, osteoporosis, and postpartum depression2. These benefits increase the longer a woman breastfeeds cumulatively across all children2.

Are there any enhanced benefits for a child to continue to breastfeed past 12 months? According to breastfeeding expert Amy Spangler in Breastfeeding: A Parent's Guide, breast milk can provide up to one-third of the calorie, protein, and calcium needs of a toddler3. This can be especially beneficial if the child is refusing to eat other foods due to illness. Spangler also found that toddler illnesses are shorter in duration due to breast milk continuing to create illness-specific antibodies3. Extended nursing also can provide comfort to the child and mother and assist with bonding3.

The research on extended nursing is just beginning. I was able to find only one possible negative to breastfeeding past age 1. In a meta-analysis, it was found that breastfeeding over the age of 1 year, as well as nocturnal feedings, was associated with an increase in dental cavities, likely due to inadequate oral hygiene4.

However, public opinion also plays a role when it comes to consequences of breastfeeding a toddler. In the US, the American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of life and to continue for at least 12 months5. But in other countries, the World Health Organization recommends breastfeeding up to the age of 2 or beyond6.

With those recommendations in mind, what are the breastfeeding statistics? In the US, 81.1 percent of infants born had breastfeeding initiatived; 22.3 percent of infants at the age of 6 months are exclusively breastfed; and 30.7 percent of infants are breastfed at 12 months7. Globally—excluding the United States, Western Europe, and Australia—43 percent of infants at 6 months are exclusively breastfed; 74 percent of infants are breastfed at 12 months; and 46 percent are breastfed at 2 years8.

Ultimately, my recommendation would be for a mother to breastfeed her baby for as long as she is able and willing. Although we cannot deny it plays a huge role, public opinion should not be a factor. All we can do is continue to push the envelope to make breastfeeding the norm. There are too many benefits to both mother and child to discourage breastfeed past infancy.

References

  1. Walker M. Breastfeeding Management for the Clinician: Using the Evidence. 3rd ed. Weston, Massachusetts: Jones & Bartlett Learning 2014.
  2. Ip S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007 Apr. (Evidence Reports/Technology Assessments, No. 153.) Internet: https://www.ncbi.nlm.nih.gov/books/NBK38337/ (accessed 19 September 2017)
  3. Spangler A. Breastfeeding: A Parent's Guide. 9th ed. United States: Amy Spangler, 2010.
  4. Victora CG, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 2016. 387(10017): p. 475-90.
  5. American Academy of Pediatrics. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 2012; 129:e827-e841. Internet: http://pediatrics.aappublications.org/content/pediatrics/129/3/e827.full.pdf
  6. World Health Organization. WHO: Breastfeeding. Version current 2017. Internet: http://www.who.int/topics/breastfeeding/en/ (accessed 11 September 2017).
  7. Centers for Disease Control and Prevention: Division of Nutrition, Physical Activity, and Obesity.
  8. Breastfeeding Report Card: Progressing Toward National Breastfeeding Goals United States, 2016. CDC 2016.
  9. United Nations Children's Fund. From the First Hour of Life. UNICEF 2016.

About the Author

Brooke A. Perry, MPH, RD, CLC, is a registered dietitian coordinator at Genesee County Health Department Women, Infants, and Children and a certified lactation counselor. She is an alumna of University of Michigan School of Public Health Environmental Health Sciences specializing in Dietetics. Perry has a passion for breastfeeding and pediatric nutrition.

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