In a culture where most mothers wean their babies from the breast before three months of age, the thought of a mother continuing to nurse her son or daughter into toddler-hood or beyond leaves some people aghast. Despite ample research identifying early weaning as a risk factor for disease and illness, and despite the recommendations of leading international medical organizations to continue to nurse for at least 2 years or beyond, fewer than 7 percent of U.S. mothers continue to breastfeed their children at 18 months.
Benefits of Extended Breastfeeding
While the benefits of breastfeeding are fairly well-known and understood, the benefits of extended breastfeeding are less well-known and even more rarely understood. The benefits of breastfeeding extend to both mother and child and continue for the duration that the mother breastfeeds her child whether that duration is six months or six years. They certainly do not cease to exist at any particular age. According to the American Association of Pediatrics policy statement on breastfeeding, “Increased duration of breastfeeding confers significant health and developmental benefits to the mother and child.
For mothers, certain benefits of breastfeeding are cumulative and the longer a woman breastfeeds her children the greater she reduces her risk of developing various diseases. Lactation reduces a mother’s risk of developing ovarian cancer, endometrial cancer, uterine cancer, breast cancer and osteoporosis. A woman who nurses her baby for at least a year effectively reduces her risk of developing breast cancer by 11%. If she nurses her toddler through age 2, she reduces her risk of developing breast cancer by 25%. If a mother breastfeeds her child or children for a cumulative seven years over her lifetime, her risk of developing breast cancer is almost entirely reduced.
Not only do mothers experience a reduction in risk of developing osteoporosis and various cancers, but they often experience other beneficial health effects during the months or years that they breastfeed their children. Diabetic mothers often experience a reduction in insulin requirements for the duration that they breastfeed. A study published in the August 2001 issue of Human Reproduction revealed that mothers suffering from polycystic ovarian syndrome-a disease marked by insulin resistance and infertility-experience beneficial effects on blood sugar levels during lactation.
Mothers are not the only ones to benefit from breastfeeding and extended breastfeeding as children also experience greater, cumulative benefits the longer they nurse. Indeed, early weaning either to infant formula for a baby under a year old or to cow’s milk at a year old is associated with greater risk of developing disease both in childhood and in adulthood.
Children who nurse beyond the first year of life benefit nutritionally from breastmilk in many of the ways that young babies benefit nutritionally, though they do not subsist entirely on breastmilk. A 1998 study published in the Food and Nutrition Bulletin published by the United Nations Press indicates that breastmilk continues to be an important source of nutrition, particularly vitamin A, in the second and third years of life.
Indeed, just 15 ounces of breastmilk provides approximately 75% of the vitamin A requirements and 60% of the vitamin C requirements during the second year. By contrast 15 ounces of whole cow’s milk supplies only 36% of the vitamin A requirements and 0% of the vitamin C requirements during the second year.
Additionally, children who are breastfed for an extended period of time exhibit fewer illnesses than their weaned peers. A mother produces antibodies to various environmental pathogens for the entire time that she breastfeeds, and her nursing child benefits from these antibodies regardless his or her of age. Beyond antibodies, another critical factor in breastmilk is the presence of immunoglobulins and other immune factors many of which increase in concentration after the first year of lactation, perhaps contributing to the fact that nursing children exhibit fewer illnesses and illnesses of shorter duration than their weaned peers. The American Academy of Family Physicians has noted that children weaned before two years of age are at increased risk of illness. The World Health Organization has stated that “a modest increase in breastfeeding rates could prevent up to 10% of all deaths of children under five: Breastfeeding plays an essential and sometimes underestimated role in the treatment and prevention of childhood illness.”
What do the experts say?
While well-respected medical organizations like the American Academy of Pediatrics and the World Health Organization may differ on the minimum amount of time a mother should breastfeed her children, they do agree on two things: exclusive breastfeeding for six months and that mothers should breastfeed their children for as long as mutually desired. Sadly, fewer than 15% of U.S. mothers follow the current recommendation of exclusive breastfeeding (no solids, no formula, no supplementary water or any other liquids) for six months according to 2005 study released by the Centers for Disease Control.
In its recommendation that infants be breastfed for a minimum of twelve months, the AAP is largely alone as most authorities on health care including the WHO, UNICEF, Canadian Pediatric Society and Australian Society of Paediatrics all recommend breastfeeding for a minimum of twenty-four months.
It should be reinforced that twelve and twenty-four months, respectively, are considered the minimum age that children should be weaned and that breastfeeding can, and ideally should continue beyond the minimum as long as desired by mother and child. On the subject of extended nursing, the AAP writes “There is no upper limit to the duration of breastfeedingandno evidence of psychological or developmental harm from breastfeedinginto the third year of life or longer.”
Many children, left to their own devices in choosing when to wean, will wean around four to four and a half years with some children weaning earlier and others weaning later. A survey conducted between 1996 and 1998 and published in the Journal of Obstetrics and Gynecology examined natural weaning among 1,280 US children who breastfed for at least three years. Among these children who were breastfed for an extended period of time, the mean age for weaning was just over four years with some children weaning as early as 3 years and others weaning as late as 9.5 years. Approximately 45% of the children weaned before four years of age with fewer than 5% weaning after 6.5 years.
Noted biolcultural anthropologist and lactation researcher Katherine Dettwyler estimates the biologically normal weaning age for humans to lay between 2.5 and 7 years with some children weaning earlier, and others weaning later. She also writes “there is no research to support a claim that breastfeeding a child at any age is in any way harmful to a child. On the contrary, my research suggests that the best outcomes, in terms of health, cognitive, and emotional development, are the result of children being allowed to breastfeed as long as they need/want to.
Indeed among the staggering amount of research conducted on breastfeeding, numerous studies indicate the perils and risks of premature weaning but no research indicates a risk to extended breastfeeding; rather, the research that exists on the subject of extended breastfeeding indicates that the practice benefits both mother and child.
So, when do you wean?
While choosing either parent-led or child-led weaning is ultimately a personal choice, as is choosing to breastfeed for an extended period of time, one must consider and reflect upon the benefits that extended breastfeeding brings to both mother and child as well as the recommendations of health care organizations and professionals in the field of lactation.
Mothers benefit from reduced risk of various diseases, as do their children. Children benefit nutritionally from breastmilk more than they do from cow’s milk-which is often recommended when a child weans.
In accordance with current recommendations, a mother should breastfeed exclusively for the first six months and continue to breastfeed for at least one year to meet the AAP minimum recommendation, preferably two to meet the WHO recommendation and as long thereafter as she and her child care to continue. The mother who continues to breastfeed beyond the minimum recommendation should take to heart that she is providing her child with innumerable benefits and she ought to be supported in her efforts.
