[back] Full term breastfeeding

Extend Breastfeeding's Benefits
Issue 144 September/October 2007
By Kyla Steinkraus


I attempted to wean my son, Caleb, at 12 months because most of the articles I'd read stated that a mother should breastfeed for six months to a year. When I hit the one-year mark, I thought I'd met my goal, but Caleb had different ideas.

We had gradually weaned during the day, and only nap and bedtime nursing remained. One night, a few days after Caleb's first birthday, I refused to let him nurse at bedtime. Tears spurting down his cheeks, he turned to me with huge, wet eyes and stricken gaze, as if to say, "What could I have possibly done to make you do this awful thing to me?" For the next 45 minutes, Caleb wept uncontrollably. Finally, near tears myself, I gave in, my resolve shattered. That night, he woke up crying several times, his fists clutching my nightgown, his open mouth seeking what he was terrified wouldn't be there.

I tried again the next night, substituting stories, a sippy cup, and extra cuddles, but was met with the same miserable outcome. Weaning Caleb now went against all my instincts to protect and nurture my son. He just wasn't ready. If he still wanted to nurse so badly, it couldn't be too horrible for him, right?

I began to do some research and discovered that, instead of being a negative, continuing to breastfeed was highly recommended by a plethora of experts.

The World Health Organization recommends that children be breastfed for up to two years and beyond, as do UNICEF and the Canadian Paediatric Society.1-3 The American Academy of Pediatrics advises breastfeeding for at least one year, and thereafter for as long as both mother and child desire it.4 In fact, in many parts of the world, it is normal to breastfeed for two or three years or even longer.5 "[There is no] documented time beyond which continued breastfeeding is harmful, useless, or detrimental," states Linda Smith, an internationally known lactation consultant, childbirth educator, and author of several breastfeeding textbooks. "There is no evidence that curtailing breastfeeding before the child self-weans is an advantage to the child."6

But even in the face of all this evidence, extended breastfeeding is often seen in the US as weird, or even as child abuse. Sexualized by society, the breast has been taken out of its original context as a source of both physical and emotional nourishment. Many mothers receive criticism from well-meaning but misinformed family and friends, and even from their pediatricians. Erin Winters, a Titusville, Florida, mother of a 17-month-old, was surprised when her pediatrician told her that, after one year, breastmilk no longer had any fat or calories. She had a hard time believing that the miracle food that had provided so many nutrients, vitamins, and antibodies to her baby could suddenly become the nutritional equivalent of water.7 She was right. Breastfeeding remains a wonderful resource long after that first birthday candle has been blown out. Here's the lowdown on the many benefits of extended breastfeeding for both you and your toddler.

The Benefits for your Toddler

Breastfed toddlers get complete nutrition
Research shows that the fat and energy content of breastmilk actually increases after the first year.8 Breastmilk adapts to a toddler's developing system, providing exactly the right amount of nutrition at exactly the right time.9 In fact, research shows that between the ages of 12 and 24 months, 448 milliliters of a mother's milk provide these percentages of the following minimum daily requirements:

Energy 29%
Folate 76%
Protein 43%
Vitamin B12 94%
Calcium 36%
Vitamin C 60%10
Vitamin A 75%

Unlike cow's milk, which can cause allergies and digestive problems, human milk provides complete nutrition.11 Nursing gives Tumwater, Washington, mom Tracey Chandos confidence that her picky 16-month-old is getting enough to eat: "It is so hard to tell how much food goes in a toddler's stomach versus how much ends up on the floor. Toddlers can love everything you give them one day and hardly eat anything the next."12 Even when your son will eat only fish crackers for three days straight, you can still be confident he's getting his nutrients. And because human milk is digested quickly and easily, nursing during an illness ensures that your child is getting both fluids and vital nutrients to help him recover.13

Breastfed toddlers are physically healthier
According to research, the immunological benefits of breastfeeding actually increase during the second and third years of nursing.14 The antibodies in breastmilk that protect a newborn against pathogens, viruses, and bacteria are still present in the milk of mothers nursing their toddlers.15 Literally thousands of antiviral, antibacterial, and antiparasitic factors are found in human milk, protecting against hundreds of infections and diseases, including E. coli, pneumonia, strep throat, Salmonella, influenza, rotavirus, rubella, West Nile virus, mumps, measles, diabetes, meningitis, and many childhood cancers such as leukemia.16 These immunological factors remain present whether the nursing child is three months or three years old.

This doesn't mean that your child will never become ill, but nursed toddlers contract fewer diseases, and when they do get sick, they heal more quickly.17 Kimberly Scappini, a mom from Maple Valley, Washington, says of her 16-month-old son, Carter: "He has never had anything worse than a cold, and I really think getting all of the antibodies from me, as well as [breastmilk] being the perfect food, has kept him very healthy."18 In addition, breastfed toddlers are much less likely to suffer from asthma and allergies.19

Breastfed toddlers are emotionally healthier
Some opponents of extended breastfeeding worry that it will stunt a toddler's independence. However, forcing independence too soon can backfire, causing the child to be clingy and insecure. Dr. Jack Newman, founder of the Newman Breastfeeding Clinic in Toronto, Canada, and author of The Ultimate Breastfeeding Book of Answers,20 believes that extended breastfeeding actually promotes a child's independence and emotional development. He says, "The breastfed toddler is more independent in the long run because his independence comes from a deep-seated security that comes from breastfeeding."21 Breastfeeding is a source not only of nutrition, but also of comfort, support, and security. Dr. Newman, whose three children were breastfed until they were between three and four, calls this time "a renewal of love"; it is a time for your child to rest and reconnect with you. The physical closeness and skin-on-skin contact provides reassurance of your unconditional love. With that assurance, your toddler feels free to explore and learn all about her bright new world.

Breastfed toddlers are smarter
Numerous studies show that breastfeeding promotes a higher IQ, including increased reading comprehension, math skills, and scholastic ability, even into adolescence.22 In one study, breastfeeding was associated with a 4.6 higher mean in three-year-olds' intelligence.23 The fine motor and language skills of breastfed toddlers also develop more quickly. According to Ginger Carney, a clinical nutrition manager and lactation consultant at Le Bonheur Children's Medical Center in Memphis, Tennessee, "The unique coordination of the tongue, lips, and jaw during breastfeeding exercises the muscles used for speech."24 In other words, the act of sucking promotes oral development, which enhances language skills.

The Benefits for You

Breastfeeding promotes your emotional well-being
The continued release of prolactin, the milk-making hormone, helps relieve stress and promotes feelings of calm and relaxation. The hormone oxytocin, which stimulates milk let-down, inspires loving, nurturing feelings, and is often called the bonding hormone. In addition, nursing releases endorphins, the body's natural opiates, into the brains of both mother and child.25

Breastfeeding reduces your risk of disease
The duration of breastfeeding is linked to lowered risks of ovarian, uterine, and breast cancer.26, 27 Women who breastfeed for 24 months have a 25 percent lower risk of premenopausal breast cancer. The length of breastfeeding is also directly linked to a lower risk of diabetes: one study found that for every year of lactation, women with a birth in the prior 15 years reduced their risk of Type 2 diabetes by 15 percent.30 In another study, breastfeeding for at least two years reduced a woman's risk for rheumatoid arthritis by 50 percent.31

Breastfeeding acts as a natural birth control
While not 100 percent effective, continued nursing helps suppress ovulation.32 Of course, if you aren't ready for another baby, you'll definitely want to use some sort of other protection as well. But here's an added perk: Your period usually won't return until a few months after your baby is weaned. Amanda Aaronson, a mom from Mountainville, California, calls her breastfeeding amenorrhea 'fabulous.' She says, "My daughter is almost 19 months old and I still haven't had a postpartum period."33

Breastfeeding makes parenting easier
Kirstie Farrar, a Willington, Connecticut mother nursing her 28-month-old son, calls breastfeeding her 'secret weapon.' She says, 'It's the one thing I can fall back on when nothing else is working. It can tame any tantrum at any time, and virtually never fails to convince a sleepy but resistant toddler that napping really is a good idea!34

Nursing soothes the aching gums, skinned knees, bumped heads, and tantrums that come with toddlerhood. Toddlers experience a roller-coaster of big, messy emotions from moment to moment, and reconnecting with the close, physical touch of nursing reminds them of your love and support during those difficult times. While mothering a toddler is an amazing journey, it can also be intense and demanding. A few moments of calm, quiet nursing throughout the day can reenergize both of you. It is also a great way for mothers who work to squeeze in extra bonding time. Beth Cooke, of Lafayette, Oregon, mom to 18-month-old Megan, says, "I am a working mother, so it is nice for Megan to be able to reconnect with me at the end of the day or before I go off to work."35

Many women never imagined themselves nursing walking, talking, little human beings. I didn't. But when the "accepted time" came to wean my son, I realized that this special bond I shared with Caleb was too precious to end so soon. He needed it. I needed it. As Erin Winters reflects, "I never expected to be breastfeeding a toddler... many of my perceptions and thoughts about breastfeeding changed once my baby arrived."36 Kirstie Farrar adds, "I wouldn't have thought I'd be nursing a 2 1/2-year-old. My pre-mom self would have thought it was weird, but now it seems like the most natural thing in the world."37 Your own toddler couldn't agree more.

Kyla Steinkraus is a freelance writer and the mother of Caleb, still nursing at 19 months. She lives in Illinois with her son and her husband, Jeremy.

1. Nutrition Committee, Canadian Paediatric Society, Nutrition for Healthy Term Infants: Statement of the Joint Working Group: Canadian Paediatric Society, Dietitians of Canada and Health Canada (Ottawa: Minister of Public Works and Government Services, 2005): www.hc-sc.gc.ca/fn-an/pubs/infant-nourrisson/nut_infant_nourrisson_term_e.html.

2. Michael S. Kramer, MD, and Ritsuko Kakuma, MSc, The Optimal Duration of Exclusive Breastfeeding: A Systematic Review (Geneva: World Health Organization, 2002).

3. UNICEF, "Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding" (1990): www.unicef.org/nutrition/index_24807.html.

4. American Academy of Pediatrics Section on Breastfeeding, "Breastfeeding and the Use of Human Milk," Pediatrics 115, no. 2 (February 2005): 496?506.

5. K. A. Dettwyler, "A Time to Wean," in K. A. Dettwyler and P. Stuart-Macadam, eds., Breastfeeding: Biocultural Perspectives (Piscataway, NJ: Aldine Transaction, 1995): 712?723.

6. Personal communication (28 February 2007).

7. Personal communication (27 February 2007).

8. D. Mandel et al., "Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation," Pediatrics 116, no. 3 (September 2005): e432?e435.

9. M. V. Karra et al., "Changes in Specific Nutrients in Breast Milk During Extended Lactation," American Journal of Clinical Nutrition 43, no. 4 (April 1986): 495?503.

10. K. G. Dewey, "Nutrition, Growth, and Complementary Feeding of the Breastfed Infant," Pediatric Clinics of North America 48, no. 1 (February 2001): 87?104.

11. A. Host et al., "A Prospective Study of Cow's Milk Allergy in Exclusively Breast-fed Infants," Acta Paediatrica Scandinavica 77, no. 5 (September 1988): 663?670.

12. Personal communication (27 February 2007).

13. R. H. Tangermann et al., "Breastfeeding Beyond Twelve Months," The Lancet 2, no. 8618 (1988): 1016.

14. A. S. Goldman et al., "Immunologic Components in Human Milk During the Second Year of Lactation," Acta Paediatrica Scandinavica 72, no. 3 (May 1983): 461?462.

15. M. Hamosh, "Bioactive Factors in Human Milk," Pediatric Clinics of North America 48, no. 1 (February 2001): 69?86.

16. J. K. Welsh and J. T. May, "Anti-Infective Properties of Breast Milk," Journal of Pediatrics 94, no. 1 (1979): 1?9.

17. E. E. Gulick, "The Effects of Breast-feeding on Toddler Health," Pediatric Nursing 12, no. 1 (January?February 1986): 51?54.

18. Personal communication (1 March 2007).

19. L. A. Hanson et al., "Breastfeeding Protects Against Infections and Allergy," Breastfeeding Review 13 (November 1988): 19?22.

20. Jack Newman, MD, and Teresa Pitman, The Ultimate Breastfeeding Book of Answers: The Most Comprehensive Problem-Solving Guide to Breastfeeding from the Foremost Expert in North America (Roseville, CA: Prima Publishing, 2000).

21. Personal communication (28 February 2007).

22. L. J. Horwood and D. M. Fergusson, "Breastfeeding and Later Cognitive and Academic Outcomes," Pediatrics 101, no. 1 (January 1998): e9.

23. D. L. Johnson et al., "Breast feeding and Children's Intelligence," Psychological Reports 79 (December 1996): 1179?1185.

24. Personal communication (3 April 2007).

25. C. C. Tay, "Mechanisms Controlling Lactational Infertility," Journal of Human Lactation 7, no. 1 (March 1991): 15?18.

26. K. N. Danforth, et al., "Breastfeeding and Risk of Ovarian Cancer in Two Prospective Cohorts," Cancer Causes Control 18, no. 5 (June 2007): 517?523. Epub (21 Apr 2007).

27. K. E. Brock et al., "Sexual, Reproductive and Contraceptive Risk Factors for Carcinoma-in-Situ of the Uterine Cervix in Sydney," Medical Journal of Australia 150, no. 3 (6 February 1989): 125?130.

28. P. A. Newcomb et al., "Lactation and a Reduced Risk of Premenopausal Breast Cancer," New England Journal of Medicine 330, no. 2 (1994): 81?87.

29. H. Furberg et al., "Lactation and Breast Cancer Risk," International Journal of Epidemiology 28, no. 3 (1999): 396?402.

30. A. M. Stuebe et al., "Duration of Lactation and Incidence of Type 2 Diabetes," JAMA 294, no. 20 (23 November 2005): 2601?2610.

31. E. W. Karlson et al., "Do Breast-feeding and Other Reproductive Factors Influence Future Risk of Rheumatoid Arthritis - Results from the Nurses' Health Study," Arthritis & Rheumatism 50, no. 11 (November 2004): 3458?3467.

32. J. K. Van Ginneken, "Prolonged Breastfeeding as a Birth Spacing Method," Studies in Family Planning 5 (1974): 201?206.

33. Personal communication (27 February 2007).

34. Personal communication (27 March 2007).

35. Personal communication (26 March 2007).

36. See Note 7.

37. See Note 34.