Women’s Health Today

Continuing to breastfeed beyond the first year: breastfeeding “forever.”

While the prevalent cultural attitude in many countries now is towards weaning babies early, during most periods of history and in most parts of the world babies have been breastfed for years rather than months (Mead & Newton, 1967). A breastfed baby depends on his mother for both food and comfort and in societies that place a high value on self-sufficiency, the baby who will not be satisfied with anyone other than his mother may regarded by many as a liability.

The World Health Organization in the Global strategy for infant and young child feeding states:

As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.

Human milk does not lose its nutritional value

Mother’s milk is an important source of energy and nutrients, providing one half or more of a child’s energy needs in children 6 to 12 months of age. Between 12 and 24 months, it can supply one third of your child’s energy needs (WHO, 2009). Human milk is a nourishing food for as long as your child drinks it.

Dewey (2001) found that for children 12 to 23 months old breastfeeding provided the following percentages of the child’s needs:

• 29% of energy
• 43% of protein
• 36% of calcium
• 75% of Vitamin A
• 76% of folate
• 94% of Vitamin B12
• 60% of Vitamin C

There doesn’t exist a wealth of research studies into breastfeeding beyond three years of age, but it is unlikely that the nutritional and immunologic qualities conferred by human milk cease at any particular cut-off date.

As a child grows, breastfeeding becomes much less about nutrition and much more about comfort and pleasure in the interaction between mother and child. It is a nice way to relax for both of you, a way to reconnect after separation, to provide reassurance for any worry, to soothe a grazed knee, to calm any turbulence, and especially to ease into sleep. It is a useful box of tricks for any mother—a super power, no less! Instead of viewing sustained breastfeeding as something to question, perhaps the real query should be,

What is there to be gained by abruptly putting an end to the breastfeeding relationship?

Some worry that continuing to breastfeed will make a child overly dependent on his mother in the future. Many presume that a child won’t grow out of breastfeeding unless he is forced. In reality, it’s a natural process for all children. It may seem as though it is going to go on forever, but in the context of a lifetime (even for those who keep on going for years) it is a very small small part of it, and the health benefits breastfeeding confers may even add a few years to your life expectancy.

My story

When my first son was born, I was determined to breastfeed him. It was an uphill struggle in which my perseverance eventually paid off. When we reached the six-month mark, it seemed as though we’d only just got into the swing of things. To my surprise, I was enjoying my new social circle of mums and babies and getting out and about with a breastfeeding baby was surprisingly simple. But I hadn’t realized just how helpless and dependent a six-month-old baby was. We certainly couldn’t have managed life easily without breastfeeding.

When he celebrated his first birthday, he still clearly exhibited a need to breastfeed even though he was eating several solid meals a day. He didn’t like cow’s milk and my milk was readily available. Breastfeeding was quick and easy and had become a natural part of mothering to me. There seemed to be no need to stop just yet.

Once he was in “big boy’s” shoes he was a bit more of an acrobat during our breastfeeding sessions, but he was obviously still a baby. When he tumbled over and hurt himself and cried, offering the breast was so much more efficient than rocking or soothing with other methods. A few minutes of nursing worked wonders no matter what the upset was.

By the time he reached his second birthday, my son was steadier on his feet but emotionally still a bit wobbly. Putting him to my breast was a great way to calm this fractious, tired, or over-stimulated toddler, and it soothed me, too! As time went by—he was three before I knew it—breastfeeding had become something familiar in a world full of new experiences. It was special for both of us: a way of connecting, relaxing, drifting to sleep, forgiving, reconnecting after separations, and a way of grounding. Breastfeeding was a source of comfort and nourishment when he was ill and could take no other food.

There were definitely moments when I wanted my own space, too. What had once been special quiet nursing sessions with my baby during the night became what felt like uncomfortable, tiring maulings. Once I became pregnant again, my son’s nipple twiddling, which used to be mildly irritating on occasion, became excruciating for me. By the time my belly had swelled I felt there was no longer room for this large child in our bed and gradually initiated weaning. At first it seemed impossible because breastfeeding was vital in easing the transition from waking to sleeping at naps and bedtimes. But with time, routines including bedtime stories, particularly from daddy, and cuddles took the place of feeding sessions. He relinquished breastfeeding around half-way through my pregnancy.

When I was pregnant with my third child and nursing my second son, who was three, I was again physically uncomfortable breastfeeding and keen to introduce restrictions. However, he was not to be put off with stories and cuddles and I struggled with my feelings. At times (in the night, especially) I wanted to push him away. The only thing that made his night nursing acceptable was to restrict it by telling him it was hurting me and that he would have to stop after I had counted to 60!

With both by second and third nurslings in turn, they gradually cut back, while still asking for milk most days (always at bedtime) for some years, little by little reducing to a token suck (lasting just seconds) and then maybe as infrequently as once a week, once a month, until we both simply forgot about it. They just grew out of it. During that time, there were some phases when they reverted to full-time breastfeeding, sometimes for days or even weeks at a time. Likely these spells corresponded with developmental leaps, anxiety, warding off sickness bugs but it was never possible to pin down any one precise reason. I’m glad that I didn’t wean any of them abruptly (though I did encourage them to cut back) because I avoided having to cope with an unhappy child resisting my efforts to stop them. It amazes me how much energy some mothers expend on such a battle.

Of course, there were some ups and downs. There were times when I felt judged by others for whom breastfeeding had been more of a fleeting experience or from those who couldn’t appreciate my child’s need to be nursed to sleep. Breastfeeding an older child can be an isolating experience (especially if you haven’t discovered a group of mothers who are also still breastfeeding their older babies, as I hadn’t with my first child). I was fortunate to have a supportive partner who appreciated the importance of breastfeeding. He also valued a good night’s sleep, which can be something of a boon for the father of a breastfed child.

Handling criticism

Understandably, some mothers find it difficult to deal with pressure to wean, whether that pressure comes from family, friends, or complete strangers. Choosing to do things differently than other mothers who initiate weaning after a few months calls for courage, self-assurance, and a good support system. Anthropologist Katherine Dettwyler points out that major contributors to premature weaning are cultural. Early weaning often occurs in cultures that promote breastfeeding as mainly nutrition for infants, view breasts as sexual objects, and look askance at breastfeeding in public.

Get support wherever you can find it: ideally, it will come from your partner, family, and friends.

If you find yourself facing criticism from people close to you, keep in mind that they are most likely voicing their opinions out of concern and based on their own experiences. If criticism comes from family members or friends, remember that they may simply be uninformed about the benefits of sustained breastfeeding or perhaps they feel guilty about their own parenting choices. Consider responding to unwelcome comments by:

• Ignoring. Walk away or change the subject.
• Informing. Share evidence-based information.
• Using humor. Tell a joke about the situation or yourself, not the other person.
• Acknowledging. Recognize the person’s viewpoint and ask further questions without agreeing or disagreeing.
• Empathizing. Demonstrate that you understand the other person’s feeling and meaning.

Breastfeeding in public

With young babies, it’s much easier to be inconspicuous while nursing in public or around others. Toddlers don’t demonstrate a great deal of discretion, even performing gymnastics while breastfeeding. Some like to pop on and off and talk to you, all the while fiddling with your breast or clothing. Depending on the company you keep, you may find this embarrassing. There is no harm in setting limits if this becomes a challenge.

Sometimes a mother may feel “touched out” or manipulated and long to have her body back to herself. Perhaps she is burned-out or overwhelmed and is seeking ways to gain back some control through weaning. These feelings are common, and the intensity comes and goes. Some mothers choose to continue breastfeeding and work through the negative feelings by finding ways to satisfy their own needs.

If you are experiencing negative feelings about breastfeeding, consider using your child’s naptime for an activity that you enjoy. Even just getting out of the house for a while may brighten your mood. If possible, plan a regular event when your partner (or other trusted person) stays with your child while you enjoy a couple of hours out on your own.

Nursing an older child is not something a mother does on cue in the same way she would breastfeed a newborn. Mothers choose to examine their own comfort levels and impose restrictions on an older child. Keep it positive. Take your own feelings seriously and say No gently when it is not convenient. Older children are capable of waiting and learn to appreciate that their needs are not always met immediately.

Limits range from not allowing your child to fiddle with your body while nursing, dropping some feedings, and going longer between feedings. Cutting down on the number or length of feeds can be done gently and gradually, progressing with the child’s readiness to defer breastfeeding or be distracted with other things and is easily reversible if the pace is moving too fast for a child. Weaning is not an “all or nothing” act.

Advantages for mother

Parenting is an exhausting business. When a mother says how tired or stressed she is, some people may point to breastfeeding as the culprit. In reality, there are many benefits of sustaining breastfeeding, some of which include:

Stress relieving qualities. Breastfeeding suppresses the nervous system’s hormonal response to stress, which is why many mothers recognize that they feel calmer and better able to cope with whatever comes along while nursing.

A few guaranteed calm moments in a day. Parenting can be hectic. Toddlers are bursting with energy and find a lot of interesting things to keep them busy. There are times, however brief, when a mother can count on breastfeeding to put her feet up and both of you can enjoy a cuddle.

Decreased risk of diseases. Including cancers, osteoporosis, and heart disease.

Amenorrhea. The natural infertility experienced while breastfeeding is known as lactational amenorrhea. Many mothers experience reduced fertility when nursing past a year, with some women going as long as two years or more without menstruating. Even after the time during which lactation alone is a reliable contraceptive, many mothers continue to enjoy freedom from menstruation and from the physical and emotional effects of ovulation and menstruation.

Advantages for toddlers

As mentioned at the start of this post, human milk is the primary source of nutrition during a baby’s first year. It becomes a supplement to solids during the second year, but it maintains nutritional value, as well as emotional benefits throughout toddlerhood.

Protection. Breastfeeding reduces the risk of a number of acute and chronic diseases in early childhood and has long-term benefits for cardio-vascular health (Horta et al., 2007). It takes up to six years for a child’s immune system to mature. Human milk continues to complement and boost the immune system for as long as it is offered. Research on the incidence of illness in breastfed or weaned toddlers reflects these dynamics. Breastfeeding toddlers between 16 and 30 months old have been found to have fewer types and shorter duration of illness and to require less medical care than their non-breastfeeding peers (Gulick, 1986).

At times of sickness, you can expect an increase in the frequency of feedings. Perhaps the poorly child simply seeks comfort in your arms, but by nursing round the clock he boosts milk production temporarily to maximize the antibodies he receives to fight the illness. If you are exposed to any bacteria or viruses, your immune system makes antibodies to fight against them, and these will be in your milk protecting your child.

Children with allergies may continue to breastfeed for nutrition longer than those who are able to tolerate a wider range of foods, and your milk can help keep the child’s digestive system healthy.

There is an ever growing body of research into the superiority of the normal way to feed a child. With declining rates of breastfeeding, the beneficial nature of breastfeeding is probably underestimated in the findings of most studies, since it is hard for researchers to find children who have been exclusively breastfed as opposed to ever having been put to the breast.

Well-being. A child who weans gradually is able to maintain his emotional attachment to his mother very easily, rather than needing to cuddle an inanimate object such as a soft toy or blanket. Weaning before a child is ready to let go requires you to find ways to substitute the frequent physical closeness somehow. You cannot spoil a child with affection. Trusting your child to grow out of breastfeeding fosters his self-esteem. It’s another way of telling him his feelings matter. Natural weaning respects differences in children by letting them grow at their own pace. Independence cannot be forced upon a child before he is ready to assume it. Independence, not dependence, is one outstanding trait that breastfed children who self-wean have in common (Ferguson, 1987). It is the child who is pushed to grow up too soon who clings the longer. Meet a need—it is gone!

If you want to sustain breastfeeding your child so that weaning happens naturally, find the support of other mothers who understand that it’s both normal and healthy for children to  breastfeed, but also that a child moves on from breastfeeding, and can use his mother’s help to do so.

All mothers and children are different and there are no prizes to be won for breastfeeding the longest.

References

Gullick, E.E. (1986). The effects of breast-feeding on toddler health. Pediatr Nurs, 12(1), 51-4.

Horta, B.L., et al. (2007) Evidence of long-term effects of breastfeeding: systematic reviews and meta-analyses. World Health Organization, Geneva.

Mead, M. & Newton, N. (1967). Cultural Patterns of Perinatal Behaviour in Childbearing: Its Social and Psychological Aspects. Baltimore, Maryland: Williams & Wilkins Company.

Weaver, J. M., Schofield, T. J., & Papp, L. M. (2017). Breastfeeding duration predicts greater maternal sensitivity over the next decade. Developmental Psychology. doi:10.1037/dev0000425

WHO. (2009). Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: World Health Organization. SESSION 3, Complementary feeding.

Photo with title: Caroline Van Nierop