Breastfeeding Beyond Infancy

Is there any benefit in breastfeeding your baby beyond their first birthday? Arent we told that after the age of 12 months a baby no longer needs formula or breastmilk and can be weaned onto straight cows milk or non-dairy milks? Most people follow this advice. But should they? Could it be that this belief is just a cultural myth? While it is true that for formula-fed children there is no increased benefit in giving formula over other forms of milk, breastfed children are a different case entirely. Essential differences between formula and breast milk mean that the benefits of breastfeeding extend into toddler-hood and exist as long as breastfeeding continues.

The World Health Organization (WHO) and UNICEF have long supported and encouraged breastfeeding for two years and longer. The American Academy of Pediatrics has recently revised its breastfeeding policy and now recommends that infants should be exclusively breastfed for the first 6 months and that breastfeeding should ideally continue for a minimum of one year. The AAP statement goes on to say that there is no upper limit to the duration of breastfeeding and no evidence of psychological or developmental harm from breastfeeding into the third year of life and longer. Indeed, scientific evidence shows that the benefits of breastfeeding (nutritional, immunological, cognitive, and emotional) continue as long as breastfeeding itself does. (1)

What then, exactly, are the benefits of nursing your toddler? Studies show extended nursing has nutritional, immunological, and developmental benefits. In the second year of life (from 12 – 23 months) 445 ml of breast milk provides your toddler with the following: 29% of energy requirements, 43% of protein requirements, 36% of calcium requirements, 75% of vitamin A requirements, 76% of folic acid requirements, 94% of vitamin B12 requirements and 60% of vitamin C requirements. Breast milk is a nutritional super food. Best of all, it is completely free. For picky eaters (and most toddlers are at some stage) breastfeeding offers a valuable nutritional supplement – with added immunological benefits. Breastfed toddlers have been shown to be sick less often (2) and to suffer from fewer allergies (3).

Not only does breastfeeding beyond infancy benefit your child, it offers health benefits for you too. Breastfeeding reduces the risk of breast cancer (4). Studies have found a significant inverse association between duration of lactation and breast cancer risk. Statistically, this means the longer you breastfeed, the lower your risk of breast cancer. Breastfeeding also reduces the risk of ovarian cancer (5), uterine cancer (6), and endometrial cancer (7). Studies have found that breastfeeding protects against osteoporosis (8) and reduces the risk of rheumatoid arthritis (9). Breastfeeding has been shown to decrease insulin requirements in diabetic women (10). Last but not least, breastfeeding mothers tend to lose weight easier due to an increase in caloric requirement (breastfeeding uses from 500 to 800 kcal a day).

A commonly held misconception is that extended breastfeeding will create an overly dependent toddler. In fact, researchers have found the opposite to be true. Studies show that there are statistically significant tendencies for conduct disorder scores to decline with increasing duration of breastfeeding. (11) Elizabeth Baldwin sums up the psychological and developmental findings in Extended Breastfeeding and the Law as follows:

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. Children who achieve independence at their own pace are more secure in that independence then children forced into independence prematurely.

Whether and how long to breastfeed is a very personal decision. All too often mothers find themselves pressured into making choices based on cultural and social expectations rather than following their personal preferences and instincts as a mother. Mothers who choose to breastfeed beyond infancy may find support and encouragement in knowing that they are providing their children with nutritional, immunological and developmental benefits while also doing something good for their own health.

(1) KA Dettwyler, “Beauty and the Breast” from Breastfeeding: Biocultural Perspectives, 1995, p. 204.
(2) Gulick EE. The effects of breastfeeding on toddler health. Pediatr Nurs. 1986 Jan-Feb;12(1):51-4.
(3) Savilahti E, et al. Prolonged exclusive breast feeding and heredity as determinants in infantile atopy. Arch Dis Child. 1987 Mar;62(3):269-73
(4) Furberg H, Newman B, Moorman P, Millikan R. Lactation and breast cancer risk. Int J Epidemiol 1999;28:396-402.
(5) Gwinn ML, Lee NC, Rhodes PH, Layde PM, Rubin GL. Pregnancy, breastfeeding and oral contraceptives and the risk of epithelial ovarian cancer. J Clin Epidemiol 1990;43:559-68.
(6) Brock KE et al. Sexual, reproductive and contraceptive risk factors for carcinoma-in-situ of the uterine cervix in Sydney. Med J Aust. 1989 Feb 6;150(3):125-30.
(7) Rosenblatt KA, Thomas DB, and the WHO collaborative study of neoplasia and steroid contraceptives. Prolonged Lactation and endometrial cancer. Int J Epidemiol 1995;24:499-503.
(8) Osteoporosis: Reduced risk with nursing? by Debbi Donovan, IBCLC
(9) Karlson EW, Mandl LA, Hankinson SE, Grodstein F. Do breast-feeding and other reproductive factors influence future risk of rheumatoid arthritis? Results from the Nurses’ Health Study. Arthritis Rheum. 2004 Nov;50(11):3458-67.
(10) Davies HA et al. Insulin requirements of diabetic women who breast feed. BMJ. 1989 May 20;298(6684):1357-8.
(11) Sally Kneidel in “Nursing Beyond One Year” (New Beginnings, Vol. 6 No. 4, July-August 1990, pp. 99-103.

Recommended reading:

Mothering Your Nursing Toddler by Norma Jane Bumgarner

The Womanly Art of Breastfeeding: Seventh Revised Edition (La Leche League International Book)

by Katharina Bishop