Breastfeeding beyond a year: Extended breastfeeding

During World Breastfeeding Week, we celebrate moms and the healthy benefits of breastfeeding, pumping, and supplementing. Breastfeeding is a uniquely personal journey, and we are here to support moms and their feeding choices.

Moms may wonder how long they should breastfeed or if breastfeeding beyond a year is too long. Extended breastfeeding is generally regarded as breastfeeding your baby past infancy or 12 months of age. Although extended breastfeeding is not the social norm in the United States, and is in fact almost taboo in Western cultures, it is normal to breastfeed children until 2- to 5-years-of-age in many parts of the world.

When I was studying extended breastfeeding prior to becoming an International Board Certified Lactation Consultant (IBCLC), one of the "ah ha" moments I had was when an IBCLC instructor said "humans are the only mammals who wean their infants prior to them being able to fend for themselves."

In the U.S., mothers may make breastfeeding choices that are influenced by social and cultural expectations. Extended breastfeeding has led to many mothers to practice what is known as closet breastfeeding, where she hides her extended breastfeeding from society, family, and friends. Extended breastfeeding benefits, however, have been well studied and documented.

Nutritional benefits of extended breastfeeding

Although the average milk intake per feeding may decrease to 1-3 ounces depending on how frequently the baby is eating and other complimentary foods they are consuming, breastmilk still has enormous nutritional benefits.

• In nutritional studies, breastmilk in the second year has higher levels of protein, lactoferrin, lysozyme, and immunoglobulin A.
• There is some concern that if children are breastfeeding they will not be taking enough of the recommended complimentary foods to meet all of their nutritional demands. That is not, however, always the case, specifically in countries where food and adequate nutrition may be difficult to come by. In one study of 250 toddlers from Kenya, solid food intake increased after weaning, but not enough to replace all the fat, vitamin A, and niacin that the child had been getting via breastfeeding.
• There may be concern that breastfed babies will not develop proper palates for certain foods, tastes and textures leading to "picky eating.” This claim has not been verified by science.

Health benefits of extended breastfeeding

Experts also agree that extended breastfeeding has a variety of health benefits.

• The American Academy of Family Physicians notes that children weaned before 2 years of age are at increased risk of illness.
• Breastfeeding toddlers have been found to have fewer illnesses, illnesses of shorter duration, and lower mortality rates.
• Antibodies are abundant in human milk throughout lactation.
• According to the World Health Organization, “Optimal breastfeeding is so critical that it could save the lives of over 820 000 children under the age of 5 years each year. Breastfeeding plays an essential and sometimes underestimated role in the treatment and prevention of childhood illness.”
• The benefits to mother are also extensive. Women who breastfeed are shown to have decreased risks of breast, uterine, ovarian, endometrial cancers, osteoporosis, rheumatoid arthritis, cardiovascular disease, and Type II diabetes, along with many other psychological and physical health benefits.

Are there drawbacks to extended breastfeeding?

Some critics of extended breastfeeding worry about psychological impact of breastfeeding an older infant/toddler.

• The American Academy of Pediatrics states: “There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.”
• The American Academy of Family Physicians further state: “As recommended by the WHO, breastfeeding should ideally continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and encouragement. It has been estimated that a natural weaning age for humans is between two and seven years.”

Many mothers who choose extended breastfeeding face cultural and social pressure to wean from breastfeeding. Talking to a doctor, reaching out to a lactation specialist, checking out online resources, or joining social media groups can help mothers get the information and support they need to make the healthiest decision for them and their baby.