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Monday, December 14, 2009

Breastfeeding Beyond the First Year

Most of the breastfeeding moms that I know usually try to breastfeed for at least a year. That is usually my goal as well. Nevertheless, after reading "Breastfeeding and Natural Child Spacing: How Ecological Breastfeeding Spaces Babies" by Sheila Kippley, I became more open to the idea of going longer.

As a result, I breastfed Bella for 15 months. I am considering going longer with Noah. I don't think many people realize how many benefits exist for both mother and babies when mom extends her breastfeeding past a year. Thus, many people seem to be generally uncomfortable with the idea of it.

Below you will find some articles that outline the benefits of extended nursing for both mom and baby!


Benefits Beyond the First Year

Post-Pregnancy News Flash
-- By Becky Hand, Licensed & Registered Dietitian

For both mother and child to receive the variety of proven health benefits, the World Health Organization (WHO) recommends mothers breastfeed their children up to 2 years of age and beyond. Due to social stigmas, breastfeeding older children (past one year of age) is often considered taboo and therefore done behind closed doors. A recent survey conducted in Australia collected information from breastfeeding moms (ages 21-45) who were currently breastfeeding children between 24 and 78 months old. The mothers answered survey questions, but were also given a list of questions to ask their breastfed child.

Typical responses from the moms:
  • I enjoy breastfeeding my child.
  • I feel it strengthens our relationship.
  • My child still enjoys breastfeeding and doesn't want to wean.
  • Breastfeeding is easier.
  • Breastfeeding helps to comfort my child.
  • I breastfeed for intimacy and closeness with my child.
  • My child likes the taste of breast milk.
  • 75% of the mothers did not intend to breastfeed past 12 months. However they delayed weaning because of increased confidence and knowledge about breastfeeding, along with their child's enjoyment as well as their own.

Extended Breastfeeding Fact Sheet

By Kelly Bonyata, BS, IBCLC

Nursing toddlers benefit NUTRITIONALLY
  • Although there has been little research done on children who breastfeed beyond the age of two, the available information indicates that breastfeeding continues to be a valuable source of nutrition and disease protection for as long as breastfeeding continues.
  • "Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant."
    -- Mandel 2005
  • "Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins."
    -- Dewey 2001
  • In the second year (12-23 months), 448 mL of breastmilk provides:
    • 29% of energy requirements
    • 43% of protein requirements
    • 36% of calcium requirements
    • 75% of vitamin A requirements
    • 76% of folate requirements
    • 94% of vitamin B12 requirements
    • 60% of vitamin C requirements
    -- Dewey 2001
  • Studies done in rural Bangladesh have shown that breastmilk continues to be an important source of vitamin A in the second and third year of life.
    -- Persson 1998
  • It's not uncommon for weaning to be recommended for toddlers who are eating few solids. However, this recommendation is not supported by research. According to Sally Kneidel in "Nursing Beyond One Year" (New Beginnings, Vol. 6 No. 4, July-August 1990, pp. 99-103.):

    Some doctors may feel that nursing will interfere with a child's appetite for other foods. Yet there has been no documentation that nursing children are more likely than weaned children to refuse supplementary foods. In fact, most researchers in Third World countries, where a malnourished toddler's appetite may be of critical importance, recommend continued nursing for even the severely malnourished (Briend et al, 1988; Rhode, 1988; Shattock and Stephens, 1975; Whitehead, 1985). Most suggest helping the malnourished older nursing child not by weaning but by supplementing the mother's diet to improve the nutritional quality of her milk (Ahn and MacLean. 1980; Jelliffe and Jelliffe, 1978) and by offering the child more varied and more palatable foods to improve his or her appetite (Rohde, 1988; Tangermann, 1988; Underwood, 1985).


Nursing toddlers are SICK LESS OFTEN
  • The American Academy of Family Physicians notes that children weaned before two years of age are at increased risk of illness (AAFP 2001).
  • Nursing toddlers between the ages of 16 and 30 months have been found to have fewer illnesses and illnesses of shorter duration than their non-nursing peers (Gulick 1986).
  • "Antibodies are abundant in human milk throughout lactation" (Nutrition During Lactation 1991; p. 134). In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991).
  • Per the World Health Organization, "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." [emphasis added]


Nursing toddlers have FEWER ALLERGIES
  • Many studies have shown that one of the best ways to prevent allergies and asthma is to breastfeed exclusively for at least 6 months and continue breastfeeding long-term after that point.

    Breastfeeding can be helpful for preventing allergy by:
    1. reducing exposure to potential allergens (the later baby is exposed, the less likely that there will be an allergic reaction),
    2. speeding maturation of the protective intestinal barrier in baby's gut,
    3. coating the gut and providing a barrier to potentially allergenic molecules,
    4. providing anti-inflammatory properties that reduce the risk of infections (which can act as allergy triggers).


Nursing toddlers are SMART
  • Extensive research on the relationship between cognitive achievement (IQ scores, grades in school) and breastfeeding has shown the greatest gains for those children breastfed the longest.


Nursing toddlers are WELL ADJUSTED SOCIALLY
  • According to Sally Kneidel in "Nursing Beyond One Year" (New Beginnings, Vol. 6 No. 4, July-August 1990, pp. 99-103.):

    "Research reports on the psychological aspects of nursing are scarce. One study that dealt specifically with babies nursed longer than a year showed a significant link between the duration of nursing and mothers' and teachers' ratings of social adjustment in six- to eight-year-old children (Ferguson et al, 1987). In the words of the researchers, 'There are statistically significant tendencies for conduct disorder scores to decline with increasing duration of breastfeeding.'"
  • According to Elizabeth N. Baldwin, Esq. in "Extended Breastfeeding and the Law":
    "Breastfeeding is a warm and loving way to meet the needs of toddlers and young children. It not only perks them up and energizes them; it also soothes the frustrations, bumps and bruises, and daily stresses of early childhood. In addition, nursing past infancy helps little ones make a gradual transition to childhood."
  • Baldwin continues: "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.


Nursing a toddler is NORMAL
  • The American Academy of Pediatrics recommends that "Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child... Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother... 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." (AAP 2005)
  • The American Academy of Family Physicians recommends that breastfeeding continue throughout the first year of life and that "Breastfeeding beyond the first year offers considerable benefits to both mother and child, and should continue as long as mutually desired." They also note that "If the child is younger than two years of age, the child is at increased risk of illness if weaned." (AAFP 2001)
  • A US Surgeon General has stated that it is a lucky baby who continues to nurse until age two. (Novello 1990)
  • The World Health Organization emphasizes the importance of nursing up to two years of age or beyond (WHO 1992, WHO 2002).
  • Scientific research by Katherine A. Dettwyler, PhD shows that 2.5 to 7.0 years of nursing is what our children have been designed to expect (Dettwyler 1995).

References [see also position statements supporting breastfeeding]

MOTHERS also benefit from nursing past infancy
  • Extended nursing delays the return of fertility in some women by suppressing ovulation (References).
  • Breastfeeding reduces the risk of breast cancer (References). Studies have found a significant inverse association between duration of lactation and breast cancer risk.
  • Breastfeeding reduces the risk of ovarian cancer (References).
  • Breastfeeding reduces the risk of uterine cancer (References).
  • Breastfeeding reduces the risk of endometrial cancer (References).
  • Breastfeeding protects against osteoporosis. During lactation a mother may experience decreases of bone mineral. A nursing mom's bone mineral density may be reduced in the whole body by 1 to 2 percent while she is still nursing. This is gained back, and bone mineral density may actually increase, when the baby is weaned from the breast. This is not dependent on additional calcium supplementation in the mother's diet. (References).
  • Breastfeeding reduces the risk of rheumatoid arthritis. (References).
  • Breastfeeding has been shown to decrease insulin requirements in diabetic women (References).
Breastfeeding moms tend to lose weight easier (References


  1. I think breastfeeding is wonderful as all of mine have been breastfed. I think the longer you can go the better...interesting to middle who was breastfed the longer (over a year) has no allergies is a Gifted student and is quite slim for his two others who were breast fed shorter times have allergies and get sick more often. Also my middle one has had one ear infection while the others had more...something to think about...

  2. Lorrie-

    That is very interesting! I am interested to see what will happen with mine in the future and if how long I breastfed them will have had any obvious affects.

    Thanks for sharing your experiences!

  3. I agree with a lot of the things in this post. I nursed for 14 months and I stopped when I found out I was pregnant. Looking back I should have nursed longer and I plan to nurse longer in the future.

  4. I nursed Jenny for one year - I was six months pregnant with Elias at the time and while I don't have a problem with nursing older babies or toddlers, I would prefer not to nurse two at one time who are not twins. I like to give my full breastfeeding attention to my new babies. Jenny actually self-weaned at exactly one year. I was committed to that much and figured it would take a few weeks for her to lose interest, but the day of her first birthday was the last time she nursed. Elias was thirteen months when he started biting me and nursing for no more than one minute per side. I was six or seven weeks pregnant with Erik at the time and I suspect that my milk changed in flavour and he didn't like it anymore. I was sick enough to stop nursing him at that point - I couldn't put up with the puking and biting. Erik was then fourteen months when he stopped nursing. The reason he stopped was that he started contorting - he would put his feet on my shoulders and continue to nurse, get off of my lap and stand on the floor or twist over onto his stomach, all while latched on! I couldn't stand it, so decided to see if he would wean willingly - he went to milk easily at that point. I will give this baby the same opportunities as my other kids and see what happens. I think in a sense I feel that my kids all self-weaned because of signs they were giving me that they were losing interest. If I manage more this time, great, if not, I won't be long as I make one year!

  5. Sorry that comment was so long. Guess I could have written my own entry on it. :D

  6. I loved nursing my children.
    I didn't know it then, but they say that breastfeeding decreases your chance for breast cancer. I was happy to hear that. Breastfeeding not only benefits the baby, but women in the long run.

  7. My youngest is going to be 4 soon and still enjoying her mommy time with me. I'm very okay with weaning her but she "seems" like she needs it so much. Besides, I've never had to really wean any of them. I just had another baby and it all happened by itself. But there isn't another baby and so I'm not sure what to do!!!

  8. What a wonderful post! I definitely did not plan to nurse for so long, but I have. I nurse my 15 month old daughter, and also nurse my 2 year old son at least once a day.

    I wanted to stop nursing my son completely, but he asks for it usually when he is tired or needs comfort. And, I usually just go ahead. He enjoys it so much, it's hard to say no. Plus I enjoy that time with him. Breastfeeding is such a precious bonding time with your children.

  9. It's great that you have this post up here LH! I have been blessed to watch and learn from the mother of the three children I have babysat for the last 6 years. I watched as she breastfed each child until about 2 years of age. They are a very health savy family and she explained to me that it is not only healthier for her babies, but that she would try to use the time to bond with them without the interruption of anyone else. My mother breastfed all of us until approx. 2 yrs, and was highly rebuked for it back in the 80's!


  10. Thanks for all the good things you said about breastfeeding. The book Breastfeeding and Natural Child Spacing (1999) is no longer in print. It is revised and updated and is now called The Seven Standards of Ecological Breastfeeding: The Frequency Factor (2008). This book is short, inexpensive and approved by LLL. There is also free info on ecological breastfeeding (Chapter 6 of the online manual)and a free brochure promoting breastfeeding at Sheila Kippley, author of the above books and a volunteer for NFP International

  11. LOVED the post and loved the comments that each mommy left. It is so evident how much you all love your children.

    How cool that Sheila K. left a comment on your blog? I also still have the older book, but will have to get the new one. I am working on a do's and don'ts of nursing, so when I post it, you will have to check in so you can check out some other AWESOME nursing books that will benefit you. I say nurse until they say when.. they meaning your babies.


  12. I always wanted to breastfeed as long as possible with all three boys. But I was forced to wean my oldest at 7 months because I became pregnant again and couldn't produce enough milk for him. My second baby self-weaned at 14 months. Then my third baby --oh my-- he breastfed until shortly after his fourth birthday. It's a shame I have to feel a little embarrassed to admit that when in other cultures it's so normal.

  13. Wow! Thanks to everyone for sharing your experiences!

    Sheila Kippley-Thank you for reading and taking the time to leave a comment with the updated information! I am such a fan of your work!

  14. Thanks for posing this LaSandra. I hadn't thought about how long I would breastfeed our son until he started reaching for food. I know a woman who recently gave birth whose family is persecuting her for wanting to breastfeed at all. I'm going to send her this blogpost to help her feel more convicted about her choice and see resources she can use to support her choice should she feel the need to do so.


Your ideas, questions, and comments are welcome!