Extended breastfeeding is a topic that has recently come up repeatedly with online mommy groups I participate in. It is almost always initiated by someone who is appaulled and disgusted by the idea or sight of a child breastfeeding. What I have found interesting is how different the definition of "child" is for so many women. Some women think an older infant (under age 1) is a child and they are horrified by the sight of an older baby nursing. The cut-off for other women is age 1, or 1 and a half, or 2. And of course almost everyone is aghast about the recently publicized family where an 8 year old girl is still nursing (which I'm not even going to give a personal opinion on because it's an extreme example that is used to bash the benefits of EBF).
Conversations regarding extended nursing almost always begin with the example of the 8 year old, with the plea that we all come to a consensus that BFing an 8 year old is wrong and that we should all agree upon an age that is universally THE CUT OFF for breastfeeding. Because a) it's our business how long a woman breastfeeds her child and b ) Obviously 8 year olds breastfeeding is a wide-spread problem that we all need to address.
I find this shock and concern about 8 year olds breastfeeding to be a red herring that directs us away from the REAL issue, which is that any sort of support or recognition of the benefits of breastfeeding makes moms who do not breastfeed feel bad. And we can't have that.
If a discussion is begun regarding formula feeding, it is rude and inappropriate to mention breastfeeding. If a discussion is begun regarding breastfeeding, it is rude and inappropriate NOT to mention the option and validity of formula feeding.
The truth of the matter is, in our society, the majority of women don't breastfeed the length of time recommended by the American Academy of Pediatrics (min 1 year), much less the length of time recommended by the World Health Organization (min 2 years), so which is really a more wide-spread and concerning problem...breastfeeding school-age children, which is rare, rare, rare, or NOT breastfeeding infants, which is incredibly widespread?
Formula companies have actually begun manufacturing toddler formula, which I believe is a mainstream gesture of recognition of the value of extended breastfeeding. This is despite the fact that many people, moms included, mistakenly believe that the benefits of breastfeeding are limited to the first year and that nursing serves only an attachment or comfort function beyond that point.
Part of the problem actually stems from the medical community. We often rely on our family doctors, obstetricians, and especially pediatricians for advice regarding breastfeeding. Unfortunately, most medical professionals are not trained regarding breastfeeding and do not stay...ummm...abreast...of new developments in our understanding regarding breastfeeding.
Women are routinely encouraged to wean at 1 year and begin an infant on cow's milk. Not only does cow's milk lack the benefits of breastmilk, but too much cow's milk (24+ oz/day) can actually contribute to anemia. Cow's milk is low in iron and when favored over iron-rich foods, an iron deficiency can develop. What's worse, cow's milk (which is also the base for formula, btw) irritates the stomach lining and can cause continual bleeding, further contributing to an anemic state.
Many a pediatrician has informed a trusting mother that there is no benefit to breastfeeding beyond a year. One oncologist informed his pregnant patient that she should not bother breastfeeding in the hospital because a full three months of breastfeeding is required for the infant to receive *any* of the benefits of breastfeeding (continuing to breastfeed long after the birth is not possible for this woman due to her treatment regimen).
Speaking of medication and treatments, an untold number of women are discouraged from breastfeeding based on a doctor's lack of knowledge regarding medications and breastfeeding compatibility. Women have access to the same information doctors do regarding medications and safety while breastfeeding. In situations where breastfeeding is contraindicated due to the mother's need for medication, there is very often an alternative medication that has been studied and found to be safe. Many doctors seem to lack the committment to encouraging breastfeeding required to take the time to look up an alternate medication.
Newly pregnant women are routinely encouraged to wean their infants or toddlers by their OBs.
The more we learn about breastmilk and breastfeeding, the more we discover how great a divide exists between manufactured formula and breastmilk. A gap that will likely never close. Breastmilk is a living substance and reflects the needs of the specific child in regards to nutrition and immunity.
Colostrum, pre-milk available from late pregnancy until mother's mature milk comes in, is often called "liquid gold". It is thick and sticky and yellow to orange in appearance and contains a concentrated level of proteins, carbs, and antibodies. It is easily digested and the absolute perfect nutrition for a newborn (there is much more to colostrum, and info on it can be found at kellymom.com or via La Leche League).
Mature milk contains the correct ratio of carbs, fats, and proteins needed for a human baby (cow's milk, and formula based on cow's milk, contains the balance appropriate for growing a baby cow...rapid physical growth with less support for brain development), digestive proteins, minerals, vitamins, hormones needed by a human infant, and antibodies. It has been recently discovered that breastmilk contains stem cells.
While everyone knowledgeable about the benefits of breastmilk agree that breastmilk is best and is the ideal food source for newborns and infants (who should receive breastmilk or formula as their primary source of nutrition for the first year of life), there is a lot of discomfort regarding an older infant or a toddler/child receiving breastmilk directly from the breast.
In our society, breasts are seen as primarily sexual appendages and while we are very comfortable with nudity in movies and cleavage in common clothing, we are bothered by the idea of an infant, but especially a toddler/child, suckling at his or her mother's breast. It must be sexual, right? How weird. How wrong.
If we can overlook how creepy it is for a woman to have an infant suckling at her breast and accept that it's beneficial and important for the baby, surely we can agree that breastfeeding should end when the child can walk. Or talk. Or ask to nurse. At that point, surely breastfeeding is just for comfort and demonstrates some weird form of coddling or a fetish on the part of the mom. Maybe mom just wants to feel needed. That can't be healthy for the child.
The WHO does recommend breastfeeding for at least the first two years of life, but that's the *world* health organization. An impoverished child in Africa is different from a middle class child in America, right? I mean, if it's either bugs and dirt or breastmilk, ok maybe breastfeeding should continue for a few years. But in America? Come on, that's just gross!
Another mother recently stated that if her child needs nutrition, she would give her (17 month old) a grilled cheese sandwich, a cup of milk, and some veggies. She saw no reason why breastmilk would be appropriate because obviously a grilled cheese sandwich, milk, and "veggies" is more nutritious.
The fact is, most toddlers are picky and while a parent can do much to provide solid nutrition, breastmilk continues to offer benefits beyond the first year of life. Breastmilk could be viewed as a supplement that is designed specifically for your child. If such a product was available in vitamin form, who would refuse to purchase it? Wouldn't most parents pay big bucks for a supplement that was formulated specifically for their child?
It exists, and it's free and available to even the poorest of families, but it is rarely taken advantage of because of the stigma surrounding extended nursing.
However, beyond the first year of nursing, breastmilk contains increased fat and energy contents to support the growth and activity of a toddler.
In the second year, approximately 15 oz (448 mL), 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
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.
Studies have shown that extended nursing, in addition to creating a foundation of excellent nutrition, promotes independence and provides psychological and developmental benefits for the toddler. The nursing mother benefits from reduced risk of certain conditions and diseases and the risk is further reduced by extended breastfeeding.
Despite the fact that much information regarding extended breastfeeding is available, it is still widely misunderstood and even our health care professionals do not know the benefits or promote the practice of nursing beyond the first year of life. The practice of extended nursing is widely misunderstood, much to the detriment of growing American toddlers.
As debate regarding nursing in public rages on in our confused society where sexual boldness is encouraged but natural, biological functions are shameful, a mom nursing a newborn may be met with stares but a generally high level of acceptance, whereas a mother nursing a toddler is often subject to removal and, later, internet tirades regarding the wrongness (often spearheaded by other mothers!).
I feel the outrage at moms who nurse "too long" (18 months? 2 years? 3 years? OMG, 4 years?!!?) is misplaced. When breastfeeding the length of time recommended by the AAP is not the norm, and extended breastfeeding, recommended by WHO (and implied by the AAP's recommendation as well) is even LESS common, the amount of attention a mom nursing an older child gets is incredibly disproprotionate to the amount of attention we turn to challenging the perception that only a young infant benefits from breastmilk.
When someone shouts how disturbing and wrong it is to breastfeed a toddler, I want to shout how disturbing and wrong it is to not even breastfeed and infant, which is the more common of the two issues. While it remains a personal choice that is best made by the individual mother and family and I certainly don't believe having all toddlers breastfeeding is an attainable or even reasonable goal, I find it highly hypocritical for our society to judge and condemn women for making a healthy choice just because we have sexual hang-ups and are uneducated regarding breastfeeding.