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Breastfeeding Beyond a Year: Why Is the AAFP Stretching the Truth About the Benefits?

The benefits of breastfeeding to a young infant’s health are well-documented (though sometimes debated), and the American Academy of Pediatrics (AAP) recommends that babies be breastfed for the first year of life if possible.  Are there any health benefits to the child for breastfeeding beyond a year?  I am curious about this as my daughter approaches her first birthday.

Photo credit: Santiago Fernánde. via Wikimedia Commons

I shouldn’t have been surprised to find that there have been very few studies of extended breastfeeding (> 1 year) conducted in the developed world.  Breastfeeding research is notoriously hard to do, and good research on extended breastfeeding is nearly impossible.  As a population, women in the developed world who breastfeed their babies are already likely to be different from mothers who choose not to breastfeed, setting their babies up for different outcomes well before their boobs even hit the baby’s lips.  (This is of course a very broad generalization, and I recognize there are exceptions.)  These differences are likely even greater in women who choose to breastfeed beyond a year.  Only 24% breastfeed to one year in the U.S. [1], and we don’t know how many continue beyond that.  These mothers are more likely to be well-educated, white, older, richer, buying organic food, fretting about BPA exposure, and the list goes on.  Sure, we can use statistics to try to account for these confounding variables, but these methods require (A) that you’ve identified the most important variables, and (B) that you have study participants that represent a spectrum along that variable.  This research is hard to do.

It is also important to point out that breastfeeding research conducted in developing countries does not tell us anything about outcomes in the U.S. and other developed countries.  There is real evidence that extended breastfeeding benefits children in the developing world, where young children are challenged by malnutrition and greater exposure to infectious diseases, which is why the World Health Organization recommends breastfeeding for two years.  My child has access to balanced nutrition and clean water, so whether she nurses beyond a year is less likely to affect her health.

These caveats aside, is there any research to support extended breastfeeding for the sake of my child’s health?

The AAP policy statement on breastfeeding doesn’t discuss breastfeeding beyond a year so didn’t provide any leads.  Next, I checked the policy of the American Academy of Family Physicians (AAFP).  On nursing beyond infancy, the AAFP position paper states,

“As recommended by the WHO, breastfeeding should ideally continue beyond infancy… It has been estimated that a natural weaning age for humans is between two and seven years [2]. Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection [3], better social adjustment [4], and having a sustainable food source in times of emergency.” And on weaning a child due to a subsequent pregnancy, they state: “If the child is younger than two years, the child is at increased risk of illness if weaned [no citation].”

Let’s look at the research cited by the AAFP:

Should I wean my child at the “natural age”?

Katherine Dettwyler is an anthropologist at the University of Delaware.  The reference of her work in the AAFP statement is for a book chapter that she wrote [2], but you can also read a summary of her research on her personal webpage.  Dettwyler reviewed research on weaning in non-human primates and extrapolated from those observations to determine that the “natural” age of weaning of humans should be 2.5-7 years.

While I appreciate this anthropological perspective, I think it is inappropriate for the AAFP to make recommendations to humans based on what monkeys do.  The monkeys do what they do because it probably does benefit their offspring, but this is not evidence that extended breastfeeding will benefit my child.  And early human societies probably did breastfeed their children beyond a year.  Let’s say that you were a mother raising a baby in a hunter-gatherer society.  In your world, you don’t have a safe way to store food, so you have periods of relative feast and relative famine.  Your food supply on a given day depends on the success of the most recent hunt and the seasonal availability of wild plant foods.  Babies and toddlers don’t cope well with intermittent food supply.  They need to eat often to support their rapid rate of growth and development.  Of course you would breastfeed as long as possible so that you could provide your child with a reliable source of nutrients.  This would allow you, the mother, to store calories and nutrients when food was abundant and later mobilize them to breast milk so that your child could continue to eat even when food was scarce.  This is a brilliant evolutionary advantage of mammalian lactation, but it doesn’t really apply in today’s developed societies, where most children have ready access to more than enough calories and nutrients.

Does extended breastfeeding give my child immune protection?

The AAFP cites a 1983 study [3], which shows that concentrations of IgA, lactoferrin, and lysozyme are similar between 12 and 24 months of lactation.  However, this was a tiny cross-sectional study, involving just 15 milk samples.  And though it tells us is that breast milk still has immunological proteins in the second year of breastfeeding – we don’t know if breastfed toddlers are actually less likely to get sick.

Will my child have better social adjustment if I breastfeed longer?

To support their statement that extended breastfeeding leads to better social adjustment, the AAFP cites a prospective study of 1024 New Zealand kids enrolled at birth and studied for 8 years [4].  The study looked at correlations between duration of breastfeeding and conduct disorders, which were assessed by both the children’s teachers and their mothers.  Once the data were adjusted for confounding variables such as family income or disruptions such as divorce, there was a small but significant correlation between longer breastfeeding and better conduct scores, as assessed by the mothers.  In other words, the mothers that breastfed their children longer thought a bit more highly of their children, but mothers can be sort of biased, don’t you think?  There was little relationship between breastfeeding and the teachers’ scores.  The authors conclude, “Certainly, the results provide no support for the view that prolonged breastfeeding makes a major impact on subsequent social adjustment.”  I agree – there are lots of ways to influence your child’s behavior in elementary school, but based on this study, breastfeeding is unlikely to help much.

Is breast milk a good food source in times of emergency?

Yes!  I’m comfortable saying this even without any science to back it up.  If we are ever victims of an earthquake or some other natural disaster, I can imagine it would be very useful to be lactating so that I know I have a ready-made clean source of food and water for my child.  However, I probably won’t make my decision based on this unlikely event.

Is my child at increased risk for illness if weaned before 2 years?

Although the AAFP makes this statement, they don’t provide any research to back it up.  I looked through countless other studies as well, and I couldn’t find anything to support this statement.  So as far as we know, your child will be just fine if you wean before 2 years.

Needless to say, I’m disappointed in the AAFP.  I whole-heartedly respect the mission of promoting breastfeeding and believe mothers should be supported if they want to continue breastfeeding beyond a year, but you shouldn’t have to stretch the truth about scientific studies to do so.  Most women would read the AAFP’s policy statement and conclude that there is scientific evidence that their kids will be healthier and better-behaved if they breastfeed to two years.  Women deserve to have accurate information with which to make their choices.  You can tell them that they might enjoy breastfeeding their toddler and there is no rush to wean.  You can even say that there may be health benefits, but there isn’t enough research to say for sure.  Just don’t cite scientific evidence where there is none.  Based on the research cited by the AAFP, there is no scientific evidence that it will compromise a child’s health to wean at a year.

I did read many more studies than these few cited by the AAFP, but this post has already gone on too long.  I’ll let you know what data I did find and my own decision about breastfeeding beyond a year in uncoming posts.  If anyone has run across a study that looked at breastfeeding beyond a year in the developed world, please pass it on!

What do you think?  Does the end justify the means?  Is it fair for the AAFP to stretch the scientific evidence to encourage women to breastfeed longer?

REFERENCES

1.  CDC, Breastfeeding Report Card – United States, 2011. 2011.

2.  Dettwyler, K.A. A Time to Wean, in Breastfeeding:  Biocultural Perspectives, D.K. Stuart-Macadam P, Editor. 1995, Aldine De Gruyter: New York, NY. p. 39-73.

3.  Goldman, A.S., R.M. Goldblum, and C. Garza. Immunologic components in human milk during the second year of lactation. Acta Paediatr Scand. 72(3): p. 461-2. 1983.

4.  Fergusson, D.M., L.J. Horwood, and F.T. Shannon. Breastfeeding and subsequent social adjustment in six- to eight-year-old children. J Child Psychol Psychiatry. 28(3): p. 379-86. 1987.

73 Comments
  1. Interesting, I am glad you thought to look into the benefits of extended breastfeeding! I have been so focused on other aspects of nursing, that I never stopped ti think about this end of it! You may be interested in my post about nursing… http://raisingnaturalkids.com/2011/10/16/returning-respect-back-to-the-breast/

    Like

    October 27, 2011
    • Thanks for reading and for the link! I admit that I have some hesitations about nursing an older child in public, and I’ve been thinking a lot about why that is. I’ll write more about my personal feelings on this soon. And I also admit that I started to feel sort of silly about scouring all the scientific literature for health benefits (when there is so little research on this topic) because I realized that I didn’t care that much what the research says. I can think of many other benefits to nursing beyond a year, and so what if they haven’t been studied? I know, how very scientific of me:)

      Like

      October 28, 2011
      • luisaperezmujica #

        Yes, I was going to ask why are the references from the 80’s?

        Like

        August 6, 2014
        • There have been so few studies of outcomes of breastfeeding beyond one year, particularly in developed countries. These are the studies we have, and they really don’t tell us much! I’d love to see some more recent studies, but I don’t think it is a research priority.

          Like

          August 7, 2014
  2. No, misstating the science is wrong no matter who does it. I think it adds to the problem we have in our society of people picking and choosing what scientific results to “believe in”.

    That said- I breastfed my oldest until she was 23 months old. I quit because I was three months pregnant and breastfeeding was exacerbating morning sickness. Also- I figured it was time to let me body concentrate on nourishing the baby inside me, instead of the toddler on the outside.

    I am now in the process of weaning my second child. She turned 2 at the beginning of the month.

    Why have a breastfed for the second year? Because I like it and my daughter likes it.

    Also, having breastmilk on hand makes treating pink eye sooo much easier and faster, and pink eye incidence seems to peak in 1-2 year olds in our day care. I’m not sure if I would have kept going just for that reason, but it sure came in handy a few times.

    Why am I weaning now? It just feels like it is the right time to me.

    Like

    October 27, 2011
    • When you say it made treating pink eye easier – do you mean that you applied breast milk around the eye? I’ve heard of that use before but thankfully haven’t had reason to try it yet. Another health benefit (that I don’t think as been studied) but that I have heard plenty of anecdotal evidence for: sick toddlers will likely still nurse (though they may not feel like eating or drinking other fluids), which can help them stay hydrated and nourished through a cold or the flu.

      Like

      October 28, 2011
      • Yep. You squirt some breastmilk in the eye and it clears up pink eye. It is faster than the commercial drops and stings less (I know, because I’ve used it on myself).

        My theory is that the natural killer cells in the breastmilk are doing the job.

        It was certainly easier to get my toddler getting over a stomach bug to nurse than to do anything else. Also, you can let them have breastmilk almost immediately after they throw up (and in our case, it usually stayed down), making it easier to keep them hydrated.

        Like

        October 28, 2011
  3. Jayda Siggers #

    We seem to have a lot in common;) I did a presentation on this topic a couple for years ago. I also found it very difficult to find relevant published data. Here is one North American study:
    J Pediatr Gastroenterol Nutr. 1984 Nov;3(5):713-20.
    Breast milk volume and composition during late lactation (7-20 months).
    Dewey KG, Finley DA, Lönnerdal B.
    http://www.ncbi.nlm.nih.gov/pubmed/6502372
    I would love to hear your thoughts! In general, I think extended breastfeeding is not a high priority for research funding:( It is difficult to even get a consistent definition of ‘extended breastfeeding’.

    Like

    October 27, 2011
    • Hi again Jayda! So nice to have your comments here! I checked this article, and it provides some data on breast milk volume and composition. Of course breast milk is a nutritious food for toddlers, but it doesn’t provide any evidence that BM is better than other foods or cow’s milk nutrient-wise. I might work up a comparison between late lactation human milk and cow’s milk though, just to see how they stack up ml by ml. And I completely agree that extended breastfeeding is not a high priority for research funding. It is even hard to find studies that compare BF for 6 months vs a year. And maybe that’s OK, because there are other research questions that are perhaps more pressing, but having some evidence for benefit might help normalize extended breastfeeding in our culture should women choose to continue nursing.

      Like

      October 28, 2011
      • Well if it were the men breastfeeding, I’m sure we’d have tons of studies on the topic!! ☺️

        I am unsure why you disagree with using data/results from studying other animals that are known to be similar to humans – I see studies all the time that correlate results in other species (eg, to demonstrate the carcinogenic properties of something, they give it to rats and watch for tumors). Why do you discount this method when it comes to breastmilk?

        For me it’s simply logic – my body isn’t counting down days until my baby turns six months or a year, and the milk doesn’t automatically switch off, so I can’t see how the benefits (including immune benefits) would suddenly stop for so arbitrary a reason either. I plan to nurse for two years, and I agree with you even if the science isn’t there to back it up, there are so many benefits to extended breastfeeding that I think it’s worth it and don’t need some men in lab coats telling me specifically how it benefits my child, I just know that it does ☺️

        Like

        May 12, 2015
        • Animal research is very useful, and it can be enlightening to look at other species, but we can never directly apply it to our own. Our understanding of biology/physiology often starts with animal research, but this doesn’t give us evidence of sufficient quality or specificity with which to make public health policy.

          I’m glad that you’re confident in your choice to continue nursing. I also found it to be a wonderful part of my relationship with my daughter.

          I wouldn’t assume that all scientists are men in lab coats, however. So much important science is being led be women, especially in the field of breastfeeding research. It’s happening everyday, and I appreciate the hard work of those researchers, both men and women.

          Like

          May 18, 2015
  4. Jen L #

    Another likely important variable that adds to the challenge of this sort of research is the variation in proportion of calories provided and number of nursing sessions per day. Maybe it makes a difference if a child is breastfeed on demand vs once per day? I did the latter after one year, enjoying bedtime nursing until 2 years 5 months. Of course, I fit into every category you list as those most likely to extend nursing….
    😉
    On the other hand, physical contact is so important that maybe there would be no difference if you could control for cuddle time regardless of nursing activity?

    Like

    October 28, 2011
    • Yes! There is so much variation in the amount of milk provided. I have seen some studies, for example, that show that nursing >6x/day past 8-9 months really put breastfed babies at high risk for iron deficiency, so I think it is possible to breastfeed an older infant or toddler too much, to the point of displacing nutrients that you can’t get enough of through breast milk. 1-2 feedings (or snackings) per day would be totally different.

      Snuggle time is a HUGE confounding factor in breastfeeding research. This is one of the major critiques of the research showing cognitive benefits of breastfeeding period. Who’s to say that a formula-fed baby who was cuddled a lot wouldn’t get the same benefits? Of course, I am guilty of checking my email on my phone while BF, so it isn’t always quality cuddle time:)

      Like

      October 28, 2011
  5. MH #

    THANK YOU. I have long had concerns about the studies that show smarter, healthier breastfed babies. I do support breastfeeding mothers – but I have real difficulty with all this “science” that’s performed without controlling for variables.

    I breastfed my son for 13 months,the choice to wean was made for me by accident (I cut my finger, requiring stitches and antibiotics) but it was pretty clear he was more ready for it than I was. I’d imagine this varies from woman to woman and child to child.

    Per Jen’s response – I’ve often wondered if the differences between breast and bottle have more to do with physical contact and the mother’s attention than with the actual milk, but you’re right – how do you measure that? I remember my son used to stuff his little hand in my mouth if I tried to have a conversation while he was nursing.

    Like

    October 28, 2011
    • MH – Thanks for reading and for your comments! I feel like breastfeeding is such a sensitive topic these days. I was nervous about posting this article, because I fully support breastfeeding and extended breastfeeding, but I think we have to really honor each woman’s right to choose how to feed her baby. I’ve heard so many stories of women who couldn’t or even didn’t want to breastfeed and were subsequently racked by guilt about it, and I think that just detracts from the joy of raising a baby. So I just feel like we all deserve to know what the science really says or doesn’t say and make our own choices without having the research spun at us all the time. I don’t think many women are breastfeeding beyond a year just because they’d feel guilty about weaning, but I bet it happens in some circles.

      Like

      October 28, 2011
  6. My daughter naturally stopped at 18 months so I’m convinced she didn’t need it anymore. Interesting post, thanks 🙂

    Like

    October 28, 2011
  7. wow. i’m pretty disgusted by the AAP on this one. another way to phrase your question might be, “is it okay to lie to patients? pretend we know things we just feel might be true?” um, NO.

    i’ve been studying the history of american health care this year, and this is a shameful return to (continuation of?) the age-old pattern of defining health via morality instead of science.

    Like

    October 30, 2011
    • I agree, Bionic. (Thought this is about the AAFP, not the AAP.) No matter how good their intentions are, medical organizations have a responsibility to give doctors and patients accurate information. The doctors part is important too. Most family practitioners aren’t going to go read all the breastfeeding literature for themselves – they’re going to count on the AAFP to give them accurate information so that they can make the best recommendations for their patients. I just hate to think of mothers who aren’t enjoying breastfeeding continuing to do it beyond a year because they think their child is going to suffer if they wean.

      I’ve been thinking about this question in light of the AAP’s television recommendations, which I wrote about last week. They don’t really have enough data to say that a little TV is really going to hurt kids under two, but they still “discourage” TV for that age group, because that was their best interpretation of the data we have. However, they clearly state the limitations of those data in their policy statement and go on to recommend more research. The problem then becomes how their policy statement is perceived in the media, but I at least think the AAP was honest in their own statement. Although it may seem like a subtle difference, to me it is huge.

      Like

      October 30, 2011
      • oops — i’ll remember to give blame where it’s due!

        yes the AAP statement — as opposed to its reception by the popular press — is a good model of how to handle a grey area better.

        Like

        October 30, 2011
  8. Okay, so a year late! Just came across your blog. 🙂 I think the biggest scientific thing here that’s missing is the milk composition. IF we are not meant to extend beyond a year, our breastmilk would not continue to change in composition to meet our child’s needs. Is that not true?

    I know we do have clean water, access to balanced nutrition, and less risk of malnutrition. However, there are a lot of things going on in the growth of a baby, too, that your body seem to be so aware of. The milk adapts to that growth. The composition never seems to stay the same month by month, nor is it ever the same for each baby. It is uniquely for that baby. I’d continue to reap the benefits of that, if I could.

    But I also see the advantages in weaning. The baby usually also seems to know when it’s time to stop.

    Like

    June 5, 2012
    • Hi! Thanks for stopping by and for leaving your comment/question. I guess the answer depends on what you mean by “meant to extend [BFing] beyond a year.” We as a species probably evolved breastfeeding for a few years, as Dettwyler suggests with her anthropological data. Our breast milk may have evolved to help meet the changing nutrient requirements of our growing kiddos, but we can’t be sure about that. For example, I think it is fairly universal that babies start eating solid foods as their teeth start to come in, but what those foods would be would vary around the world. Our breast milk could not have evolved to be the perfect complement to all traditional diets around the world – these could range from plants, insects, game meat, grain crops, seal blubber, fish – you get the picture. And whether it is a great complement to a today’s Western diet is not a given either (I’m not saying it isn’t – it is probably one of the higher quality foods in most toddler diets, mine included!).

      Milk composition changes across the lactation are fascinating, and they occur in all species. We extend the lactation of modern day dairy cows by milking them beyond the age at which their calves would naturally wean. (As a side note, if you’ve ever watched a mama cow trying to fend off her adolescent calf butting aggressively at her udder – you know that this is not calf-led weaning!) Their milk composition changes as the lactation wears on, but that doesn’t mean that their calves are at a disadvantage because they aren’t still nursing. Their calves may be happily munching on grass or alfalfa or grain and doing just fine.

      The point is that there just isn’t evidence that kids are missing out nutritionally or immunologically if they wean at a year, at least not in developed countries. In developing countries, outcomes are sometimes worse in kids that breastfeed for longer, probably in part because this might be occurring in poorer families with other challenges, but having breast milk displace other foods, such as those rich in iron, is probably part of the picture. And there may well be benefits of breastfeeding beyond a year in developed countries – it honestly hasn’t been studied well. But without studies, I don’t think it is OK for a medical organization to make a recommendation for something that to me, should really be a personal parenting choice. That said, it has been my choice to continue to nurse my toddler, not out of a desire to meet an arbitrary recommendation, but because we both still enjoy it.

      Like

      June 5, 2012
      • noodle #

        One small problem with your argument… earlier, you complained about comparing humans to other species (monkeys), and yet here you compare humans to cows. Not necessarily disagreeing with you, but just pointing out an inconsistency.

        Like

        July 26, 2013
        • Not a small problem at all & THANK you for noticing the hypocrisy…when in fact she compares complete & natural human milk with factory farmed bovine milk that is nearly dead nutritionally, after all the pasteurization & homogenization that is done, well I just am flabbergasted. it is especially surprising coming from someone touting that they have really tried to look at research….apparently the research stopped with human milk & never looked at human ingesting cow’s milk I don’t give my kids cow’s milk at all, ever. We keep a small amount around for cooking only. There is no dietary benefit to it & plenty of actual data that shows it to be detrimental, particularly in the volumes many children consume, even containing components that block the absorption of iron. It is one of the leading causes of anemia in the US in children under age 3. You can easily google cow’s milk anemia & find LOTS of medical sources for this. It is only recommended for calcium & fat content that can be easily made up in other areas if you wish to remove human milk from a toddler’s diet. I would never be so bold as to say a child is old enough to wean and no longer needs breastmilk AND THEN turn around & to say they need milk from another mammal. :/ How does that make any sense?

          Questioning specific data is ALWAYS fine – spouting off as if you have any evidence that human milk is somehow no better for children than bovine milk is ludicrous & has no scientific backing either – in fact all logic will conclude that human milk, high in antibodies, nutrients, iron & other vitamins/minerals, cannot compare, at any age, to the nutritional content of processed utter milk. It just can’t. It would be healthier for YOU and me to drink breastmilk than cow’s milk. I am not suggesting you do so, as you likely do not need the anitbodies & don’t want to ingest it – but insinuating that the two are dietarily equal is ludicrous and TOTALLY without any science to back it.

          Be consistent. I don’t believe every claim made about breastmilk either – I also don’t buy into some idea that my toddler is just as good off without any added antibodies or ingesting milk from a different mammal that design’s its milk for its own offspring. I didn’t birth calves…so I don’t give them cow’s milk. I don’t care if YOU do…at all, everyone *I* know does. I ONLY care when you sell it as if it is the same nutritionally, because it absolutely is not.

          Like

          July 30, 2013
          • Go back and read what she said, under NO circumstances did she say that cow’s milk was the same nutritionally as human milk, she was approaching the subject of lactation changes over the course of extended breastfeeding:

            “Milk composition changes across the lactation are fascinating, and they occur in all species.” including humans.

            Look, a cult of keeping a child at the breast until advanced age has become a trend among primarily white, educated, affluent women, the blogger is simply making a point that there is no concrete science to back-up the claims being made for the benefits.

            She also points out that extended breastfeeding is a choice some mothers make because they and their child ENJOY it and that should be a good enough reason to do it. What I don’t like is the tendency of the extended-breastfeeding-brigade to scold women who would rather not,or can’t, BF their babies and toddlers for years by suggesting that their children won’t reap these magic benefits. Let me tell you as a healthy, 50 something who was mostly bottle fed, generations of humans have grown -up healthy and have done just fine without suckling on mother’s boob as a toddler.

            Like

            November 30, 2013
            • lena #

              Hmmm… I’m neither white, affluent nor a cult member(I am educated, if that helps), yet I’m still nursing my 24 month old. He still wants the interaction and I allow him, especially because he’s a picky eater eater and veggies tend to wind up on the floor and not in his mouth.

              Keep generalizing though, Jade.

              As far as the antibodies, I had a really bad flu right after Christmas and I kept nursing. My son didn’t contract it though dh did. Anecdotal, but it works for me and mines.

              Like

              February 22, 2015
    • am battling with my seven months son concerning him stopping breastfeeding naturally. am forcing him to suck for the past three days and he not picking any interest at all . Am really afraid of him not breastfeeding as before. plz pal any advice plz.

      Like

      February 27, 2016
      • Stacy Weaver #

        Hi! I’m a breast feeding mommy of an 11 month old. I encourage you to pump your milk and store it while your son is on his nursing strike. It is VERY rare for babies under a year to self-wean. Teething can make nursing uncomfortable or he may not like something you’ve eaten. Also 7 months is a very “awakening” time for babies’ brains and distraction from the breast may occur. Don’t give up or get too stressed about this. Stress hormones are horrible for the body (which is backed by much science these days) so I believe that they are also detrimental to lactation. I hope this helps. Good luck momma!

        Like

        May 11, 2016
  9. Padmini #

    My 1 yr old son has diary allergies so I have decided to nurse him beyond the 1 year mark. You could include this point in your article because extended breastfeeding is very beneficial to toddlers who cannot consume cows milk products.

    Like

    July 17, 2012
  10. Brandon #

    Thank you for this wonderful post. As a biologist that critically reviews scientific literature and sincerely values objectivity, I have been seriously investigating the details of breastfeeding in recent weeks (our first child is on the way shortly). I have found precious little information supporting extended breastfeeding and actually a couple of studies suggesting extended breastfeeding (in developed nations) may leave children deprived of other critical nutrients attained through varied diets past ~six mos. of age and may even lead to a reluctance in accepting other foods as you pass through the toddler years (leading to unintended impaired growth, malnourishment, and added parenting difficulties). I really do appreciate this cogent and well-researched post. Your in-depth investigations significantly add to the legitimacy of your review and are greatly appreciated. I wish folks took the time to do what you did more often (with all subjects, from A to Z).

    Like

    August 1, 2012
  11. Karleeng #

    Great blog….there’s some stuff looking at morbidity and mortality in young children who have been weaned (or not) that might be worth looking at…all developing country contexts but that’s where you find enough children breastfeeding past infancy to look at! The relevance to developed country contexts is not clear, you would not expect to see huge differences in infection rates between weaned and breastfeeding children but in individual cases there are no doubt situations where breastfeeding makes a difference. However, the difference in breast cancer rates between women that breastfeed each child for years vs those who breastfeed for months is large! Briend A, Bari A 1989, Breastfeeding improves survival, but not nutritional status, of 12-3 months old children in rural Bangladesh. Eur J Clin Nutr 43: 603–608. Feachem RG, Koblinsky MA 1984, Interventions for the control of diarrhoeal diseases among young children: promotion of breast-feeding. Bull World Health Organ 62: 271–291. Lepage P, Munyakazi C, Hennart P 1981, Breastfeeding and hospital mortality in children in Rwanda. Lancet 2: 409–411. Molbak K, Gottschau A, Aaby P, Hojlyng N, Ingholt L, da Silva AP 1994, Prolonged breast feeding, diarrhoeal disease, and survival of children in Guinea-Bissau. BMJ 308: 1403–1406. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality 2000, Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 3: 41–4. World Health Organization 1998, Complementary Feeding of Young Children in Developing Counties: a Review of Current Scientific Knowledge World Health Organization, Geneva.

    Like

    October 26, 2012
  12. Viki #

    As a pregnant woman, I plan to breast feed for at least 2 years…. for my own benefit. Years of breastfeeding are inversely correlated with Breast Cancer rates. Researchers found a real drop-off in cancer rates among mothers who breastfed for at least 2 years.

    If this is my only baby, I want to make sure I have the lowest possible risk of breast cancer; and I have never seen a comment like this on a breast/formula/weaning discussion.

    Like

    December 17, 2012
    • It’s a great point, and I’m happy that you brought it up since i didn’t address it in this post. The AAFP doesn’t list it as a reason to encourage women to breastfeed for 2 years. But yes, if you only have one child, this would be a reason to keep going. My understanding is that the 2 years is cumulative – it doesn’t have to come from one lactation. And I’m curious if breastfeeding one child for two years would really have the same effect on breast cancer risk as breastfeeding 4 for 6 months each. For me, lactating during that second year meant feeding just a couple of times per day and probably making just a few ounces of milk. Definitely lower intensity physiologically than the first 6 months of lactation. I should look closer at the cancer data, but given the rates of breastfeeding over the last few decades, especially of breastfeeding past 1 year, I would guess that most of the cancer data comes from women with several shorter lactations.

      I just recently weaned my daughter, shortly after her second birthday. I can tell you that I really enjoyed this second year of breastfeeding. That was enough of a reason to me to keep breastfeeding, but it is a personal thing and I completely understand if other moms feel differently.

      Like

      December 17, 2012
      • Viki #

        And we can’t ignore the benefits of breastfeeding amenorreah. I think the cancer reducing benefits of breastfeeding are two fold
        1) the breast tissue is ‘doing it’s job’ (possibly diminishing impacts after 6-8 months)
        and 2) the breast tissue is protected from hormonal surges relating to menstruation.

        Thanks for your reply!

        Like

        December 17, 2012
        • Karleen #

          There’s only one study that I am aware of that has looked at the impact of a decent length of breastfeeding on risk of breast cancer.
          Zheng, T., L. Duan, et al. (2000). “Lactation reduces breast cancer risk in Shandong Province, China.” American Journal of Epidemiology. 152(12): 1129-1135.
          Results from studies of western populations investigating lactation and breast cancer risk have been inconsistent. To examine this issue, the authors conducted a hospital-based case-control study in Shandong Province, China, in 1997-1999. A total of 404 cases and an equal number of controls were included. Detailed information regarding lactation, menstruation, and reproduction was collected through in-person interview. The authors found a significant inverse association between duration of lactation and breast cancer risk. For women who breastfed for more than 24 months per child, the odds ratio was 0.46 (95% confidence interval (CI): 0.27, 0.78) when compared with those who breastfed for 1-6 months per child. A significantly reduced risk of breast cancer was also found for those whose lifetime duration of lactation totaled 73-108 months (odds ratio = 0.47, 95% CI: 0.23, 0.95) and for those who breastfed for > or =109 months (odds ratio = 0.24, 95% CI: 0.11, 0.53). The test for trend was statistically significant for both mean duration of lactation per child (p = 0.02) and lifetime duration of lactation (p = 0.00). Further stratification by menopausal status resulted in the same conclusion. These data suggest that prolonged lactation reduces breast cancer risk.

          Like

          December 20, 2012
      • Thank you, Karleen, I’m happy to know about this study! I will be interested in looking at it closer. And wow, I’m impressed with those >109 month breastfeeding moms!

        Like

        December 20, 2012
  13. Joanie #

    Two words: lactational amenorrhea, haha. No, seriously though, I do know that exclusive breastfeeding followed by “delayed introduction of solids (at 6+ months)” and continuing with extended breastfeeding plus TOTAL pacification at the breast has kept my cycles at bay so we can more easily space our children about 3 years apart. I am at 13 months breastfeeding and we are hoping to go to 2 years at least, not just for this reason but because of other health reasons for myself (like the decreased breast cancer rates listed above). Another reason we have continued is simply because we don’t plan on introducing cow’s milk for dietary reasons. We just plan on using (my) human milk until he decides to wean himself naturally. Oh and boob juice is incredible when you have a sick little one (especially when they can’t keep food down). I’d extend breastfeeding for this reason alone!

    I also catch milk and donate, so while the AAFP might be stretching their “benefits”, there certainly are many others.

    Like

    March 30, 2013
  14. vega #

    Most of the discussions around extended nursing involves going to two years old. What about going beyond 4? This often involves tandem nursing as the pre schooler only nurses once or twice a day and if there’s no other infants involved then milk production will reduce or stop. Any harm or benefit to the baby as does this change the quality of milk? Any studies on the child?

    Like

    July 9, 2013
  15. Autumn #

    Thank you so much for this article. I wish there were more!

    Like

    November 7, 2013
  16. Jacklyn Rymer #

    “These mothers are more likely to be well-educated, white, older, richer, buying organic food, fretting about BPA exposure, and the list goes on.”

    This is extremely ignorant on your part. I suppose healthy children aren’t important to you. Look a little harder and you will find research. Who knows though maybe, just maybe science can’t tell us everything.

    Like

    December 26, 2013
    • No, science can’t tell us everything. As someone who studies parenting science every day, I’m constantly aware of this. Just as science might be helpful, clarifying, and fascinating, it also has its limitations. In the case of this question, there really isn’t good research to answer it. What research we do have doesn’t point to any amazing health benefits to breastfeeding past a year. That doesn’t mean you shouldn’t do it – there are lots of good reasons for making the choice to breastfeed as long as you like. I happily breastfed my daughter for 2 years. And it is possible that there are health benefits that haven’t yet been discovered because good studies haven’t been done. But I do believe that it is important to be honest about what we do and don’t know about breastfeeding so that each mom can make an informed choice. And in this case, I think the AAFP is overblowing the case for breastfeeding beyond a year, citing poor science to support their opinion. And this blog is about science, so that’s what I focus on.

      But this: “I suppose healthy children aren’t important to you.” That’s just mean. Why sprinkle your meanness around the internet just because you disagree with my post?

      Like

      December 26, 2013
  17. Sandra Chapman #

    Is there research somewhere that states that when the immune system of a toddler has reached 100%? Isn’t the immune system not fully developed before 2 years of age and therefore breastfeeding is still beneficial and helpful for the toddler? I have heard it somewhere, but not read a study. From personal experience I have noticed, that when my 2 year old got a stomach bug and had diahrreah and threw up lots and lots and wasn’t interested in any food or drink apart from nursing, that it did save me a trip to the emergency room. And she got better within 24 hours…

    Like

    January 24, 2014
    • Sandra, you’re right that a child’s immune system is still developing until age 2, but that isn’t evidence that an 18-month-old that is still breastfed will necessarily be healthier than an 18-month-old not breastfed. The immune system is extremely complex. The part that is slow to mature is B-cell responsiveness, and breast milk may not do much to help with that. The major immunoglobulin in breast milk is secretory IgA. Although the immunoglobulins in milk are no doubt helpful to a young infant, infants do produce their own secretory IgA within the first weeks of life. I’m not saying there aren’t immunological benefits to breast milk beyond 12 months – the immunoglobulins ARE there, and they may help the toddler, but there just isn’t research that shows that. It’s just a bit of a jump to say that the immune system isn’t fully developed, breast milk has immunological components, therefore breast milk must make for healthier toddlers. Do you see what I mean?

      I have heard lots of anecdotal evidence that breastfeeding is helpful with sick toddlers in ensuring that they’re getting fluids, calories, and comfort. That was my experience as well, and although I don’t have a study to support that, I think it is probably a real benefit.

      Like

      February 15, 2014
  18. kathryn #

    I can see your points, however they are solely based on the lack of studies. Just bc there isn’t a scientific study doesn’t mean the benefits aren’t there. It honestly looked to me like you were looking for a justification to wean your own child after 12 mos, or an out, bc you are a tired mom who’s looking to regain some sense of normalcy. I get it. I have 3 kids, I’m tired too. But I’m not going to stop nursing my 13 month old because of a lack of studies.

    Liked by 1 person

    February 11, 2014
    • Kathryn, I’m puzzled why you would assume from this post that I was looking for a justification to wean my child. I was looking for science and, as you pointed out, found little – but I also found it disturbing that the AAFP wasn’t up front about that. But before you assume that you know anything about my breastfeeding relationship with my daughter, perhaps you should read a few more posts on my blog.

      Like

      February 15, 2014
      • Jen #

        I think what Kathryn is saying is that no matter how you intended the delivery of your blog, it has undertones that appear to some as though you’re trying to justify stopping at 12 months. Look at the comments to your post-many women are thanking you for this justification. My daughter’s immune system is in her gut and intend to flow breastmilk through it as long as I can tolerate milking myself like a Jersey Cow. After that, she will be on raw milk. What we should be telling moms is “do the best you can and go as far as you can.” Splitting hairs seems to be science these days, and common sense is children need their mothers to think for themselves.

        Like

        May 11, 2014
        • I hope you’ll reconsider your choice to give your daughter raw milk. It really increases her risk of foodborne illness, which is particularly dangerous, even deadly, in children. It’s one thing to make that choice for yourself but quite another to endanger a child that way.

          This is an important read on the topic: http://www.foodsafetynews.com/2014/02/a-mom-and-a-dairymans-plea-dont-feed-children-raw-milk/#.VVqp9qax1Og

          Be wary of information about raw milk on the internet. Be savvy and ensure that you’re looking at reliable sources. It’s important, for the health of our children, to take care with these decisions.

          Like

          May 18, 2015
  19. Wren #

    Thank you for this!

    I am still breastfeeding my almost 3 year old and every now and again look online for evidence to support this decision. This is basically because it is now socially quite embarassing and I’d like to be able to say I do it for all the health benefits rather than I do it because she still likes it (maybe needs it?) and I don’t mind (in fact quite like it).

    I always find plenty of ‘evidence’ for extended breastfeeding but for some reason I have always been a little sceptical of it (and don’t have the time, money or inclination to read the articles referenced) – probably because the sources are pro-extended breastfeeding and therefore less than objective.

    So tonight I searched for evidence AGAINST extended breastfeeding and found your article, which is well-written, balanced and just what I was looking for, i.e. an opinion from someone who seems intelligent, unbiased and trustworthy, and has done the research. It would have been nice if your conclusions were that the research supports extended breastfeeding but hey-ho! At least you have probably (maybe) saved me searching again and, like you, I’ll probably continue breastfeeding it as long as daughter and I enjoy it 🙂

    Like

    February 12, 2014
    • Wren – I read through all the comments on this blog post and enjoyed yours the most. 🙂 I suspect you and I have a lot in common. I’m still BF my 31 month old. It’s not something I planned to do or thought would ever happen. He still enjoys nursing and asks for it at least a couple times a day. And I still enjoy nursing him. I will say, it’s been almost a year since he was sick. I have no idea if that’s due to the breastfeeding or not. He’s also significantly taller than most of his peers. I’m a petite 5’2″ and my husband is an average 5’11”. I wonder if there is a correlation? And, like you, I imagine I’ll probably continue breastfeeding as long as my son and I enjoy it. 🙂

      Like

      July 8, 2014
  20. Babs #

    I love your blog! So balanced! So well researched! I’m so happy to have come across it.

    Like

    July 2, 2014
  21. Jessica Ballard #

    I absolutely love this article, I’m a nursing mother of a one and a half year old. This is the longest I’ve nursed out of my four children, and unfortunately I have family and friends pressuring me to quit. Honestly I don’t want to, this was informative.

    Like

    September 22, 2014
  22. Lea #

    Breast milk components change according to what the child needs, the mothers and childs body communicates with each other through skin to skin, saliva on the nipple and they mothers body makes a customized milk for her baby! and the best news is that a mothers milk will always do this! Breast milk is being studied to help cure cancer because of its unique ability to customize for its drinker! This article is doing NO ONE any good. It is already hard enough for us moms who are doing what is natural and best for our children – we don’t sleep and we are 100% absorbed into another human being- We don’t need someone trying to steer us away from doing whats best. I didn’t need to read studies to understand that i needed to nurse my child to a natural weaning age. Its common sense. Sorry to be so rude but I have heard too many mothers “give up” because of reading things like this. babies need Breastmilk. end of story.

    Liked by 1 person

    October 27, 2014
  23. michellep #

    I am looking for the research that either supports or doesn’t support the immune factors in breastmilk being helpful after 6 months. Both “sides” swear that immune system factors are either useful for as long as baby breastfeeds, or no longer useful after 6 months. Neither side provides evidence for their argument. You seem like a lady who has waded through all of this stuff…any thoughts? I am an RN and IBCLC and like to provide evidenced based practice to my patients, but in this case, it is proving impossible. Thanks!

    Like

    November 2, 2014
  24. Whitney #

    Ok, I read the whole post, and I honestly don’t know for sure whether I could find other better studies or not on which you spoke. The main reason I wanted to comment was that I was offended and slightly appalled at your quite judgmental comment about how, “these mothers are more likely to be well-educated, white, older, richer, buying organic food, fretting about BPA exposure, and the list goes on”. Ok, so I’m white, yes. I also have quite a bit of Native American blood in me, although my skin is quite pale (but I tan easily). I’m not rich (not even middle class), I can’t afford all organic foods, although I wish I could, I’m only 25, and I don’t fret about BPA exposure. I’m educated at 12the grade and have a month left of cosmetology school. I consider myself intellectual. I try to research a lot and read and find information to know things. And I know people who don’t, which is beyond me. I think you could have worded that a lot better before you open your mouth and start offending people. My child is 14 1/2 months old right now, and yes, still currently breastfed. I wanted to do all I could for her because my mother didn’t ever do much at all for me, let alone breastfeed me. Also, I get what you’re saying about there being no evidence to back up whether they’re more likely to get sick, but don’t you think that maybe your breast milk knows more than science does yet if it has immunological properties in it between the child’s ages of 1 and 2?

    Liked by 1 person

    March 17, 2015
    • Hi Whitney,
      My statement about characteristics of moms that tend to breastfeed longer wasn’t meant to be judgmental at all, so I’m sorry that it felt that way to you. It’s honestly just a statement about the evidence that we have from studies on breastfeeding duration. These are very general trends, and we always have to be on the lookout for them when we’re comparing outcomes between babies who were breastfed and those who weren’t (or not as long, etc). There are OF COURSE exceptions, LOTS of them! Every mother and child have their own set of factors that go into how they feed and for how long. However, when you look at large populations of women, we do see statistically significant differences in these factors. (I’m speculating about organic foods and BPA, but those are a couple of examples that might vary along with feeding choices, and they may or may not impact outcomes.) a lot of these differences come down to the difficulties that come with breastfeeding and working in our society; it’s nearly impossible to do in some jobs. All of these disparities make breastfeeding outcomes really hard to study! As I think I said in the post, I do think it is possible that there are benefits to BF beyond a year that we haven’t yet quantified. Honestly, what matters most is if it feels beneficial to you, on whatever level, and if you and your child are both enjoying it. Great job feeding your baby, mama! I’m feeding mine as I type this!

      Like

      March 17, 2015
      • Whitney #

        I understand you saying how it wasn’t meant to be judgmental now after explaining how it has to be looked at for the study. I still say it slightly came off that way how you put it. I didn’t know whether this was true in all states or just Tennessee, where I live, but here, if you get hired on somewhere, legally your job is required to allow you to breastfeed at least to the age of 1 year old (pumping). Some businesses, who aren’t douches, probably would let you for longer. But in my case, I didn’t work and pump like that. I exclusively breastfed my child from birth until now. I didn’t work. We live with family and I kind of can’t work outside the home in our current situation. It won’t be that long from now that we no longer live with family AnD I can work.. but since I have no other choice than to stay home, the way I see it is like you said. We are both content with breastfeeding so why not do it until we don’t want to or I’m able to work? But I’m not too worried about a next child and breastfeeding because of the law in TN about pumping at work until age one at least. But, if you ask some people here, they say legally most jobs can fire you anytime for whatever reason without letting you know why. I have yet to try that with a job to be able to tell you about it. But by that time, if nothing else, my fiance will be making more money because of the way that his mechanic job works (you take tests, you earn more per hour). So I’m thinking and hoping I’ll still be able to breastfeed another child to at least a year. I’m glad I found your post, though, because the more I thought about it, the less angry I got with that comment and the more I thought, “hey, maybe I don’t have to be as obsessed with it as I’ve been in raising my child and breastfeeding for a long time.” I like your name, btw. Science of mom. I’m a spiritual person, but also a scientific person, and not religious by any means. I love getting all the facts and listening to knowledgeable people talk about what they know and what they’ve discovered. Also, some Native American tribes used to breastfeed one child between lots of mothers. And back in the day, people used to raise a child together, not just two parents. I think if things were still that way, not only would it be less stressful, but parents wouldn’t get all offended at someone giving advice on their kid because they’ve done it alone for so long that they don’t want help and don’t think they need it. But if breastfeeding was like that, the child wouldn’t get so attached to you like mine is to me and refuses anyone but you. I don’t necessarily think it’s as healthy as it would be if we did it like the Native Americans.

        Like

        March 18, 2015
  25. Debra Dougherty #

    Oh my goodness. This is the first thing I’ve read that seems to be objective. I’m a grandmother who nursed all of my babies even though it was not the ‘in’ thing to do at the time. My concern is that mothers are being sold a bunch of garbage and in essence being guilt tripped into nursing and then again into the how long of it. My first experience was terrible and the next three were a piece of cake. I personally have no intentions of sharing this blog with any of the young women I know who are nursing their babies. Because from their perspective I’m old and senile and they are going to be better mothers than I ever was. Strange since all of my adult children are incredibly independent, successful, well adjusted adults and excellent parents themselves (the ones that have children). Add to the idea that not only are these mothers expected to nurse on demand and for as long as the child wants the trends of “baby wearing” and “bed sharing” are not helping either. I remember well how exhausting being a mom is. I remember not getting much sleep. So now if you’re a good mother you carry the baby nine months and then another two or more years on your back. And when it comes time to sleep it doesn’t matter if you get any sleep or rest as long as the baby/toddler is happy. At some point logic or common sense really does need to be addressed. I know a young woman with a nine month old and a two and a half year old. She nurses both of them round the clock, wears both of them (one on the front and the toddler on her back) and sleeps with them where they crawl all over her and she gets little or no sleep. Her husband has moved completely out of their bed because “he needs his sleep”. She is so tired that she started texting me one night that she “didn’t want to be a mother anymore’ and “someone has to come get these kids…I don’t want them”. She completely rejects any suggestions of taking better care of herself. After she has had her meltdown and been an absolutely scary mother she takes a million selfies of her nursing both kids, wearing both kids and sleeping with both kids and once again promotes all of these on her fb page and presents herself as the perfect mommy doing all the things that good mothers do. Good mothers check things out the way you have and then decide how to proceed. Some are not intelligent enough to do so and the media is killing them. Most mothers would do anything they could for their kids but I believe that the media is putting mothers in a dangerous situation and thereby putting a lot of children at risk. In my experience and in observing other couples having a baby, while the most wonderful thing in the world, is also stressful on a relationship. With all of the added demands put on a mother…not the dads…relationships have to suffer and the trickle down effect is that the children suffer. This same mom screams at her kids at the top of her lungs when no one is around. I have only seen and heard her when she thinks no one is around or can hear. I truly wish I could say she is the only one I know but unfortunately I know several others who are equally exhausted from being the “good” mom and while I haven’t witnessed their meltdowns others have. I think that anyone should be able to nurse their baby as long as they want but when it becomes attached to the undocumented “definition” of being a “good mom” they have taken a good thing and turned it into a nightmare. One question….what does the milk composition do when a mom is nursing two or three kids, all different ages, at the same time? Oh…I know…they don’t know right? Thanks for providing me a place to vent. It’s making me crazy watching these young moms killing themselves and I worry about the well being of all parties concerned. It also seems odd to me that many of these young women I know came from less than attentive parenting themselves. Because of their intense desire to be a better mother than they themselves had they are quite literally willing to do anything to be a good mom. Even if it kills them or turns them into monsters to their children when no one is looking. Throw in a real case of baby blues/postpartum depression and these young moms are truly having some unattainable standards set before them. Thanks for the info and letting me vent. Blessings to all.

    Like

    April 7, 2015
  26. This is an old thread but WOW, that’s some very strong accusations in the direction of a credible organisation. I am not sure that any potentially inconclusive white papers really support your accusation. I have read a number of paper that whilst limited in data, definitely prove the link between breastmilk and ongoing benefits.

    The nutritional content of breastmilk is evidence enough to support the argument for health / immune support benefits. Also in constrast to average cows milk, will not have traces of antibiotics and all the nasty stuff the cows are fed.

    If you were looking for a case to support not continuing – you needn’t have bothered. If you don’t want to continue then you shouldn’t (not in a bad way) or you will become irritated / resentful.

    I am still nursing my toddler and well I have to say my breastmilk has been a god send through colds, rotavirus, teething and well just about anything. Mummy does need to keep up her vitamins though as they need to pass over into the milk 🙂

    As for the comfort and attachment, I see the difference between those children weaned too soon and those who self weaned. Those who were ready are much more secure than those who were weaned unnaturally.

    I nursed my toddler through a pregnancy with hideous Morning Sickness and that was tough but when I miscarried our breastfeeding relationship / closeness helped me to cope.

    So I guess for those deliberating whether to continue, first answer with your heart. I never once questioned whether I would continue, we just keep going until the time is right.

    Nb: as an emergency food (thinking more airports, slow restaurant, traffic jams) it’s superb. We all know how impatient toddlers are 🙂

    Like

    April 25, 2015
    • Hi Diane,

      I agree that the AAFP is a credible organization. That’s why I’m particularly disappointed that they make this recommendation without good data to back it up. As I stated, I think it would be more appropriate to simply support mothers and babies in continuing their nursing relationship as long as they wish while also giving them accurate information about the science that we have.

      I’m confused about the “potentially inconclusive white paper” that you mentioned. Also, I would appreciate any leads you have on studies that do provide evidence for benefits of breastfeeding beyond a year. If I see good evidence for this, I would definitely amend this post. The last time I looked, I wasn’t able to find any.

      I don’t know why so many people responding to this post have assumed that I was “looking for a case to support not continuing.” That’s not the point of science. It’s not there to support my choice or your choice – it’s there to get us closer to the truth. In this case, there isn’t good science one way or the other. Thus, I would be uncomfortable advising mothers that weaning their toddlers from breast milk after a year will cause them harm, because I don’t think we have the science to say that. It isn’t about my opinion or my own choices. I’m just trying to look clearly at the science.

      On a more personal note, I can tell you that I wrote this post when my daughter was about a year old. I continued breastfeeding her until she was two because we both enjoyed it a lot! (If you look at the next blog post after this one, you can read more about that). Having read the science on this topic, though, I wouldn’t tell a friend who weaned earlier that my daughter would be healthier or more attached or better behaved because we breastfed for longer. There isn’t evidence for that, and so that would be an unfair accusation to make about the personal choices of another family. (You made different observations about this, but these are anecdotes. We really need an objective study to determine this – we need data. In fact, where researchers have looked at attachment and behavior of children that were formula-fed or breastfed as infants, they have been unable to see a difference.)

      I’m genuinely happy for you that you’ve so enjoyed breastfeeding your daughter, and I think it’s great that it is beneficial for you. (Easy food access in airports IS a benefit! I found it useful for that as well!) I’m also sorry to hear about your miscarriage but glad that breastfeeding helped you through that. Best wishes to you and your family, Diane.

      Like

      April 25, 2015
  27. ophelia #

    I have not seen the phenomenon that women who nurse past a year are well-educated, white, older, richer, buying organic food, fretting about BPA exposure, except as asserted online. Where I come from, that hasn’t been at all my experience. It has been mommas who are tryoing to get back to basics so to speak & skip out on all teh things “they say” are needed to parent (like swings & playmats & such). By no means would I consider teh women I know well-educated, at least not in the formal sense of the word (in fact not one had a degree), nor richer at all (in fact although some are SAHM’s – most make huge cuts to do it, if they do it) and nothing to do with organic & the rest. Among those *I* know – including myself I worked & had all sorts of obstacles. I nursed past a year because no doubt it is healthier than cow milk. I could not offer my children every advantage, nor even most – I could do *this*. This has been so common to what I have seen I just have a hard time believing the other is true & isn’t just a convenient way to discount the topic. In fact, *I* am the only long term nurser I have met that isn’t on WIC or assistance of any sort. it is hard for me to fathom I live in the only bubble that is like this.

    Like

    May 19, 2015
  28. Esophian #

    wow what a terrific read!! it’s so interesting to me how personally many people take your post, when I read it as an objective person trying to chase down evidence. It’s detective work. I truly admire your level-headed, forthright responses to the commenters, some of whom have really emotional critical responses, and many of whom clearly didn’t fully read your post or your responses to commenters. I am looking forward to reading your other posts!

    Like

    June 30, 2015
    • Wren #

      Totally agree!

      Like

      June 30, 2015
  29. Anita #

    I’ve greatly appreciated your posts on various topics but I may have to disagree with you here. I see the subtle point you are making…i.e., there is insufficient data to confidently say one way or another. However, your article doesn’t seem to quite portray this point but rather seems to suggest AAFP of engaging in shoddy practices, as though they consciously made unsupportable claims. As I see it, there’s a big difference between unsupportable (i.e., zero science to back up a claim) and recommendations being made based on the existing literature base as it stands. It’s not the AAFP’s fault that there are such limited data. I don’t necessarily see anything wrong with taking a position based on the avaliable evidence. Sure, a study of only n=15 is not ideal, but it’s also not nothing either. Aside from an organization that egregiously misrepresents a study, or hand picks only select studies from a wealth of data to suit its agenda, or takes limited research and makes very dangerous recommendations or claims that go against practice as usual, then I don’t see the problem with the recommendations and position that AAFP has made.

    Like

    July 22, 2015
  30. Sarah #

    I have failed to find any real research on breastfeeding for longer than 2 years in developed countries. There is some on breastfeeding 12-24 months. Someone showed me this paper http://www.bpni.org/Article/Oddy.pdf , which found better mental health outcomes for children breastfed longer than 12 months in Australia. This one is similar and from the Philippines http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957551/?tool=pubmed

    Like

    August 2, 2015
  31. Melissa #

    Thank you so much for this. I am an exclusive pumper for my 18 month old twins. I tried so hard to breastfeed them, I had countless lactation consultant appointments, and kept trying for 9 months. 9 months! My twins just wouldn’t do it, but I still wanted to provide them with milk so here I am pumping while everyone else is sleeping. My goal was first a year but then I read the AAFP statement and decided I needed to go to 18 months. I’m only pumping twice a day now and definitely drying up. I’m ready to be done. Pumping to 2 years would be great if I made a lot of milk easily but I don’t and it’s keeping us housebound which isn’t good anymore.

    That’s the back story to my real question. So one of my twins was recently diagnosed with Juvenile Idiopathic Arthritis. 😦 We’re probably going to have to put her on a medication that suppresses her immune system to knock back the JIA in several of her joints. I have a science background but I’m sleep deprived and emotionally involved. I’m so ready to be done pumping but what if she needs the milk? She’s going to start immune suppression right in the beginning of winter. Is there any data on this? I’ve emailed our rheumatologist, but I want a second opinion from someone who has looked into this. Could the antibodies help her this winter? How much milk is needed to get that benefit? I’m currently pumping about 20oz a day and that takes 4 hours of pumping. 😦 Thank you for listening. I’m so sad and tired and confused on what to do.

    Like

    October 24, 2015
  32. Melissa #

    I just tried to post a long comment and don’t see it, so I’m trying again. Hope it doesn’t post twice.

    So I’m an exclusive pumper for twins. I tried for 9 months to make breastfeeding work. So many lactation consultant appointments, SNS systems, you name it. It didn’t work for us. Here I am at 18 months (that AAFP statement kept me going) and starting to wean. I’m just not making much with two pumps a day and I’m exhausted. I pump for 4 hours a day and get less than 20 oz now. This keeps us housebound a bit and that’s not great.

    I have a question though. Sadly, one of my twins was just diagnosed with Juvenile Idiopathic Arthritis. We’re going to probably have to put her on an immuno suppressive drug staring in November. Right in time for cold season. I’m exhausted and sad and would love your opinion on whether or not I should keep going with the pumping for her sake? Would those IgAs help her? I’m so emotional about this I’m having a hard time thinking critically about this and there isn’t much data! Also how much milk is needed to confer the immune benefits? Maybe I could keep going if just a few ounces would work. Thanks so much for this post though. It’s very helpful. Not all of us can make it work easily and it’s nice to know the truth about the lack of data.

    Like

    October 24, 2015
    • Hi Melissa,
      Sorry that you had to post this twice! And gosh, I’m sorry to hear about your daughter’s diagnosis. I really admire your commitment to pumping for your twins for so long and also understand why you feel ready to be done. I wish I could answer your question, but I really don’t feel qualified as I don’t know very much about the disease. I hope the rheumatologist can offer some information for you. Just don’t forget to include your own health and well-being in your decision-making. You have all my best wishes for your family!
      Hugs,
      Alice

      Like

      October 24, 2015
      • Melissa #

        Thanks so much for your reply and sentiments Alice. I have decided that it’s best for our family that I still stop pumping. I was a bit panicked because I was already drying up (which is emotional to begin with) and suddenly I was thinking I needed more milk for my daughter. I don’t think there is anyway to get the answers I need at is point in time, so I’m going to keep with our plan and try to get more sleep rather than pumping like crazy.

        For some reason my comments don’t show up when I use my phone. I apologize for the double comment!

        Thanks again for this great post and for bringing clarity to so many topics,
        Melissa

        Like

        October 25, 2015
        • Yes to sleep, for sure! I’m glad you’ve made the choice you feel is right for your family. All my best to you, and I hope that your daughter’s health improves!

          Like

          October 26, 2015

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