Why is it recommended to breastfeed for 2 years?

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Breastfeeding benefits toddlers and young children… nutritionally, immunologically and psychologically.

• Breastfeeding contributes to your child’s NUTRITION
• Breastfeeding contributes to your child’s HEALTH
• Breastfeeding contributes to your child’s INTELLECTUAL DEVELOPMENT
• Breastfeeding contributes to your child’s SOCIAL and MENTAL DEVELOPMENT
• Breastfeeding your child past infancy is NORMAL
• MOTHERS also benefit from breastfeeding for a longer duration
• Additional Resources

Breastfeeding contributes to your child’s NUTRITION

• 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 in the second year postpartum contained significantly higher concentrations of total protein, lactoferrin, lysozyme and Immunoglobulin A, than milk bank samples, and significantly lower concentrations of zinc, calcium, iron and oligosaccharides.”
  — Perrin 2016

• “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

• In a study of 250 toddlers in western Kenya, breastmilk provided, on average, 32% of the child’s total energy intake. “Breast milk made an important contribution to the fat and vitamin A intakes of toddlers in this community.”
  — Onyango 2002

• “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. Research does indicate that in situations where breastfed toddlers have an increased risk of malnutrition, this appears to be due to inadequate complementary feeding or reverse causality (the mother is more likely to continue breastfeeding a child who is ill or growing poorly). In one study of 250 toddlers in Kenya, solid food intake increased after weaning, but not enough to replace all the fat, vitamin A, and niacin that the child had been getting via breastfeeding (Onyango 2002).  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).

References

Breastfeeding contributes to your child’s HEALTH

• The American Academy of Family Physicians notes that children weaned before two years of age are at increased risk of illness (AAFP 2008).

• Breastfeeding toddlers between the ages of one and three have been found to have fewer illnesses, illnesses of shorter duration, and lower mortality rates  (Mølbak 1994, van den Bogaard  1991, 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. (Lawrence & Lawrence 2011, Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991)
• “Human milk in the second year postpartum contained significantly higher concentrations of lactoferrin, lysozyme and Immunoglobulin A, than milk bank samples” collected from donors less than 12 months postpartum. (Perrin 2016)

• 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]

References

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Breastfeeding contributes to your child’s INTELLECTUAL DEVELOPMENT

• 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.

References

Breastfeeding contributes to your child’s MENTAL and SOCIAL DEVELOPMENT

• A couple of studies have shown a positive relationship between longer breastfeeding duration and social development.
  — Duazo 2010, Baumgartner 1984

• “A shorter duration of breastfeeding may be a predictor of adverse mental health outcomes throughout the developmental trajectory of childhood and early adolescence.”
  — Oddy 2010

• 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.

References

Breastfeeding your child past infancy 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 2012, AAP 2005)

• The American Academy of Family Physicians recommends that breastfeeding continue throughout the first year of life and that “As recommended by the WHO, breastfeeding should ideally continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and encouragement. It has been estimated that a natural weaning age for humans is between two and seven years. Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment, and having a sustainable food source in times of emergency. The longer women breastfeed, the greater the decrease in their risk of breast cancer.” 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 2008)
• The Academy of Breastfeeding Medicine affirms breastfeeding beyond infancy as the biological norm. “The average age at weaning ranges anywhere from six months to five years… Claims that breastfeeding beyond infancy is harmful to mother or infant have absolutely no medical or scientific basis,” says Arthur Eidelman, MD, president of the Academy of Breastfeeding Medicine.  “Indeed, the more salient issue is the damage caused by modern practices of premature weaning.”  The global organization of physicians further notes that “Human milk contains nutrients, antibodies, and immune-modulating substances that are not present in infant formula or cow’s milk. Longer breastfeeding duration is further associated with reduced maternal risks of breast cancer, ovarian cancer, diabetes, hypertension, obesity, and heart attack.” (ABM 2012)

• 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 1993, 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 breastfeeding for a longer duration

• 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 also reduces the risk of ovarian cancer (References), uterine cancer (References), and 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 reduces the risk of cardiovascular disease (References).

• Breastfeeding has been shown to decrease insulin requirements in diabetic women. There is also a decreased risk of Type 2 diabetes mellitus in mothers who do not have a history of gestational diabetes (References).

• Breastfeeding moms may lose weight easier (References).

Additional Resources

Extended Breastfeeding Links @

Extended Breastfeeding References @