The Benefits of Breastfeeding Beyond Infancy

There are so many benefits of breastfeeding for both baby and mama.   No one can deny that.  The research is clearly there and easy to find. However, most people believe that these benefits have some sort of cutoff date that expires around the baby’s first birthday.  “It’s not normal to nurse past a year”, I’ve heard many times.  Heck, before I became I mommy, it’s something that I believed and possibly had even uttered myself (**I embarrassingly cringe at my own ignorance**).

However, once I had my beautiful daughter and we began our breastfeeding relationship, I knew in my heart that I couldn’t just one day “cut her off” from it.  How cruel would that be?  I started to think about why anyone would even do that.  I realized that it was because of lack of knowledge – about the benefits that continue and even begin with long term breastfeeding and also the misplaced stigma upon nursing an older baby/child.  (The latter I will address in a future blog entry.) 

What’s interesting is that many pediatricians lack the knowledge of the benefits of breastfeeding beyond infancy.  That is troubling to me, since the majority of parents look to their pediatricians as the sole source of information about their children.  It’s also puzzling to me, because both the American Academy of Pediatrics and the American Academy of Family Physicians recommend extended breastfeeding.

The American Academy of Pediatrics recommends that "Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child... Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother... There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer." (AAP 2005)

The American Academy of Family Physicians recommends that breastfeeding continue throughout the first year of life and that "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)

I decided to do a little research so that I have information to back up what I know it my heart about extended breastfeeding.  I also figured it would come in handy when I run into the many skeptics who look at me like I have three heads when I tell them I’m still nursing my 20 month old daughter.

I found two studies that show a correlation between extended breastfeeding and higher intelligence. ( Mortenson EL, MIchaelsen KF, Sanders SA, Reeinisch JM. The association between duration of breastfeeding and adult intelligence. Journal of the American Medical Association 2002;287:2365-2371.  And .Daniels M C, Adair L S. Breast-feeding infuences cognitive development of Filipino children. J Nutr. 135: 2589-2595, 2005)

In addition, “Children who are breastfed score higher on intelligence tests than children who were not, with the ones who were breastfed longest showing the most benefit. I.Q. scores, reading and math tests, and reports from teachers compiled during a study conducted by L.J. Horwood concluded that there were statistically significant increases in child cognitive ability and educational achievement based on long-term nursing”. [Breastfeeding and Later Cognitive and Academic Outcomes, Pediatrics, 1998].

As for health benefits – all of the already known health benefits such as strong immune systems, reduced allergies, etc. continue the longer you breastfeed.  In addition, studies done in rural Bangladesh have shown that breast milk continues to be an important source of vitamin A in the second and third year of life. (Persson V, Greiner T, Islam S, and Gebre-Medhin M. The Helen Keller international food-frequency method underestimates vitamin A intake where sustained breastfeeding is common. Food and Nutrition Bulletin, vol.19 no.4. Tokyo, Japan: United Nations University Press, 1998.)

What about the health benefits for the nursing mama?  We all know that nursing reduces a new mama’s chance of breast cancer and helps her lose her pregnancy weight quicker.  But does she stop having any benefits after a year?  Not at all!  Several studies have found a significant inverse association between duration of lactation and breast cancer risk. (Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet. 2002 Jul 20; 360(9328): 187-95, Furberg H, Newman B, Moorman P, Millikan R. Lactation and breast cancer risk. Int J Epidemiol 1999;28:396-402, Ing R, Ho JHC, Petrakis NL. Unilateral breastfeeding and breast cancer. Lancet July 16, 1997;124-27, Jernstrom H, et al. Breast-feeding and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. J Natl Cancer Inst. 2004 Jul 21;96(14):1094-8, Layde PM, Webster LA, Baughman AL, Wingo PA, Rubin GL, Ory HW and the cancer and steroid hormone study group. The independent associations of parity, age at first full term pregnancy, and duration of breastfeeding with the risk of breast cancer. J Clin Epidemiol 1989;42:963-73, Lee SY, Kim MT, Kim SW, Song MS, Yoon SJ. Effect of lifetime lactation on breast cancer risk: A Korean Women's Cohort Study. Int J Cancer. 2003 Jun 20;105(3):390-3.)

The benefits of extended breastfeeding aren’t just limited to intelligence and health benefits for baby and mama.  It extends to their social and emotional well being, as well. “Research reports on the psychological aspects of nursing are scarce. One study that dealt specifically with babies nursed longer than a year showed a significant link between the duration of nursing and mothers' and teachers' ratings of social adjustment in six- to eight-year-old children (Ferguson et al, 1987). In the words of the researchers, 'There are statistically significant tendencies for conduct disorder scores to decline with increasing duration of breastfeeding.'"  (Ferguson DM et al. Breastfeeding and subsequent social adjustment in six- to eight-year-old children. J Child Psychol Psychiatr Allied Discip 1987; 28:378-86).

According to Jack Newman, MD, FRCPC, “And breastfeeding makes the toddler dependent? Don't believe it. The child who breastfeeds until he weans himself (usually from 2 to 4 years), is generally more independent, and, perhaps more importantly, more secure in his independence. He has received comfort and security from the breast, until he is ready to make the step himself to stop. And when he makes that step himself, he knows he has achieved something, he knows he has moved ahead. It is a milestone in his life.”

There you have it – some research to back what you already knew in your heart – that breastfeeding beyond infancy has many benefits. Keep up the good work, mamas!