by Kelly Griffith
Issue 97, November/December 1999
Breastmilk is by far the best nutrition for human babies. The reams of scientific data supporting that fact would impress even the most unenlightened skeptic. If a pharmaceutical company had made the stuff, everyone in America would know that it helps babies fight infection,1 hastens a mother’s postpartum recovery,2 and provides countless other benefits to both mom and baby.3
But when does all that good stuff end?
Scientific research and the slowly changing attitudes of an often-traditional medical establishment continue to push the boundaries of status quo thinking that says these benefits somehow halt at six months, nine months, or one year. More and more mothers have discovered the benefits of nursing through the potty-training stage and beyond, while their children continue to reap many known and unknown benefits of a lengthy nursing period.
While extended breastfeeding is not the societal norm in the US, many doctors, health experts, and even mothers believe that it should be. And the research agrees with them.
What the Research Shows
A better approach might be to ask, "What does the research not show?" What it does not show is at what point the long list of benefits of nursing stops.
Dr. Katherine A. Dettwyler, PhD, associate professor of anthropology and nutrition at Texas A&M University, has spent a career studying breastfeeding. As coeditor of Breastfeeding: Biocultural Perspectives, and researcher on milk composition and weaning, Dettwyler has concluded one thing for sure: Most children in America are weaned from the breast too early. Way too early.
In Breastfeeding: Biocultural Perspectives, Dettwyler wrote about the natural age of weaning for humans, meaning the length of time humans would likely nurse if cultural expectations did not interfere.
In comparing humans to other primates, research showed that humans’ natural age of weaning is a minimum of two and a half years and a maximum of between six and seven years. Researchers compared things such as the age of sexual maturity; the age of the eruption of permanent molars; the time when children quadrupled their birthweight; and the length of gestation.4 In every other primate, nursing continues for years, not just months.
According to Dettwyler, "The very word infant in zoological terms refers to the time between birth and the eruption of the first permanent molars." Dettwyler further emphasizes, "The research looking at weaning time in primates and dental eruption shows that breastfeeding ends when infancy ends, when the first permanent molars are erupting. In humans, that happens between 5.5 and 6.5 years."
Moreover, Dettwyler has compiled references for all the studies that address the benefits of breastmilk beyond six months, data that will be included in the upcoming new edition of her book. She cites 23 studies, not including numerous studies on allergies, that link positive outcomes with breastfeeding beyond six months.
"Another important consideration for the older child is that they are able to maintain their emotional attachment to a person rather than being forced to switch to an inanimate object such as a teddy bear or blanket," Dettwyler wrote in the book. "I think this sets the stage for a life of people-orientation, rather than materialism, and I think that is a good thing."
Elsie E. Gulick, PhD, RN, a professor at Rutgers University, found that the benefits of human milk lasted long after actual breastfeeding had stopped. In Pediatric Nursing, Gulick wrote of her research with children ages 16 through 30. "The findings support the theoretic premise that duration of breastfeeding is directly related to infant health and indirectly related to toddler health,"5 Gulick wrote.
Most research doesn’t currently look at children breastfed more than 24 months, because most American women don’t nurse for more than just a few weeks, and most surveys indicate that only around 20 percent are still breastfeeding at six months.
"I am collecting brief data from moms who have nursed beyond three years," Dettwyler says of a survey that so far includes 600 responses representing 2,000 children. "Most of these are US moms . . . I am gathering data first of all simply to show that lots of women in the US are nursing children beyond three years. I also hope that this data bank will become the foundation of a long-term study on the health benefits and cognitive development of children breastfed for three years or longer."
Existing studies show that breastfeeding for up to two years may create smarter children. A fatty acid found in mother’s milk, called DHA, is linked with brain development. Since a child’s brain is dramatically growing during the first few years not just months of life, some believe that this could account for the differences in IQ between breastfed and bottle-fed children. Numerous studies show that breastfeeding boosts IQ in children regardless of the income or educational status of their mothers.6, 7, 8, 9
How significant are these benefits? "That depends," Dettwyler says. "It depends on the child’s genetic predisposition to diseases, and his or her exposure to diseases in the environment. The problem is that the parents have no clue if their child has a genetic predisposition to diabetes, say, or schizophrenia, or multiple sclerosis, heart disease, breast cancer, or allergies and asthma, for example. So you can’t say that there is any simple answer to the question of how significant the health benefits are. To some children, they may be minuscule, but to others, they may be a matter of life and death. According to my research, however, all children were designed to expect breastfeeding for a minimum of two and a half years."
The World Health Organization recommends exclusive breastfeeding that is, no fluid or food other than breastmilk for the first four to six months of life. who also recommends that children continue to be breastfed at least until they are two.
The American Academy of Pediatrics recommends exclusive breastfeeding for six months and continued breastfeeding for a minimum of one year, but offers no upper limit. While it’s unlikely that hordes of women will immediately change their views should the AAP’s official stance be extended, the group’s recommendations if they change could influence more physicians to support women to nurse longer. Studies show that women who are encouraged by a health professional either doctor or nurse to breastfeed will likely do so. 10
Jan Barger, lactation consultant, nurse, and past president of the International Lactation Consultant Association, says that mothers often take cues from their physicians about how long to nurse. The mom "will be much more likely to stay with breastfeeding if her pediatrician is nurturing and pro-breastfeeding, and steers her in the right direction when trouble comes up," says Barger. "A comparison is the "Back to Sleep" campaign. If this was only the aap, the mothers wouldn’t pay any attention. But it is because the individual pediatrician comes into their rooms and says, ‘We have found we can significantly decrease the risk of sids by placing infants on their sides or backs to sleep, and I recommend that you do that.’ Since every mother is terrified of sids, she complies immediately. I wonder what moms would do if pediatricians came into the room and said the same thing about breastfeeding."
"I find that doctors who think breastfeeding past a year is wrong or weird are fewer than they used to be," says Anne Montgomery, a family practice physician and an instructor at St. Peter’s Hospital in Olympia, Washington. "It amazes me that people don’t know about the research, but when I share it most are receptive. I would encourage moms to educate their doctors about why breastfeeding past a year matters to their children and themselves. Providing doctors with medical evidence about the benefits of breastfeeding is important, but they also need to know about the normal development of independence and that weaning is a gradual growing away from infantile needs.
What Is Weaning?
" From a nutritional standpoint, weaning is a gradual transition from breastmilk meeting all of the baby’s needs to other foods meeting those needs," Montgomery says. "Weaning from a psychodevelopmental standpoint is also a gradual transition from having all needs met by mom to a healthy self-reliance appropriate for a child’s age. Both are important, and both have an appropriate endpoint which will vary somewhat from child to child and family to family."
The weaning process begins when the first solid foods are introduced. Babies not only begin experiencing the different tastes and textures of new foods, but also begin exploring their world with rolling, crawling, and walking. Venturing farther and farther from mom begins the gradual emotional weaning.
True child-led weaning means that the mother does not interfere with the nursing process, nor encourage weaning by withholding the breast from a willing child.
So what can a mother committed to gradual physical and emotional weaning expect from her toddler?
"Every baby is different," says Kathleen G. Auerbach, PhD, coauthor of Breastfeeding and Human Lactation, a textbook for healthcare providers. "Toddlers nurse in a variety of patterns, as do newborns. This is obvious to mothers who have nursed more than one baby."
A study of women who practiced child-led weaning in the US showed the average weaning age to be two and a half to three years. Researchers also said that extended breastfeeding has documented benefits and that health practitioners should support mothers who choose child-led weaning.
The Mother’s Perspective
Marti Grahl, a 32-year-old mother of three from Hagerstown, Maryland, found nursing her toddler to have many practical benefits. After weaning her first child, now six, at around five months, Grahl committed herself to breastfeeding longer with her second daughter, now two, although she took that commitment a step at a time. First she committed to six months of breastfeeding, then 12 months. After a year, the months just began ticking by.
Rachel, her two year old, still nurses frequently, even though Grahl is pregnant with her third child. Grahl finds that extended breastfeeding has provided options for comfort that she did not have with Emilee, her first daughter. From a practical standpoint, she had more to offer Rachel.
"It’s very soothing for both of us," Grahl says. "With Rachel, it’s much easier to find the right solution than with Emilee. Rachel is so much more at peace with herself than Emilee was at her age."
Dr. William Sears, an internationally renowned pediatrician and author of The Baby Book and more than 20 other childrearing books, says that the mother who nurses a toddler often has Grahl’s experience. Sears has seen thousands of breastfeeding couples in his more than 25 years of pediatric practice. He says that mothers of nursing toddlers find themselves looking at life from the child’s point of view more often, searching for solutions to typical toddler problems in a way that the child can relate to. The mother will be more apt to support the child. "The main difference in nursing a toddler is discipline," he says. "A nursing mom will get behind her toddler. Suppose the child spills [something]. A nursing mother will see things through the child’s eyes."
Kateri Rein, a 29-year-old expectant mother of a two year old from Richmond, Virginia, found other practical reasons for nursing her toddler. Since her daughter, Caroline, suffered from food allergies, it only made sense to keep her on breastmilk as long as possible, Rein says. By doing so, she kept Caroline’s rashes to a minimum. Caroline thrived despite not going strong on solids until she was 18 months old.
Rachel Cash, a 25-year-old mother of two from Willits, California, finds that nursing her 14 month old was extra special after weaning her three year old at six months. "I decided to do things differently with my second," she says. "I love the feeling that I get when we are together. It is something nobody in this world can give her. When she is next to me, I know that she is safe, and nothing will or can happen to her."
Can You Breastfeed Too Long?
U.S. societal norms, some experts say, place unrealistic and possibly damaging expectations on moms and babies when it comes to weaning. Many women who nurse longer than one year feel a need to remain secretive, sometimes not even sharing the fact that their baby is still nursing with their doctors. "I just choose not to nurse my toddler in front of people," Rein says.
Others simply wean early, emotionally upsetting themselves and their babies because they have been led to believe by misguided friends or family that a child needs to "grow up."
Grahl, for instance, never knew anyone who nursed more than just a few weeks when her first daughter, Emilee, was born five years ago. She only recently "came out of the closet" and nursed her two year old, Rachel, in public.
Auerbach says women should feel perfectly normal breastfeeding in private if that’s how they feel comfortable. Nursing a toddler in private is a wonderful way to continue sharing the relationship without feeling societal pressure to wean prematurely.
"There are many women who are nursing well beyond the ‘appropriate’ time in a predominately bottle-feeding culture," she adds, "and they do so in the privacy of their home."
Montgomery says that a mother has been nursing too long when nursing is the only positive interaction between mother and child.
Dettwyler stresses the fact that children are not truly capable of mothering themselves for several years, not several months. "Our culture is way out of whack regarding when independence should happen, especially when it comes to self-comforting," she says. "Many people struggle and struggle to toilet train their two year old, for example, not realizing that most two year olds are not capable of being toilet trained. Wait until your child is three or three and a half and say ‘Here’s the toilet, and this is how it works,’ and let your child see you using the toilet often. Then there’s no struggle.
"The idea that a two or three year old should be able to self-mother," she adds, "has no substantiation." "Advocating that children suck their thumbs, fingers, or pacifiers instead of sucking on mom or insisting that they cling to blankets or teddy bears instead of to mom in order to go to sleep, or to be comforted has no basis in any scientific research."
1. J. Newman, "How Breastmilk Protects Babies," Mothering 82 (Spring 1997): 63-65.
2. Kathleen G. Auerbach and J. Riordan, Breastfeeding and Human Lactation (London: Jones and Bartlett Publishers International,
3. Ibid., 105-134.
4. K. Dettwyler and P. Stuart-Macadam, Breastfeeding: Biocultural Perspectives (New York: Walter de Gruyter, 1995), 39-73.
5. E. E. Gulick, "The Effects of Breastfeeding on Toddler Health," Pediatric Nursing 12, no. 1 (1986): 51-54.
6. D. L. Johnson et al., "Breastfeeding and Children’s Intelligence," Psychol Rep 79, no. 3 (December): 1179-1185.
7. W. J. Rogan and B. C. Gladen, "Breastfeeding and Cognitive Development," Early Human Development 3 (January 31, 1993):181-193.
8. M. Morrow-Tlucak, et al. "Breastfeeding and Cognitive Development in the First Two Years of Life," Soc Sci Med 26, no. 6 (1998):635-639.
9. C. I. Lanting et al., "Neurological Differences between 9-year-old Children Fed Breastmilk or Formula," Lancet 344, no. 8933(November 12, 1984): 1319-1322.
10. K. T. Young et al., "The Commonwealth Fund Survey of Parents with Young Children," The Commonwealth Fund, 1996, B-4.