Breastfeeding - How Long Is Optimal

Dear Dr. Dave and Dr. Dee,

My friend has an 18-month old son that she is still breastfeeding. He is not a baby any more and is walking and running around. Isn't a toddler a little too old to be breastfeeding? I stopped breastfeeding at 6 months with our two children. I've mentioned this to her numerous times, but she doesn't get it. What should I say?

Signed,

Bothered by breastfeeding

Dear Bothered by breastfeeding,

Generally, babies are breastfed until they are weaned, which is when babies gradually transition from mother's milk to the introduction of solids, usually around six months of age. However, the decision to breastfeed and for how long is a personal decision between the mother and child.

Not all mothers breastfeed, but many do for at least a few months. According to the Centers for Disease Control, "over 80% of the infants in the U.S. have been breastfed at some point, but only 25.5% of infants are xclusively through 6 months" (www.cdc.gov/breastfeeding/data/reportcard.htm)

HOW LONG TO BREASTFEED - RECOMMENDATIONS

Major leading health organizations recommend babies be exclusively breastfed to about six months. After six months of age, these organizations advocate for continued breastfeeding along with complementary foods for at least a year or two years with no age limit provided for when to stop breastfeeding. Policy statements of these organizations are summarized below:

The American Academy of Pediatrics (AAP) recommends that "babies be exclusively breastfed for about the first 6 months of life. This means your baby needs no additional foods (except Vitamin D) or fluids unless medically indicated. Babies should continue to breastfeed for a year and for as long as is mutually desired by the mother and baby" (http://www2.aap.org/breastfeeding/faqsbreastfeeding.html).

The American Academy of Family Physicians (AAFP) "recommends that all babies, with rare exceptions, be breastfed and/or receive expressed human milk exclusively for the first six months of life. Breastfeeding should continue with the addition of complementary foods throughout the second half of the first year. Breastfeeding beyond the first year offers considerable benefits to both mother and child, and should continue as long as mutually desired" (http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpolicy.html)

UNICEF recommendations: "initiation of breastfeeding within the first hour after the birth; exclusive breastfeeding for the first six months; and continued breastfeeding for two years or more, together with safe, nutritionally adequate, age appropriate, responsive complementary feeding starting in the sixth month" (http://www.unicef.org/nutrition/index_24824.html)

World Health Organization (WHO) "recommends exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond" (http://www.who.int/topics/breastfeeding/en/).

HEALTH BENEFITS OF BREAST MILK FOR BABY

Besides bonding of mother and baby along with the security and comfort provided by breastfeeding, breast milk is very nutritious. Colostrum in the breast milk contains several antibodies, so mother's milk provides the ideal nutrition (i.e. vitamins, protein, calcium) and antibodies for infant growth and development.

The U.S. Department of Health and Human Services lists several reasons why breastfeeding is important (www.womenshealth.gov). To summarize in brief:

1. Early breast milk is liquid gold - Known as liquid gold, colostrum is the thick yellow first breast milk that you make during pregnancy and just after birth. This milk is very rich in nutrients and antibodies to protect your baby.

2. Your breast milk changes as your baby grows - Colostrum changes into what is called mature milk. By the third to fifth day after birth, this thinner mature breast milk has just the right amount of fat, sugar, water, and protein to help your baby continue to grow, and still provides all of the nutrients and antibodies your baby needs.

3. Breast milk is easier to digest - For most babies, especially premature babies, breast milk is easier to digest than formula.

4. Breast milk fights disease - The cells, hormones, and antibodies in breast milk protect babies from illness. This protection is unique; formula cannot match the chemical makeup of human breast milk.

Compared to formula-fed babies, breastfed babies had:

1. Lower incidence of ear infections and diarrhea.

2. Lower risk of necrotizing enterocolitis, a disease that affects the gastrointestinal tract in preterm infants.

3. Reduced risk of lower respiratory infections

4. Lower risk of asthma

5. Lower risk of obesity

6. Lower risk of Type 2 diabetes

5. Reduce the risk of Type 1 diabetes, childhood leukemia, and atopic dermatitis (skin rash)

6. Lower the risk of SIDS (sudden infant death syndrome).

For more information, go to www.womenshealth.gov/breastfeeding/