Monday, March 08, 2010

AAFP Statement: Breastfeeding Beyond Infancy


The following is an excerpt from The American Academy of Family Physicians 2008 Position Paper on breastfeeding.

Note that breastfeeding at least until the second year of a child's life is not considered 'extended' breastfeeding. Rather, breastfeeding until the bare minimum age of 2 years is the norm and anything less brings about detrimental consequences. Human milk for growing human babies is expected (physiologically) by the baby's body in order to receive all that is needed (and only found in human milk) for this important period of rapid brain, body, and immune system development.

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As recommended by the World Health Organization (WHO), breastfeeding should ideally continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and encouragement. (1)

It is estimated that the 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.

The longer women breastfeed, the greater the decrease in their risk of breast cancer. (5)

Mothers who have immigrated from cultures in which breastfeeding beyond infancy is routine should be encouraged to continue this tradition. There is no evidence that breastfeeding beyond infancy is ever harmful to mother or child.

Breastfeeding during a subsequent pregnancy is not unusual and poses no risks. If the pregnancy is normal, and the mother is healthy, breastfeeding during pregnancy is a woman's personal decision.

If the child is younger than two years, the child is at increased risk of illness if weaned.

Breastfeeding a nursing child after delivery of the next infant (tandem nursing) may help provide a smooth transition psychologically for the older child. (6)



References:

1) Scott JA, Landers MC, Hughes RM, Binns CW. Psychosocial factors associated with abandonment of breastfeeding prior to hospital discharge. J Hum Lact. 2001;17(1):24-30.

2) Powers NG, Slusser W. Breastfeeding update. 2: Clinical lactation management. Pediatr Rev. 1997;18(5):147-161

3) Dettwyler KA. A time to wean. In: Breastfeeding: Biocultural Perspectives. Stuart-Macadam P, Dettwyler KA, eds. New York, NY; Aldine De Gruyter, 1995:39-73.

4) Goldman AS, Goldblum RM, Garza C. Immunologic components in human milk during the second year of lactation. Acta Paediatr Scand. 1983;72(3):461-462.

5) Fergusson DM,Horwood LJ, Shannon FT. Breastfeeding and subsequent social adjustment in six- to eight-year-old children. J Child Psychol Psychiatr Allied Discip. 1987;28(3):378-386.

6) Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical professional. 6th ed. St. Louis: Mosby, 2005.


Review the full 2008 AAFP Position Paper on Breastfeeding here.

15 comments:

  1. I did a piece today on questioning readers' thoughts and/or feelings about breastfeeding older children. On Wednesday I have a review to post of the book Breastfeeding Older Children. Just in case you wanted to take a look. http://www.breastfeedingmomsunite.com/2010/03/what-do-you-think-about-breastfeeding-older-children/

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  2. Melodie, I noticed a lot of moms mentioned the "well, they are a little person now and they don't need to nurse..." basically saying it's for babies. Maybe not just for little infants, but for babies. What's wrong with nursing little people who can sing three different songs and recognize all the ABC's? And I felt a little bad for that little boy who was weaned while he had a broken leg. I know the mom was exhausted but it couldn't at least wait until he healed? I'm sure the milk would have been helpful to him both physically and emotionally while he was recovering.

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  3. One more thing I wish I'd known when I was breastfeeding. I did the best I could with the knowledge I had at the time, however. Here's to educating my children and other women who come across my path!

    Thanks for the post.

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  4. When my son was one, his pediatrican scolded me for continuing to breastfeed. From that point on, my husband, mother-in-law, and a few friends fussed at me for continuing to bf. By his second year, I was literally bf hiding in the closet, or sitting by a window so I could quit if dad came home early.

    I managed to bf secretly into his third year. At that point I felt the mixed message of going against dad's wishes outweighed the benefit of continuing to bf. If the doctor had supported me, my husband would have too.

    Here's what I know about extended bf that some doctors do not.

    It is not just about food. It is about comfort. And wellness.

    Comfort - When friend's toddlers acted up they put them in time out. Not my boy. When he got cranky (overwhelmed) a few quiet minutes with mom (in the closet) was like pressing a reset button. A happy, confident, restored child emerged, ready to take on the world again. Cranky 2 year olds are generally tired, overwhelmed, or hungry. They don't need time out. They need a few minutes with mom on the boob.

    Wellness - On those few occasions my boy got sick, I kept him close until he got well - sleeping with him (to allow the forbidden access to bf) and staying close all day - lots of holding. I would purposefully breath his breath to give myself whatever he had so my immune system could support him. My milk helped him get well, as also the comfort of being close to mom all the time.

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  5. anonymous-i love what you say... 'they don't need a time-out, they just need a few minutes on the boob'
    great article!

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  6. Oh but it's so true! A nursing relationship is so much more than the actual food consumed (and that in itself is amazing!).

    Why should 1, 2, 3 even 4 and 5 year olds need time outs or physical punishment? Most of them don't even have the brain development required for impulse control. They still need our comfort and guidance. Nursing into toddlerhood has been an amazing resource for ME. When she is tired, stressed, angry, sad, and anything else, nursing calms her immediately.

    Parents who willfully wean before toddlerhood are missing out on a great opportunity to continue to affirm and reassure their children.

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  7. what a touching satement from anonymous...how sad you had to hide breastfeeding from your husband. I too have been made to feel bad for still breastfeeding my 18 month old, my husband acts as if it is not normal to still be breastfeeding my boy. I totally agree with what you have said, and think it is what's best for babies and their immune systems and brings such comfort. I will continue to breastfeed until atleast 2, or when my baby decides to wean. It is very refreshing and encouraging to read stories from Mums who have the same opinions as me. Thank you for sharing :)

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    Replies
    1. i have continued to BF my son past the recomended ages he will be turning 7 years in another months time thankfully my husband has beed supportive but i BF in secret from the rest of my family and some friends i see a child that is strong and confident gets sick very little and overcomes all illness quickly when he is overwhelmed,tired or stressed i am his comforter and it is a good relationship. he falls asleep easily in my arms and is always close by my side i do have days and NIGHTS that i wish he would stop BF but those moments are short lived this young age is short and goes by fast now is the time to do all for them that we can to give them the greatest start in life to be the strong health children god intended them to be it is a selfless and loving mom who puts aside the opinions of others and gives her child the best start in the future life so to all women who choose to breast feed and to all those that continue i encourage you stay strong for your child and fight for the well beeing of their mind and body allow them to decide they are ready to wean because they choose to not because and unknowlagable adult says they should but because they are ready to step into the next stage of there own growth and development.

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  8. I love reading this. I am alone, completely, in this arena but headstrong enough to do it anyway. My dd is 13 mths old.

    If she was ready to eat food - then evolution would have blessed her with a full set of teeth.

    And, if she wasn't suppose to nurse now, she would have stopped willfully on her own, no matter how much I offered them.

    How I agree so much with how the BB offers them comfort. When she gets fussy, I offer it first (well I offer the potty first) then if that it isn't it, we go for the BB.

    And, she uses the BB as a great communication tool for when she needs to potty. From birth, she was telling me when she need to go.

    Now, she uses it as a tool fo comfort, to complete her diet, to make her healthy, to make her happy, and complete.

    Why would I stop this.

    My DH is now struggling with the idea that I may be nursing her until she is two or three.

    However, I noticed that as everyday passes by, he is more and more comforted by the happy baby he has.

    Or, is it stockholm syndrome?

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  9. There have been a few people who have written saying they cannot find the AAFP position paper that these statements come from. This source is highlighted and directly linked in the above article (last line). Or, if you prefer to copy/paste URLs it is:

    http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpositionpaper.html

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  10. My religion says to nurse until baby is at least 2yo (and one school of thought says children can be allowed to nurse until they are 7yo), so that's what I do. Fortunately, my DH is supportive of that (though other people frown upon it) so I am still nursing both our sons (34 and 50 months old), and nursed the older one while I was pregnant with the second. Now I'm pregnant with our third and plan to continue on nursing them all until they wean themselves, turn 7yo or until I just can't take it anymore...

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  11. I'm so glad to have been shown this site. I'm urrently 10 weeks along with my first child. Here's hoping all goes well.

    I suppose I am lucky in that my boyfriend supports extended breastfeeding. As in, he mentions 8 years. I don't think I'm going to be alright with it for that long. That's starting to get a bit to mature for me. But 2 years, I'm sure I can do that. Maybe 4.
    I just hope that when I'm ready to stop, and hopefuly the baby seems ready to stop, Daddy won't insist on continuing.

    -Invi

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  12. When you think about it, adults "breast-feed" on another species. How many people drink cow milk? When you think of it that way how can milk from your own species be bad for you? Personally I think that somewhere along the way we lost site of what's best for our children, I grew up in Germany and mothers there breastfeed usually until their kids start school...you mention that here and people say "OMG that's so gross!" or "That's perverted." These are usually people who have never breastfed, and I have had people literally ask me if it was a sexual thing. I would love to let my kid latch on to them and have them tell me if they found anything appealing in the pain of nursing for the first time. Puritan society makes mothers who ONLY want what's best for their child feel like they are sinners and pedophiles for just wanting a healthy, happy, and intelligent child.

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  13. Has anyone else noticed that the newest version (2012) of the AAP statement on breastfeeding has much less to say about breastfeeding beyond infancy than their previous statement did, and certainly less than the AAFP statement does.

    http://lactationnarration.com/index.php/2012/02/breastfeeding-beyond-infancy-in-the-new-aap-statement/

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  14. I have recently had my second child and I am breast feeding, I didn't do it with my first, and now I wish I would have. I feel such a closeness to my baby, I can give her something no one else can.

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