Wednesday, May 06, 2009

They Say:

They say that breastfeeding into toddlerhood and beyond is healthy and normal. "They" includes moms like those who posted in the Carnival yesterday. It also includes a few medical organizations. I'll share a couple of quotes. Purple emphasis is mine.

The World Health Organization:

Breastfeeding should continue with complementary feeding up to 2 years of age or beyond, and it should be on demand, as often as the child wants....Breast milk continues to provide higher quality nutrients than complementary foods, and also protective factors. Breast milk is a critical source of energy and nutrients during illness, and reduces mortality among children who are malnourished. In addition...breastfeeding reduces the risk of a number of acute and chronic diseases. Children tend to breastfeed less often when complimentary foods are introduced, so breastfeeding needs to be actively encouraged to sustain breast-milk intake."
quoted from Infant and young child feeding: Model Chapter for textbooks for medical students and allied health professionals, 2009, page 20, downloaded from here.

The American Academy of Family Physicians:
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.... There is no evidence that extended breastfeeding is harmful to mother or child. Breastfeeding during a subsequent pregnancy is not unusual. If the pregnancy is normal and the mother is healthy, breastfeeding during pregnancy is the woman's personal decision. If the child is younger than two years, the child is at increased risk of illness if weaned. Breastfeeding the nursing child after delivery of the next child (tandem nursing) may help provide a smooth transition psychologically for the older child.
Government statements (I'm limiting this to English-speaking countries because this blog is in English, not because other countries don't have statements or aren't important):

American Academy of Pediatrics, because the US Department of Health's statement is a quote from the AAP: "Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child."

Health Canada promotes "continued breastfeeding for up to two years and beyond."

Australian Government: "continued breastfeeding until the age of 12 months – and beyond if both mother and infant wish."

The European Union seems to use the WHO's recommendation of 2 years- I had a hard time navigating their site to find an exact link.

I found the WHO's recommendation to continue breastfeeding on demand into the second year of life and to continue encouraging the child to breastfeed so that wearning doesn't occur before their second birthday to be very interesting. I have heard many times, "breastfeed on demand" but never heard of age being addressed in the discussion. I aksed an LLL leader about this and she said that it's fine to ask your toddler to wait a few minutes as you finish something up that you're busy with, but waiting more than half an hour is a weaning technique, so if you're not trying to wean, don't use it. And I mention she's an LLL leader- not because that's LLL's official stance, but to emphasize that she is very immersed in breastfeeding literature and research. I don't know LLL's official stance (or even if they have one) on that.


  1. I think it is interesting that the AAP statement acknowledges that breastfeeding longer than a year goes againsts our cultural norms. I don't know if I appreciate it or not. On one hand, it could be seen as saying, "Yeah, it may make people uncomfortable, but go ahead and do it for the health benefits". On the other hand, it could be like, "Because this goes against our cultural norms, you don't HAVE to do it, but we are going to recommend it anyway, because it is really good for the breastfeeding pair."

  2. Mallory,
    Today in Brightonwoman's post, she suggests it might be that the AAP "recommends nursing at least 12 months because they don't think they can talk the average American woman into nursing for longer." Her speculation is probably pretty spot on.

  3. Oh, dear... the AAFP aren't being all that honest in their interpretation of the research!

    Their claim: 'ongoing benefits to the child of extended breastfeeding [include]...better social adjustment'

    What the abstract for the study they gave as reference for that claim actually says, when I looked it up:

    'While there were significant associations between the duration of breastfeeding and maternal and teacher ratings of conduct disorder obtained at six, seven and eight years, these correlations appeared largely spurious arising from the effects of errors of measurement and confounding factors which were correlated with both breastfeeding and conduct disorder measures. When errors of measurement and confounding factors were accounted for the correlations between breastfeeding and measures of conduct disorder tended to become both small and statistically non-significant. The study provides no evidence to suggest that breastfeeding makes a major contribution to the subsequent social adjustment of children.'

    I'm really disappointed in the AAFP for citing that reference in such an inaccurate way - they're a source I have great respect for normally. (Ironically, only a few hours ago I was telling my appraiser that they're one of the main sources I use for informative on-line articles about medical conditions.)

    I would also question their blanket assertion that there is *no* evidence that extended breastfeeding is harmful to mother or child. Although studies give conflicting results, there do seem to be several studies linking extended breastfeeding to increased risk of caries. I would have thought the risk would likely be pretty negligible if you only breastfeed a child once or twice daily and make sure their teeth are brushed after each time (which is what I did with my toddler while I was still breastfeeding her), but I don't think they should have just ignored it as a potential disadvantage.

  4. I was going to talk about thatl issue today (Thursday), but if you saw today's post, you'll see that we had a bumpy week and I didn't want to approach a topic without my full faculties of thought.

    When I read the "no evidence" part, I got the impression that they were trying to reassure parents that breastfeeding into toddler years isn't going to cause children to be sexually perverse, like I've heard some people suggest.

    As for social adjustment, I'll say that we have to remember that it's not that breastfeeding benefits children. Breastfeeding isn't a "benefits" thing. It's normal for children to breastfeed beyond what we expect- and it's going to produce normal children. The product of the normal care of children will be normal children- not exceptional ones. Being exceptional is something that children cause all on their own. :)

    I was also going to talk about dental care. Kellymom discusses it here pretty fairly. Advice: brush your kids' teeth after they eat something.

  5. Goodness, yes – it sounds as though you've had an awful time. Beautiful post, by the way – I loved the way you were able to get beyond your frustration with your baby for not 'behaving' and see that you were doing the same things as she was!

    With regard to whether breastfeeding should be described as a 'benefits' thing, I think the problem with describing it as the norm is that it's less likely to convince women to breastfeed. It's well established in psychology that people are more motivated by aiming for a benefit than by avoiding a harm, so phrasing breastfeeding in terms of the former is likely to be more successful. Also, talking about formula feeding as something harmful can be so hurtful to women who formula-fed that it can put them off trying to seek help to breastfeed future children, because they've learned that the people who could potentially help them out with advice are also likely to be the people who'll criticise the choices they've made in the past.

    But all of that is a completely separate point from the one I was trying to make – namely, that the AAFP *misrepresented* what that study said. They claim that extended breastfeeding creates better social adjustment, and cite that study as a reference, when in fact what it shows is that length of breastfeeding is *not* related to conduct disorder. They're claiming that the research shows something that it doesn't. That's out of line.

    With regard to Kellymom's article on breastfeeding and teeth, I would disagree that she discusses it 'pretty fairly'. She focuses on the studies that support her position, but doesn't tell us about studies that show something different. I think a fairer approach would be to weigh up all the evidence as best as possible, even that which supports a different position, and decide what the consensus honestly seems to be. When a woman I know from a mailing list was upset because her dentist had told her to stop breastfeeding her older child, I looked up the subject on Pubmed so that I could dig up some research to support her, and was a little taken aback to find that, well, actually, there were quite a few studies coming up that *did* show a link. You just don't hear about those on sites like Kellymom's. Overall, I would say the evidence paints a mixed picture, so I don't know that it's enough reason not to breastfeed – my conclusion was simply to cut down to one or two feeds by the toddler stage so that I could brush my daughter's teeth after each one, since I figured the risk to her teeth that way had to be minimal. I just don't think it's true to say that there's *no* evidence of harm.


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