Breastfeeding past infancy
by Cordelia Uys, NCT Breastfeeding Counsellor
January 2022
In our society, we almost never see older babies being breastfed, let alone toddlers or older children. Most of us who have breastfed past 12 months, and then 2 years, never imagined that we would be doing so, and have memories from before we had children, of thinking it was a very strange thing do to, and definitely not something we imagined would be for us.
Here’s what a client of mine wrote:
“Before I had my daughter, I was of the opinion that once a child could ask for milk, it was time to stop breastfeeding. Then I had my baby! She'll be a year next week and I find breastfeeding a joy - when she giggles whilst latched on, when she kicks her squidgy legs, when she stares at me. I can't really imagine our journey ending and I never thought I'd feel this way when, a week into motherhood, breastfeeding felt utterly impossible. It's support groups like NWL Breastfeeding that have helped me challenge my own assumptions about feeding older children and I'm so glad my opinion has changed."
In my almost 13 years as an NCT Breastfeeding Counsellor, it as become clear to me that all sorts of women breastfeed their children past infancy, not just hippies and earth mothers.
Here I am in the photo above, breastfeeding my middle son in 1996. I’m really sad this is the only photo I have of myself breastfeeding any of my three boys past the newborn phase, even though I breastfed the first one for just under 2 years, the second for around 2 and a half years, and the third for 3 and a half years.
Looking back, I’m very proud of myself, as breastfeeding rates in the UK were even lower in the 1990s than they are today, and I had no idea of all the health benefits of continued breastfeeding. I just did it because it was lovely and felt right. I was really lucky that my husband was very supportive.
Why continue to breastfeed? Some facts about breastfeeding past 6 months and beyond
The U.K. has some of the lowest breastfeeding rates in the world at 6 months, and probably the lowest at 12 months, which is a real shame, because there are so many physical and emotional advantages, to both a mother and her child, of continuing to breastfeed past 12 months. UNICEF and the World Heath Organisation recommend exclusive breastfeeding for 6 months, and continued breastfeeding up to, and beyond, 2 years.
1) Nutritional benefits for your child
Nutrition past 6 months
From the Breastfeeding Network (BfN) website:
Breastfeeding continues to be important for children’s nutrition, development and care after the first 6 months of life. On average, breastfed babies of 6-8 months obtain 75% of their energy needs from breastmilk, this falls to around 55% at 9-11 months, and 40% at 12-23 months. When breastfeeding is well established, it can contribute an even larger percentage to energy and nutrient requirements.
Breastmilk is also a major provider of protein, vitamins, minerals, essential fatty acids and protective factors. It provides more calories and nutrients per ml than most of the other foods, and much more than the soft cereals, baby rice or pureed vegetables that are typically some of the first foods given to older babies. If babies’ stomachs are filled with nutritionally poor foods, they will take less breastmilk and their overall diet and health will be inferior. The contribution of breastmilk is often overlooked in the enthusiasm to get complementary feeding started. The challenge is how to feed other foods so that they add to the nutritional contribution of breastmilk, rather than replace it.
Breastmilk can act as a valuable safety net when older nurselings are unwell and not eating much solid food.
Nutrition past 12 months
Breastmilk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.” (Dewey 2001). Dewey calculates that a nursling who is aged 12-23 months and is consuming 448ml of breastmilk daily will receive 29% of their energy requirements, 43% of their protein requirements, 36% of their calcium, 75% of their vitamin A, 76% of their folate, 94% of their vitamin B12 and 60% of their vitamin C.
There is a remarkable consistency in human milk composition over natural-term lactation and a possible increase in overall fat content. (Shenker et al, 2020)
2) Health and immune protections for your child
Your child will continue to be protected by the antibodies in your breastmilk for as long as he or she is getting any breastmilk.
"Breastfeeding toddlers between the ages of one and three have been found to have fewer illnesses, illnesses of shorter duration, and lower mortality rates.” (Mølbak 1994, van den Bogaard 1991, Gulick 1986).
“Antibodies are abundant in human milk throughout lactation” (Nutrition During Lactation 1991; p. 134). In fact, some of the immune factors in breastmilk increase in concentration during the second year and also during the weaning process. (Lawrence & Lawrence 2011, Goldman 1983, Goldman & Goldblum 1983, Institute of Medicine 1991)
"Human milk in the second year postpartum contained significantly higher concentrations of total protein, lactoferrin, lysozyme and Immunoglobulin A, than milk bank samples collected from donors less than 12 months postpartum." (Perrin et all, 2017)
According to Emma Pickett, in her book Supporting breastfeeding past the first six months and beyond: “Lysozyme breaks down the cell wall of bacteria protecting against infections like salmonella and E. Coli. Lactoferrin binds with iron which makes iron more easily metabolised and also prevents its use by pathogens, preventing infection. One 2019 study looked at lactoferrin into the 48th month and suggested: “Evidence of stable or rising immunoprotein levels during prolonged lactation provides an argument for foregoing weaning. (Czosnykowska-Lukacka et al. 2019)”
3) Protection and reduced severity of illness from Covid-19 for your child
Now with Coronavirus, there’s an additional reason why a mother might wish to continue breastfeeding: her breastmilk will confer immunity to her child if she has had the virus, or if she has been vaccinated:
https://www.nytimes.com/2021/04/08/health/covid-vaccine-breast-milk.html
Breastfeeding mothers can be given any of the three vaccines currently authorised in the UK:
https://www.breastfeedingnetwork.org.uk/coronavirus/
4) Positive psychological impacts on your child
A couple of studies have shown a positive relationship between longer breastfeeding duration and social development, cognitive and psycho social maturity and school readiness. (Duazo 2010, Avila and Kuzawa 2010, Baumgartner 1984)
An Australian study found a longer duration of breastfeeding was associated with positive mental health outcomes into adolescence: “Breastfeeding for a longer duration appears to have significant benefits for the onward mental health of the child into adolescence. Following adjustments of the associated socioeconomic, psychological and birth exposures in early life, breastfeeding for 6 months or longer was positively associated with the mental health and well-being of children and adolescents.” (Oddy et al. 2010)
Decreased parental concerns about language and motor development as breastfeeding continues past 9 months. (Dee et al, 2007)
In her book Supporting Breastfeeding Past the First Six Months and Beyond, Emma Pickett writes: “Research suggests that continued breastfeeding is associated with reduced incidence of of ADHD and autistic traits: “After adjustment for several confounders, longer duration of breastfeeding was independently associated with better cognitive development and with fewer autistic traits.” (Boucher et all. 2017). It should be noted that is not the same thing as saying ‘breastfeeding reduces the chance’ of some of these behaviours. The researchers from this 2017 study noted: ‘We cannot rule out the possibility that infants who develop more autistic traits or ADHD symptoms during early childhood behaved in ways that incited their mothers to stop or reduce breastfeeding.’
5) Positive impact on your child’s IQ
There's evidence that infants who are breastfed into their 2nd year have higher IQs. At around a year, when babies are experiencing a period of rapid brain growth, a mother's milk changes to have a higher fat content. A lot of that fat is in the form of triglycerides, and it is triglycerides that form the main ingredient in myelin, the fatty sheath that coats the axon of a neuron and speeds up the transmission of messages from one neuron to another.
Here’s a study from Brazil linking duration of breastfeeding with IQ:
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70002-1/abstract
Here’s a more recent study: https://www.ndph.ox.ac.uk/news/new-study-finds-that-breastfeeding-directly-supports-children2019s-cognitive-development?fbclid=IwAR3tOjMPueDcQbT48uWrWXLGeb6aLbN_ri6P3Vn9PHDj3EoCpC4umPmMnQs
Here’s a study by researchers at Oxford University, published in June 2023 in the journal Archives of Diseases in Childhood: https://adc.bmj.com/content/early/2023/05/04/archdischild-2022-325148
Children breastfed for 12 months were three times more likely to achieve a grade worth an A or A* in GCSE maths and English….After taking into account confounding factors, the overall association showed that compared with children never breastfed, children breastfed for at least 12 months were 39% more likely to have a high pass for both exams and were 25% less likely to fail the English exam.
The researchers say that the “main mechanism” for why breastfeeding boosts exam results is through brain development: “Breast milk contains polyunsaturated fatty acids and micronutrients, which enhance neurodevelopment.”
6) Health protections for you of continuing to breastfeed
The protection again all the ‘female’ cancers (breast, ovarian, uterine and endometrial) is dose-related, so the longer you breastfeed, the more protected you are. Women who breastfeed have a lower risk of many illnesses including cancer (particularly breast and ovarian), high blood pressure, high cholesterol, heart disease, stroke, diabetes and endometriosis:
TEDMED - Talk Details - How mothers can nurse themselves healthy
Breastfeeding reduces mothers’ cardiovascular disease risk: https://www.sciencedaily.com/releases/2022/01/220111091356.htm
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00423-0/fulltext
Longer duration of breastfeeding means lower risk of cardiovascular disease for breastfeeding mothers (@10% lower risk). (Peters et al, 2017)
Every 12 months of breastfeeding means 4.3% reduction in invasive breast cancer risk. (Parkin, 2011)
Lactation is associated with a significantly reduced risk of maternal type 2 diabetes over the life course, particularly in women with gestational diabetes. The protective effect seems to increase with longer duration of lactation. (Pinho-Gomes et al, 2021)
This Lancet Breast Cancer Commission study found that one in 20 cases of breast cancer in the U.K. were caused by women not breastfeeding after giving birth. The lifetime risk of developing breast cancer decreases by 4% for every 12 months women spend breastfeeding. Coles, CE et al. The Lancet Breast Cancer Commission. Lancet; 15 Apr 2024; DOl: 10.1016/S0140-6736(24)00747-5
7) Emotional and hormonal benefits for you
A client called Natalia commented to me: ‘There is something I’ve noticed from my breastfeeding experience: I don’t know if there is any research on this, but I feel that the milk production hormones improve my mental health, and help me to tackle frequent night feeds, physical tiredness, lack of socialising, and other motherhood challenges! I would really like to keep this little help from Nature for a bit longer, so I hope I will be able to keep breastfeeding until 1 year and beyond.’
I replied that there is indeed research that shows that oxytocin and prolactin, the two main hormones involved in milk production, are mood enhancers. Prolactin, the hormone that creates milk, induces calmness & relaxation & helps with bonding; oxytocin, the hormone responsible for the let-down reflex, causes the contractions of orgasm, birth and lactation. Often called the hormone of love, it promotes feelings of love, bonding and well-being, and increases trust and empathy. It also increases one’s tolerance of monotony, which is very helpful for new parents.
8) Less time off work for you
Working mothers will need to take less time off work if their child is breastfed due to the immunological protections in breastmilk, so employers and the economy benefit too.
In her book Supporting Breastfeeding Past the First Six Months and Beyond, Emma Pickett writes: “In a 1995 study of parents returning from maternity leave after an uncomplicated birth: ‘Approximately 28% of the infants in the study had no illnesses; 86% of these were breastfed and 14% were formula-fed. When illnesses occurred, 25% of all one-day maternal absences were among breastfed babies and 75% were among the formula-fed group. (Cohen, Mrtek and Mrtek 1995).”
Please see my article: https://www.cordeliauys.co.uk/how-to-manage-going-back-to-work-when-youre-breastfeeding-an-older-baby
9) Breastfeeding as a mothering tool
Above all, breastfeeding is the most brilliant mothering tool. It’s a lovely way for a working mother and her child to re-connect at the end of the day. One couple I know compared breastfeeding their toddler to using the ‘re-set’ button because no matter how worked up their child was, just a brief moment at the breast was enough to calm him down. I’ve seen toddlers in the playground fall over, run to their mother, have a quick breastfeed, wipe their tears and run off to play again. Breastmilk is full of calming hormones, as well as endocannabinoids, which are natural painkillers. These calming hormones can also help mothers feel less anxious about leaving their baby when they go back to work.
Many women worry that continuing to breastfeed when they go back to work will be a burden on top of an already busy working week, but it can be a wonderful way of reconnecting with your child after hours spent apart, and by far the easiest way of pacifying an upset child. Mothering through nursing is a kind of superpower. As one mother puts it: “It’s how I reconnect with him after a long day apart, I sit at night in a dark room and feed him to sleep. It’s one of my favourite parts of the day.”
The Association of Breastfeeding Mothers produced this document for breastfeeding mothers to share with their GPs:
Breastfeeding Beyond Infancy a GP Guide - ABM
Links:
Emma Pickett’s Supporting breastfeeding past the first six months and beyond: https://www.waterstones.com/book/supporting-breastfeeding-past-the-first-six-months-and-beyond/emma-pickett/9781787759893
This study by Dr Natalie Shenker et al., suggests stability in human milk composition in terms of both metabolomic and microbiome composition for up to 24 months: https://www.mdpi.com/2072-6643/12/11/3450
Effects of breastfeeding on children’s gut colonization with multidrug-resistant Enterobacterales in peri-urban Lima, Peru: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10841006/
Conclusion: This study examined whether breastfeeding, which is universally recommended for children less than 2 years of age, might also reduce children’s risk of acquiring ESBL-producing Enterobacterales in a peri-urban low resource community in Peru. Because we used daily surveillance data collected over the first 16 months of life, we were able to classify children’s feeding practices with a high degree of confidence. Our findings suggest that continuing to breastfeed after 6 months, even after children have begun to consume other foods, confers significant protection against children’s incident gut colonization with ESBL-Ec. Overall, policies that support continued breastfeeding after 6 months while ensuring mothers’ access to education and economic opportunities may be a useful tool in global efforts to curb the spread of antimicrobial resistance.
Breastfed children get the best GCSE exam marks: https://www.independent.co.uk/news/uk/home-news/breastfeeding-babies-gcses-higher-marks-b2352149.html
My article on how to manage breastfeeding when you go back to work: https://www.cordeliauys.co.uk/how-to-manage-going-back-to-work-when-youre-breastfeeding-an-older-baby
Prof Amy Brown spoke to mothers breastfeeding past infancy: https://sway.office.com/RDNSWWX1oUeUcXDL?fbclid=IwAR3b6RBeVd3wLqEnNSM2PnxGvs6hOA0hPDmkvu3rNIcTOlDsDrb5jUJ3vn0
http://kellymom.com/ages/older-infant/ebf-benefits/
http://kellymom.com/bf/normal/toddlernursing/
Canadian paediatrician Dr Jack Newman: http://whale.to/a/newman.html
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