Extended breastfeeding

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Two-year-old breastfeeding Lactancia 2 anos.jpg
Two-year-old breastfeeding

In Western countries extended breastfeeding usually means breastfeeding after the age of 12 to 24 months, depending on the culture.

Contents

Breast milk is known to contain lactoferrin, which protects the infant from infection caused by a wide range of pathogens. The amount of lactoferrin in breast milk increases significantly during the months of 12 through 24 and remains elevated for as long as the infant continues to nurse. Research shows breastfed toddlers aged over 12 months have fewer and lower mortality rates. La Leche League writes that extended nursing provides comfort, security, and a way to calm down for the toddler, while the mother enjoys a feeling of closeness with her child. [1]

In most Western countries, extended breastfeeding is not a cultural norm and a person may face judgement with some critics saying that extended nursing is harmful. However, the American Academy of Family Physicians states there is no evidence that extended breastfeeding is harmful to the parent or child. The Academy of American Pediatrics makes a similar claim saying they find "no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer."

Recommendations

The CDC reports that about 36% of babies are still nursing at 12 months, while about 15% are still doing so by 18 months. Most toddlers naturally wean sometime between the ages of 2 and 4. [1]

Health benefits

Longitudinal research shows breastfed toddlers aged over 12 months have fewer illnesses and lower mortality rates. [5] Breast milk is known to contain lactoferrin (Lf), which protects the infant from infection caused by a wide range of pathogens. The amount of Lf in breast milk is lactation-stage related. One study looked at Lf concentration in prolonged lactation from the first to the 48th month postpartum. It was found to be at the highest level in colostrum, dropped to the lowest level during 1 - 12 months of lactation, and then increased significantly during the 13-24 months of lactation, close to the Lf concentration in colostrum. At over 24 months the level dropped, though not significantly. [6] [7] These have been shown to support the child's immune system's antibodies. [7]

Psychological effects

In A Time to Wean, Katherine Dettwyler states that "Western, industrialized societies can compensate for some (but not all) of the immunological benefits of breastfeeding with antibiotics, vaccines and improved sanitation. But the physical, cognitive, and emotional needs of the young child persist." [8] Many children who are breast-fed into their toddler years use the milk as a comforting, bonding moment with their mothers. [9] The La Leche League writes:

Toddlers breastfeed for many of the same reasons babies breastfeed: for nutrition, comfort, security, for a way to calm down and for reassurance. Mothers breastfeed their toddlers for many of the same reasons they breastfeed their babies: they recognize their children’s needs, they enjoy the closeness, they want to offer comfort, and they understand the health benefits. [1]

While the personalized nutrients of their mother's breastmilk is beneficial to the child no matter how it is delivered (bottle or breast), being fed breastmilk through a bottle takes away some of the benefits of traditional breastfeeding. The physical contact that comes with traditional breastfeeding increases the release of oxytocin in both the mother and child's blood stream. [10] This hormone is frequently referred to as the "love hormone" and plays an important role in the development of trust and bonding within a relationship. On top of the emotional bonding that comes with breastfeeding, it has been found that children who are breastfed develop language, intellectual, and motor skills both quicker and easier than those who are not and are less likely to contract a variety of viruses and diseases. [10]

Social acceptance

In most Western countries, extended breastfeeding is not a cultural norm and a person may face judgement and shaming. The American Academy of Family Physicians states, "There is no evidence that extended breastfeeding is harmful to parent or child." The Academy of American Pediatrics makes a similar claim saying they find "no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer." [1]

Practice by country or region

North America

Percentage of U.S. infants breastfeeding by month since birth.
Dotted line: Exclusive breastfeeding
Dashed line: Any breastfeeding
* Estimated at 7 days after birth Breastfeeding chart.svg
Percentage of U.S. infants breastfeeding by month since birth.
Dotted line: Exclusive breastfeeding
Dashed line: Any breastfeeding
* Estimated at 7 days after birth

Elizabeth Baldwin says in Extended Breastfeeding and the Law, "Because our culture tends to view the breast as sexual, it can be hard for people to realize that breastfeeding is the natural way to nurture children." [11] [ failed verification ] In Western countries such as the United States, Canada and the United Kingdom, extended breastfeeding is a taboo act. It is difficult to obtain accurate information and statistics about extended breastfeeding in these countries because of the mother's embarrassment. [9] Mothers who nurse longer than the social norm sometimes hide their practices from all but very close family members and friends. This is called "closet nursing". [9]

In the United States, breastfeeding beyond 1 year is considered extended breastfeeding,[ citation needed ] and in contrast to WHO recommendations which recommend exclusive breastfeeding until six months, and "continued breastfeeding up to 2 years of age or beyond" [with the addition of complimentary foods], [12] the American Academy of Pediatrics stated in 1997 that, "Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child". [13] [14]

In the United States overall, according to a 2010 CDC "report card", 43% of babies are breastfed until 6 months and 22.4% are breastfed until 12 months, though breastfeeding rates varied among the states. [15]

Breastfeeding rates in the U.S. at 6 months rose from 34.2% in 2000 to 43.5% in 2006 and the rates at 12 months rose from 15.7% in 2000 to 22.7% in 2006. The U.S. Healthy People 2010 goals were to have at least 60% of babies exclusively breastfed at 3 months and 25% of babies exclusively breastfed at 6 months so this goal has yet to be met. [16]

There have been several cases in the United States where children have been taken away from their mother's care because the courts or government agencies found the mother's extended breastfeeding to be inappropriate. In 1992, a New York mother lost custody of her child for a year. She was still breastfeeding the child at age 3 and had reported experiences of sexual arousal while breastfeeding the child. The authorities took the child from the home in the fear that the mother might sexually abuse the child. Later, the social service agency that took over the case said that there was more to the case than could be released to the press due to confidentiality laws. In 2000, an Illinois child was removed from the mother's care after a judge ruled that the child might suffer emotional damage as a result of not being weaned. The child was later returned to the mother and the judge vacated the finding of neglect. A social service agency in Colorado removed a 5-year-old child from the mother because she was still breastfeeding, but the court ordered the child returned to its family immediately. [11] [ failed verification ]

Africa

Ethiopian child breastfeeding. Etiopia - omo river valley DSC 2835 (19).jpg
Ethiopian child breastfeeding.

Guinea-Bissau

In Guinea-Bissau, the average length of breastfeeding is 22.6 months. [17]

Asia and Oceania

India

In India, mothers commonly breastfed their children until 2 to 3 years of age. Cows milk is given in combination with breast milk though use of formula has been on the rise. [14]

As of November 2012, [18] the Ministry of Women and Child Development, with UNICEF as a technical partner, have kicked off a nationwide campaign to promote exclusive breastfeeding to infants up to the age of six months - one among a series of advisories it is issuing - as part of an awareness program targeted at eradicating malnutrition in the country. Indian actor Aamir Khan serves as the brand ambassador, and has acted in numerous televised public service announcements.

Philippines

In the Philippines, the Implementing Rules and Regulations of the Milk Code require that breastfeeding be encouraged for babies up to the age of 2 years old or beyond. Under the same code, it is illegal to advertise infant formula or breastmilk substitutes intended for children 24 months old and below. [19] However, a 2008 WHO survey found that on average, mothers in the Philippines breastfed their babies until 14 months of age, with breastfeeding lasting up to 17 months on average in rural areas. Almost 58% of mothers surveyed around the nation were still breastfeeding their babies when the babies were a year old, and 34.2% of mothers were still breastfeeding when their babies were 2 years old. [20]

In 2012, it was reported that legislation had been introduced which would narrow down the application of the Milk Code (reducing the period recommending against artificial baby foods for babies from 0 to 36 months to 0 to six months only), would lift the restriction on donations of artificial milk products in emergency situations (encouraging mothers with disabilities to shift to milk substitutes instead of encouraging them to continue breastfeeding assisted by support persons), would change the legally mandated lactation break period for breastfeeding mothers from paid to unpaid status, and would remove the ban on milk companies giving away free samples of artificial milk products in the health care system. [21] [22]

In religion

Islam

The central scripture of Islam, al-Quran, instructs that children be breastfed for two years from birth. [23] Islam relies on the Islamic calendar, in which "year" refers to a lunar year of 12 lunar cycles, totaling 354 days in length, potentially with the addition of 1 day for a leap year.

Related Research Articles

<span class="mw-page-title-main">Infant formula</span> Manufactured food designed for feeding infants

Infant formula, also called baby formula, simply formula, baby milk or infant milk, is an ultra-processed food designed and marketed for feeding to babies and infants under 12 months of age, usually prepared for bottle-feeding or cup-feeding from powder or liquid. The U.S. Federal Food, Drug, and Cosmetic Act (FFDCA) defines infant formula as "a food which purports to be or is represented for special dietary use solely as a food for infants by reason of its simulation of human milk or its suitability as a complete or partial substitute for human milk".

<span class="mw-page-title-main">Breast milk</span> Milk produced by the mammary glands in the breast of a human female

Breast milk or mother's milk is milk produced by mammary glands located in the breast of a human female. Breast milk is the primary source of nutrition for newborns, containing fat, protein, carbohydrates and variable minerals and vitamins. Breast milk also contains substances that help protect an infant against infection and inflammation, whilst also contributing to healthy development of the immune system and gut microbiome.

<span class="mw-page-title-main">Lactational amenorrhea</span> Post-partum infertility due to breast feeding

Lactational amenorrhea, also called postpartum infertility, is the temporary postnatal infertility that occurs when a woman is amenorrheic and fully breastfeeding.

Baby-led weaning is an approach to adding complementary foods to a baby's diet of breast milk or formula. BLW facilitates oral motor development and strongly focuses on the family meal, while maintaining eating as a positive, interactive experience. Baby-led weaning allows babies to control their solid food consumption by "self-feeding" from the start of their experience with food. The term weaning does not imply giving up breast milk or formula, but simply indicates the introduction of foods other than breast milk or formula.

<span class="mw-page-title-main">Erotic lactation</span> Sexual activity involving the stimulation of womans breast

Erotic lactation is sexual arousal by breastfeeding on a woman's breast. Depending on the context, the practice can also be referred to as adult suckling, adult nursing, and adult breastfeeding. Practitioners sometimes refer to themselves as being in an adult nursing relationship (ANR). Two persons in an exclusive relationship can be called a nursing couple.

<span class="mw-page-title-main">History and culture of breastfeeding</span>

The history and culture of breastfeeding traces changing social, medical and legal attitudes to breastfeeding, the act of feeding a child breast milk directly from breast to mouth. Breastfeeding may be performed by the infant's mother or by a surrogate, typically called a wet nurse.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

<span class="mw-page-title-main">Breastfeeding</span> Feeding of babies or young children with milk from a womans breast

Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommends that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.

<span class="mw-page-title-main">Breastfeeding in public</span> Attitudes to and legal status of breastfeeding in public

The social attitudes toward and legal status of breastfeeding in public vary widely in cultures around the world. In many countries, both in the Global South and in a number of Western countries, breastfeeding babies in open view of the general public is common and generally not regarded as an issue. In many parts of the world including Australia, some parts of the United States and Europe, along with some countries in Asia, women have an explicit legal right to nurse in public and in the workplace.

Lactation suppression refers to the act of suppressing lactation by medication or other non pharmaceutical means. The breasts may become painful when engorged with milk if breastfeeding is ceased abruptly, or if never started. This may occur if a woman never initiates breastfeeding, or if she is weaning from breastfeeding abruptly. Historically women who did not plan to breastfeed were given diethylstilbestrol and other medications after birth to suppress lactation. However, its use was discontinued, and there are no medications currently approved for lactation suppression in the US and the UK. Dopamine agonists are routinely prescribed to women following a stillbirth in the UK under the NHS.

<span class="mw-page-title-main">Human milk bank</span> Service that collects and dispenses human milk

A human milk bank, breast milk bank or lactarium is a service that collects, screens, processes, pasteurizes, and dispenses by prescription human milk donated by nursing mothers who are not biologically related to the recipient infant. The optimum nutrition for newborn infants is breast milk for at least the first 6 months of life. For women who are unable to breast feed or produce enough milk, pasteurized donor breast milk may be an effective approach to feeding. Breast milk supplied by a woman other than the baby's mother that is not pasteurized and informal breast milk sharing is associated with a risk of transmitting bacteria and viruses from the donor mother to the baby and is not considered a safe alternative. If pasteurized donor breast milk is not available, commercial formula is suggested as a second alternative.

<span class="mw-page-title-main">Breastfeeding promotion</span> Activities and policies to promote health through breastfeeding

Breastfeeding promotion refers to coordinated activities and policies to promote health among women, newborns and infants through breastfeeding.

The Baby Friendly Hospital Initiative (BFHI), also known as Baby Friendly Initiative (BFI), is a worldwide programme of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), launched in 1992 in India following the adoption of the Innocenti Declaration on breastfeeding promotion in 1990. The initiative is a global effort for improving the role of maternity services to enable mothers to breastfeed babies for the best start in life. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breast-milk Substitutes.

Infant feeding is the practice of feeding infants. Breast milk provides the best nutrition when compared to infant formula. Infants are usually introduced to solid foods at around four to six months of age.

Breastfeeding and medications is the description of the medications that can be used by a breastfeeding mother with no or few consequences and those medications which should be avoided. Some medications are excreted in breastmilk. Almost all medicines pass into breastmilk in small amounts. Some have no effect on the baby and can be used while breastfeeding. The National Institutes of Health (NIH) maintain a database containing information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. Some medications and herbal supplements can be of concern. This can be because the drug can accumulate in breastmilk or have effects on the infant and the mother. Those medications of concern are those medications used to treat substance and alcohol addiction. Other medications of concern are those that are used in smoking cessation. Pain medications and antidepressants need evaluation.

In breastfeeding women, low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nutritional needs of her infant.

<span class="mw-page-title-main">Breastfeeding and mental health</span>

Breastfeeding and mental health is the relationship between postpartum breastfeeding and the mother's and child's mental health. Research indicates breastfeeding may have positive effects on the mother's and child's mental health, though there have been conflicting studies that question the correlation and causation of breastfeeding and maternal mental health. Possible benefits include improved mood and stress levels in the mother, lower risk of postpartum depression, enhanced social emotional development in the child, stronger mother-child bonding and more. Given the benefits of breastfeeding, the World Health Organization (WHO), the European Commission for Public Health (ECPH) and the American Academy of Pediatrics (AAP) suggest exclusive breastfeeding for the first six months of life. Despite these suggestions, estimates indicate 70% of mothers breastfeed their child after birth and 13.5% of infants in the United States are exclusively breastfed. Breastfeeding promotion and support for mothers who are experiencing difficulties or early cessation in breastfeeding is considered a health priority.

<span class="mw-page-title-main">Delayed onset of lactation</span>

Delayed onset of lactation (DOL) describes the absence of copious milk secretion (onset of lactation) within the first 72 hours following childbirth. It affects around 20–40% of lactating women, the prevalence differs among distinct populations.

<span class="mw-page-title-main">Establishment of breastfeeding</span>

Establishment of breastfeeding refers to the initiation of providing breast milk of mother to baby. According to the World Health Organisation(WHO), breastfeeding is the best way to provide nourishment, including essential nutrients, energy and antibodies, to infants and toddlers. The start of breastfeeding is supported by the milk production which depends on the development of internal and external breast structure and hormonal control on milk secretion. Besides milk supply, adopting the correct approach of breastfeeding helps build up the maternal bond, which in turn promotes breastfeeding. Not only does nursing strengthen the mother-child relationship, but it also improves the intelligence and immunity of breastfed children and diminishes breastfeeding mothers' risks to have ovarian and breast cancer.

Breastmilk medicine refers to the non-nutritional usage of human breast milk (HBM) as a medicine or therapy to cure diseases. Breastmilk is perceived as an important food that provides essential nutrition to infants. It also provides protection in terms of immunity by direct transfer of antibodies from mothers to infants. The immunity developed via this mean protects infants from diseases such as respiratory diseases, middle ear infections, and gastrointestinal diseases. HBM can also produce lifelong positive therapeutic effects on a number of chronic diseases, including diabetes mellitus, obesity, hyperlipidemia, hypertension, cardiovascular diseases, autoimmunity, and asthma.

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