By Debbie Page, RN, IBCLC, CEIM, director of TheNewBornBaby.com

In Western societies, it is commonplace to expect a child to breastfeed for six months to a year only. Many mothers set that as their goal unaware of what is normal and natural: children wean naturally. Natural weaning, when allowed, occurs sometime after the child is two and one-half years old, not before. In some societies, children will nurse for five to six years.

Where did the notion that breastfeeding is only for the first year of life come from? It came from modern, industrialized societies. The benefits for the child continue as long as the child receives breast milk. The benefits to the mother continue as long as she produces milk. Therefore, nursing well into the second or third year of life is of great value and critical to the child’s overall health.

What Are the Recommendations?

• The World Health Organization: at least two years.
• The American Academy of Pediatrics: one year and beyond.
• Health Canada: two years and beyond.

Is Breast Milk Still Valuable after a Child’s First Birthday?

It certainly does not become less nutritional. Instead, the fat and energy content increases, and the composition of the milk continues changes from feeding to feeding and from day to day to meet the needs of the growing child. Breast milk continues to be a significant provider of nutrition. A total of 450 milliliters of milk daily provides these minimum daily requirements:

• 29% energy
• 36% calcium
• 76% folate
• 43% protein
• 75% vitamin A
• 94% vitamin B12
• 60% vitamin C.

Breast milk is only 10% nutrition. The remaining 90% continues to contribute to the health and proper development of every system in the child. It continues to provide an essential supply of antibodies for illness protection. The immunological protection from breastfeeding actually increases during the second and third years. Breast milk is antibacterial, antiviral, anti-parasitic, and antifungal. It provides protection against:

• Upper respiratory infections
• Diarrhea
• Pneumonia
• Strep throat
• E. coli
• West Nile Virus
• Influenza
• Salmonella
• Diabetes
• Certain childhood cancers.

Breastfeeding toddlers may still get sick but usually with less frequency and severity. Breast milk also protects against allergies – it can delay the child’s exposure to certain food allergens, lessen the severity of the reaction to allergens, and decrease incidence of asthma.
 
How Does Extended Breastfeeding Benefit the Mother?

The protection to women afforded by breastfeeding is all duration related: The longer you breastfeed, the greater the safeguard against various diseases. Breastfeeding reduces the risk of:

• All female cancers, including breast, endometrial, ovarian, and uterine
• Osteoporosis, because the bone density actually increases once the child is weaned
• Insulin requirements in diabetic women
• Rheumatoid arthritis
• Postpartum depression.

Losing weight is usually faster and more significant with breastfeeding women, and some women experience a suppression of ovulation. However, others do see the return of menses and therefore fertility.
 
How Often Do Toddlers Breastfeed?

Each child is different. Some toddlers will breastfeed first thing in the morning and before bed. Others will continue to nurse throughout the day. Some will nurse as often as a newborn. The frequency and length of nursing sessions typically decrease as children get older, especially once they reach 15 months old.
 
Keep in mind that toddlers will nurse to reconnect emotionally within the safety of their mother’s breasts. This is how they re-charge. They may play intensely and then run over for a few sips and just as quickly return to their toys.
 
Toddlers, like babies, may want to nurse more frequently when in a different environment or when the house is full of “other” people. Once everything settles back to normal, these increased nursings will likely disappear.
 
What about Encouraging My Child to be Independent?

Even though some experts will argue that extended breastfeeding will create clingy, dependent children, breastfeeding medicine specialist Dr. Jack Newman argues that the opposite is true: Children gain independence gradually as they are given free reins, not because they are pushed before they are ready. Children mature emotionally through the comfort and security of breastfeeding.

He calls this a “renewal of love.” It is a beautiful way of communicating unconditional love to your child. This message will last a lifetime and spill over into every relationship your child will have. Treating others with love and respect are hallmarks of an independent and emotionally mature adult.
 
What Breastfeeding Positions Do Toddlers Like?

Think gymnastics, and you may be able to think of all the imaginable positions for nursing. Toddlers can be quite entertaining when nursing. They nurse standing on tip-toes, on one foot, upside down, with both feet in the air, hands free or both hands on the breast, wriggling, or twisting. As the circus director, you can decide if you enjoy these antics. If you don’t, set limits just as you must do for everything your toddler does or attempts. You can do this by:

• Speaking firmly (not loudly, which could scare your child) to “be still.”
• Tell your child what she may and may not do while breastfeeding.
• Read to your child while she nurses.
• Wear a nursing necklace that she can finger and play with.
• Interrupt the feeding until your child is willing to stop clowning around.
• Expect that this behavior will go away once the newly discovered acrobatic ability wears off.

What about Nursing a Toddler in Public?

This may be your greatest fear, as you worry about what others will think or even say. If your child is 18 months or older, nursing her before you leave may carry her over. If she wants to nurse before you return home, offer her a snack or a drink of water.

If you do nurse in public, hats off to you! By this time, you will be very quick with keeping your breast covered when your child lets go and most will not have a clue as to what is transpiring between the two of you.

And, if you do get a snide remark? One mother told me that when someone told her she should cover up (and she was nursing very discreetly), she kindly asked him to cover his head so he couldn’t see!
 
Will Nursing Beyond a Year Make Weaning More Difficult?

I hear people all the time exclaim that if you don’t wean before your child gets too old, meaning six or 12 months, that your child will never want to stop breastfeeding. This is just a myth and not based on any truth. Remember that children naturally breastfeed until at least two and one-half to three years. Some children need to breastfeed until they are four years old. Breastfeeding until your child weans himself allows the child to reach this milestone when developmentally and nutritionally ready.
 
You may decide to lead the weaning instead of letting your child. This is certainly fine. You can always do this at anytime you desire. It will not be harder except that your child may be old enough to show or tell you that he is not ready, unlike the six month old or even the 12 month old. The closer your child is to self weaning, the easier it will be.
 
When children are self weaning, they gradually decrease the number of feedings over months, not weeks. They will sometimes not nurse for a day or more and then nurse several times in one day. They may be happy to spend the night with Grandma and then rush to breastfeed as soon as they see Mama.
 
How do you make your decision about how long you will breastfeed? As with most things in life, you have the freedom to make your own decision based on what you feel is best for you and your family. My suggestion is to not be in a hurry. Children grow quickly and outgrow breastfeeding in just a few years – only a fraction of the span of childhood. The incredible benefits of extending breastfeeding for you and your child far outweigh the pettiness of others’ opinions. Be strong, take courage, and breastfeed for years, not months.