So, why not wean?

I'm sure some of you were wondering, but too polite to ask (or didn't want to get me started on this particular soap box yet again). In case it was the former, I'll share some of the research on the subject. For us, though, the bottom line is that it is a good thing for my kids and for me, and we are both happy with the current arrangement.

I have several links, but for some reason, they aren't always clickable here. If you cut and paste them, they should work.

First, many thanks to Ms. Cameron for permission to share this. She has a lovely post on this at: http://threegirlpileup.wordpress.com/2009/05/05/this-is-what-a-nursing-toddler-looks-like/

Breastfeeding Beyond Infancy: Information for Clinicians

Barbara Maclay Cameron, M.A., M.S.W.

How long should a child breastfeed?

AAP (2005): Breastfeed for at least a year, and as long as mutually desired by mother and baby. There are no negative consequences known for nursing into the third
year and beyond.

AAFP (2004): Breastfeed for at l east a year. Physicians should support mothers who wish to nurse beyond infancy, nurse during pregnancy, and/or tandem nurse.

WHO (2002): Breastfeed for a minimum of two years.

Dettwyler (1995) Based on a comparison with other primates, the biological age of weaning in humans is between 2-1/2-7 years

What are the medical benefits of breastfeeding beyond the first year?

Human milk is a healthy food for toddlers:
• A significant source of protein, fats and most vitamins (Dewey 2001)
• The fat and calorie content of breastmilk increases as duration of lactation increases (Mandel et al. 2005).

Nursing Toddlers are Healthier:
• Nursing toddlers between 18-36 months of age have fewer and shorter illnesses than their non-nursing counterparts (Gulick 1986).
• Antibodies and immune factors in milk increase in the second year (Harnosh et al 1991; Goldman 1983).

Health benefits to the child have been shown to be dose-dependent, including:
• decreased risk of childhood leukemia (Tripathy et al. 2004; Guise at al. 2005)
• improved adult cardiovascular health for women nursed as babies (Williams et al. 2006).
• improved IQ scores and cognitive development (Slykerman et al. 2005; Angelsen et al. 2001)
• decreased risk of childhood and adult obesity (Singhal 2007;Harder et al. 2005; Arenz et al. 2004)
• reduced risk of childhood type 1 diabetes (Sadauskaite-Kuehene et al. 2004)
• reduced environmental allergies (Obihara et al. 2005).
• reduced rates of malocclusion (Labbok & Hendershot 1987)

Health benefits to the mother are also dose-dependent, including:
• Lowered risk for breast cancer (Collaborative Group on Hormonal Factors in Breast Cancer, 2002; Freund et al., 2005), particularly for carriers of the BRCA-1
mutation (Jernstrom et al., 2004)
• Lowered risk for ovarian cancer (Wiltemore, 1994; Gwinn et al., 1990).
• Lowered risk for rheumatiod arthritis (Karlson et al., 2004)
• Lowered risk for endrometrial cancer (Rosenblatt & Thomas, 1995).
• Increased maternal weight loss (Kac et al., 2004; Akkus et al., 2005).
• Lowered risk of future osteoporosis and hip fractures (Cumming & Klineberg, 1993; Huo et al., 2003).
• Reduced risk of Type II Diabetes (Steube et al., 2005).
• Reduced risk of metabolic syndrome in midlife (Ram et al., 2008)

What about breastfeeding toddlers who are falling on the growth charts?
There is no research that supports the clinical recommendation to discontinue breastfeeding due to slowed growth (e.g.Gonzalez 2005), particularly given the health
benefits for continued nursing (see above).
• The growth charts are not based on breastfeeding toddlers, and in fact we don’t really know what normal growth patterns are for these children (Huffman 1985).
• In matched cohort studies, breastfeeding toddlers are taller and healthier than their weaned counterparts (Prentice, 1994; Castillo et al., 1996; Marquis et al., 1997;
Onyango et al., 1999).
• When differences are seen between the growth of nursing and non-nursing toddlers, they disappear by the end of the second year (Habich, 2000).

Does extended breastfeeding cause dental decay?
• The American Academy of Pediatric Dentistry says maybe, and recommends limiting nursing at night and on demand once teeth emerge. However, not all research
supports this recommendation.
• Humans are the only mammals whose young suffer from dental decay, and prehistoric human skulls—before the introduction of a more processed diet—show no
incidence of dental caries (Palmer 2000).
• Studies that demonstrate a link between dental caries and extended breastfeeding often fail to control for confounding factors such as oral hygiene (e.g. Yonezu et al
2006).
• In populations with dental caries, exclusively breastfed children are rare (Hunter et al.,1997).
• The relationship between risk factors and caries development is complex, and multiple population based-studies do not support a relationship between extended
breastfeeding and early childhood caries (Hallonsten et al., 1995; Weeheijm, 1998; Slavkin, 1999: Valaitis et al., 2000; Hallett & O’Rourke, 2002;).
• The cariogenicity of human milk is somewhat open to debate (Erickson, 1999; Peres et al., 2002; Bowen & Lawrence, 2005), but researchers and clinicians agree
that good oral hygiene is important for all children.

Breastfeeding families need encouragement from their clinicians!
• As the age of their child increases, more mothers perceive a social stigma for breastfeeding: 44% at 12 months, 61% at 24 months (Kendall-Tackett and Sugarman,
1995)
• Women nursing past a year are in a minority: about 18% at 12 months, and only 5% at 18 months (Ryan et al, 2002; CDC, 2004). They may feel isolated.
• Many women nursing into toddlerhood may be facing pressure to wean from friends or family (Lawrence & Lawrence,1999).
• Positive attitudes and encouragement from health care providers have a strong influence on whether or not a woman continues to breastfeed (Losch et al., 1995).

REFERENCES
Akkus Z, Cambeviren H, Celik F, Gur A, Nas K. 2005. Determination of osteoporosis risk using a multiple logistic regression model in postmenopausal Turkish women. Saudi Med J.
26(9):1351-9.
American Academy of Family Physicians (2004). Breastfeeding (Position Paper). <> [September 18. 2005]
American Academy of Pediatric Dentistry (2000). Breast-feeding. Oral Health Policies Reference Manual, 2000-2001.
American Academy of Pediatrics (2005). "Breastfeeding and the Use of Human Milk." Pediatrics 115 (2), 496-506.
Angelsen NK, Vik T, Jacobsen G, Bakketeig LS. 2001. Breastfeeding and cognitive development at age 1 and 5. Arch Dis. Child. 85(3):183-8
Arnold RR. 1977. A bactericidal effect for human lactiferrin. Science 197:263-65.
Arenz S, Ruckerel R, Koletzko B, Von Kries R. 2004. Breastfeeding and childhood obesity: A systematic review. Int J Obes Relat Metab Disord 28(10):1247-56.
Bowen, WH Lawrence RA. (2005). Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose. Pediatrics 116(4):921-6.
Bumgartner, N. 2000. Mothering Your Nursing Toddler, 3rd. Ed. Schaumburg, IL: La Leche League International
Castillo C, Atalah E, Riumallo J, Castro R. 1996. Breast-feeding and the nutritional status of nursing children in Chile. Bull Pan Am Health Organ 30(2):125-33.
Centers for Disease Control and Prevention, 2004. National Immunization Survey, Department of Health and Human Services.
Collaborative Group on Hormonal Factors in Breast Cancer. 2002. Breast Cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30
countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 360 (9328):187-95
Cumming RG, Klineberg RJ. 1993. Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. Int J Epidemiol. 22(4):684-91.
Dettwyler KA. 1995. A time to wean. In Breastfeeding: Biocultural Perspectives. Stuart-Macadam P and Dettwyler KA, Eds. NY: de Gruyter, 305-345.
Dewey KG (2001). Nutrition, growth, and complementary feeding of the breastfed infant. Pediatri Clin North Am 48(1) 87-10.
Erickson PR. 1999. Investigation of the role of human breast milk in caries development. Am Ac Pediatr Dent 221(2):86-90.
Ferguson DM.( 1987). Breastsfeeding and subsequent social adjustment in six- to eight- year old children. J Child Psychol Psychiatr Allie Discip 28:378-86.
Freund C, Mirabel L, Annane K, Mathelin C. 2005. [Breastfeeding and breast cancer] [Article in French]. Gynecol Obter Fertil. 33(10):739-44.
Goldman AS, Goldblum RM, Garza C. 1983. Immunologic components in human milk during the second year of lactation. Acta Paediatri Scand 72(3): 51-4.
Gonzalez CG. 2005. My child won’t eat: How to prevent and solve the problem. Schaumburg, IL: La Leche League International.
Guise JM. 2005. Review of case-control studies related to breastfeeding and reduced risk of childhood leukemia. Pediatrics 116 (5):e724-31.
Gulick EE. 1986. The effects of breastfeeding on toddler health. Pedatri Nurs 12(1):51-4
Gwinn ML, Lee NC, Rhodes PH, Layde PM, Rubin GL. 1990. Pregnancy, breastfeeding, and oral contraceptive and the risk of epithelial ovarian cancer. J. Clin Epidemiol 43(6): 559-68.
Habich JP. 2000. The association between prolonged breastfeeding and poor growth--what are the implications. Adv Exp Med Biol. 478:193-200.
Hallet KB, O’Rourke PK. 2002. Early childhood caries and infant feeding practice. Community Dent Health 19(4):237-42.
Harder T, Bergmann R, Kallischnigg G, Plagemann A. 2005. Duration of breastfeeding and risk of overweight: a meta-analysis. Am J. Epidemiol 162 (5): 397-403.
Harnosh M, Dewey KG, Garza C. 1991. Nutrition During Lactation. Washington DC: Institute of Medicine, National Academy Press.
Hills-Concyzk SG, Tromiczak KR, Avery, MD, Potter S, Savik, K, and Duckett LJ. 1994. Women’s experiences with breastfeeding longer than 12 months. Birth 21(4):206-12.
Huffman SL. 1985. Breastfeeding of exclusively breastfed infants. Mothers Child. 5(1):5,7
Hunter ML, Hood CA, Hunter B, Kingdon A. 1997. Reported infant feeding, oral hygience and dental attendance patterns in children aged 5 years and under referred for extraction of teeth
under general anaethesia. Int J Paediatr Dent. 7(4):243-8.
Huo D, Lauderdale DS, Li L. 2003. Influence of reproductive factors on hip fracture risk in Chinese women. Osteoporos Int. 14(8):694-700.
Jernstrom H, Lubinski J, Lynch HT, Chadirian P, Neuhausen S, Isaacs C, Weber BL, Horsman D, Rosen B, Foulkes WD, Friedman E, Gershoni-Baruch R, Ainsworth P, Daly M, Garber J, Olsson
H, Sun P, Narod, SA. 2004. Breast-feeding and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. J Natl Cancer Inst. 96(14):1094-8.
Kac G, Benicio MH, Velasquez-Melendez G, Valente JG, Struchiner CJ. 2004. Breastfeeding and postpartum weight retention in a cohort of Brazillian women. Am J Clin Nutr. 79(3):487-93.
Karlson EW, Mandl LA, Hankinson SE, Grodstein F. Do breast-feeding and other reproductive factors influence future risk of rheumatiod arthritis? Results from the Nurses’ Health Study.
Arthritis Rheum. 50(11):3458-67.
Kendall-Tackett, KA, and Sugarman M. 1995. The social consequences of long-term breastfeeding. J. Hum. Lact. 11(3): 179-83.
Labock, MH, Hendershot GE. 1987. Does breastfeeding protect against malocclusion? An analysis of the 1981 child health supplement to the national health interview survey. Amer J
Prevent Med 3(4):227-31.
Lawrence RA, Lawrence RM.1999. Breastfeeding: A guide for the medical professional, 5th ed. St. Louis: Mosby.
Losch, M., Dungy, CI, Russell, D, and Dusdieker, LB. 1995. Impact of attitudes on maternal decisions regarding infant feeding. J. Pediatr. 126(4)507-14.
Mandel, D, Lubetzky, R., Dollberg S, Barak S, Mimouni FB. 2005. Fat and energy contents of expressed human breast milk in prolonged lactation. Pediatrics 116(3): e432-5.
Marquis GS, Habicht JP, Lanata CF, Black RE, Rasmussen KM. 1997. Association of breastfeeding and stunting in Peruvian toddlers: an example of reverse causality. Int J. Epidemiol
26(2):349-56.
Obihara CC, Marais BJ, Gie RP Potter P, Bateman ED, Lombard CJ, Beyers N, Kimpen Z. 2005. The association of prolonged breastfeeding and allergic disease in poor urban children. Eur
Respir J 25(6):970-7.
Onyango AW, Esrey SA, Kramer MS. 1999. Continued breastfeeding and child growth in the second year of life: a prospective cohort study in western Kenya. Lancet 354(9195):2041-5.
Palmer B. 2002. Breastfeeding and infant caries: No connection. ABLM News and Views 6(4):27-31.
Peres, RC, Coppi LC, Franco EM, Volpato MC, Groppo FC, Rosalen PL. 2002. Cariogenicity of different types of milk: an experimental study using animal model. Braz Dent J. 13(1):27-32.
Prentice, A. 1994. Extended breast-feeding and growth in rural China. Nutr Rev. 52(4)144-6.
Ram, KT, Bobby P, Hailpern SM, Lo JC, Schocken M, Skurnick J, Santoro N. 2008. Duration of lactation is associated with lower prevalance of the metabolic syndrome in midlife. Am J Obstet
Gyn 198(3), 268e1-268-e6.
Riberio NM, Riberio MA. 2004. [Breastfeeding and early childhood caries: a critical review]. J Pediatri (Rio J) 80(5 Suppl): S199-210.
Rosenblatt KA, Thomas DB. 1995. Prolonged lactation and endometrial cancer. WHO collaborative study of neoplasia and steriod contraceptives. Int J Epidemiol. 24(3):499-503.
Ryan, AS, Wenjun, Z, Acosta A. 2002. Breastfeeding continues to increase into the new millennium. Pediatrics 110: 1103-9.
Sadauskaite-Keuhne V, Ludvigsson J, Padaiga Z, Jasinskiene E, Samuelsson U. 2004. Longer breastfeeding is an independent protective factor against development of type 1 diabetes
mellitus in childhood. Diabetes Metab Res Rev. 20(2):150-7.
Singhal A. 2007. Does breastfeeding protect from growth acceleration and later obesity? Nestle Nutr Workshop Ser Pediatr Program 60:15-29.
Slavkin HC. 1999. Streptococcus mutans, early childhood caries,, and new opportunities. JADA 130:1787-92.
Steube AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. 2005. Duration of lactation and incidence of type 2 diabetes. JAMA 294(20):2601-10.
Slykerman RF, Thompson JM, Becroft DM, Robinson E, Pryor JE, Clark PM, Wild CJ, Mitchell EA. 2005. Breastfeeding and the intelligence of preschool children. Acta Paediatr 94 (7):832-7.
Tripathy AK, Mishra L, Bakshi S, Arya LS. 2004. Breastfeeding and childhood hematological malignancy. Indian J. Pediatr 71(5):417-8.
Valaitis R, Hesch R, Passarelli C, Sheehan D, Sinton J. 2000. A systematic review of the relationship between breastfeeding and early childhood caries. Can J Public Health 91(6):411-7.
Weeheijm KL. 1998. Prolonged demand breastfeeding and nursing caries. Caries Res 32(1):46-50.
Williams MJ, Williams SM, Poulton R. 2006. Breastfeeding is related to C reactive protein concentration in adult women. J. Epidemiol. Community Health 60(2):146-8.
Wiltemore AS. 1994. Characteristics relating to ovarian cancer risk: implications fro prevention and detection. Gynelcol. Oncol. 55(3 pt. 2): 515-9.
World Health Organization(2002). Global Strategy for Infant and Young Child Feeding. Geneva: World Health Assembly.
Yonezu T, Ushida N, Yakushiji M. 2006. Longitudinal study of prolonged breast- or bottle-feeding on dental caries in Japanese children. Bull Tokyo Dent Coll. 47(4):157-60.
 2008 Barbara Maclay Cameron Permission granted for reproduction for non-commercial uses that do not violate the WHO code for marketing of breastmilk substitutes

Also, here is a link with multiple points addressed, including nutrition, also with references: http://www.kellymom.com/bf/bfextended/ebf-benefits.html