Thursday, May 28, 2009

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:

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
• 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,
• 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).

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 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:

1 comment:

Shooting Starchild said...

I don't even know what to say. THANK YOU!!!!!!!!!!

I've just read several of your posts on tandem nursing (something that I want to do) and am excited to read about nursing an older toddler (mine is 18 months and I don't want to stop anytime soon even though I don't feel like anyone else is totally on board with my plan). Your blog is a bonanza!

This post, with relatively recent research and professional sources... Thank you!