This post was inspired by a question from Sally who directed me to the article below debunking the many “benefits” touted in blogs and sites about breastfeeding beyond a year.  I was going to make it an Ask EP, but felt a post itself was warranted.  But a huge thanks to Sally for getting this on my radar!

There’s a fair amount of people out there who argue that there’s no reason to breastfeed a baby beyond a year and that it is gross, wrong, awful, etc.  We’ve seen that whole debate play out after Time released their controversial attachment parenting cover.  But there is also a growing number of people who are arguing the opposite – that by weaning earlier, we put our children at risk of various problems that breastmilk provides an antidote to.  Kelly Mom has a whole page of citations about the benefits to breastfeeding beyond a year.  But in comes Good Enough Mummy who decided to really tackle the question of what the evidence shows.  I should note now that she is actually quite fine with women breastfeeding beyond a year, but argues the whole point is that you want to, not that there are any inherent benefits in doing so.

First let me say that the research Good Enough Mommy debunks should be debunked.  She’s right.  I’ve taken a look at the articles myself and they do not find what people have been trying to claim for them and that’s a problem we must face when we take another person’s account of what an article says without researching it ourselves (which I acknowledge isn’t always possible given the cost of accessing these articles).  So in that sense I must applaud what Good Enough Mummy has done and brought to light the limitations of the research on breastfeeding and toddlerhood.

But that still isn’t the whole story.

In fact, I would argue that she’s still wrong, despite having taken apart the studies mentioned on Kelly Mom and other sources.  And here’s why…

Cancer

Good Enough Mummy acknowledges that breastfeeding beyond a year “slightly” reduces a woman’s risk of breast cancer.  I would argue it’s a bit more than slight given that it’s cancer.  But that may just be me – if I’m told I can reduce my risk by 2% I’m probably taking it.  In one reanalysis of studies (which GEM links to), there’s a 4.3% risk reduction for every 12 months of breastfeeding (this is above and beyond other risk factors)

[1].  Another study looking at women who breastfed longer than two years found that, compared to women who never breastfed, there was a risk reduction of 33% in getting breast cancer[2].  Those are odds I think are worth discussing.  As a woman with breasts who doesn’t want cancer, the increased risk from not breastfeeding (or even prolonged breastfeeding) is not something I would be willing to undertake lightly.  (Please note that I try to phrase things with breastfeeding being the norm, but not all articles do and thus I stick with the terminology they use so others don’t go read them and suddenly question everything I’ve written.)

Unfortunately, breast cancer is one of the only types of cancer for which there is research going beyond six months of breastfeeding.  Due to the rather low rates of breastfeeding, most studies consider anything beyond six months to be “long-term” breastfeeding.  For many childhood cancers, not breastfeeding greater than six months increases the risk factor for these cancers (see Two B’s and The Big C), but it’s unclear what happens at the year mark.  I will say that I for one would be completely shocked if it came out that there was simply no effect at a year.  It may be a small effect, but again, looking at the outcome (i.e., cancer), it’s an effect I’d still consider valuable, even if small.  In fact, there are other researchers who simply take it for granted that the risk for various cancers remains increased past the year mark if not breastfeeding because the idea of it stopping at one year flies in the face of logic[3].

 
Toddler Diets and Nutrition

Good Enough Mummy agrees that breastmilk in toddlers in developing nations is an invaluable source of nutrition and acknowledges there are studies that support that.  We agree on that.  Her idea, though, is that in Western nations with our plethora of food sources, we need not worry about these issues unless we have picky eaters (so there is an acknowledgement that parents with picky eaters will benefit from breastfeeding beyond a year).  What I’d like to challenge here is the idea that most children over a year are getting adequate nutrition from the foods they eat.  Research on the topic of toddler nutrition has highlighted a few findings that are pertinent here:

  • In one study looking at normative toddler eating habits, 35% of parents reported their child was a “picky eater” and 42% of parents said their child stopped eating after a few bites of food[4].
  • Parental education programs aimed to improve the diets of low income toddlers do nothing to improve the actual food toddlers are given[5].
  • Prevalence of overweight children in the US has increased approximately 50% in the last twenty years[6].
  • In Canada, 1.1 million individuals live in a household deemed to be “food insufficient” and report a plethora of health problems related to this food insufficiency[7].

So while we can probably all agree that there are children who obtain all their needed nutrients from foods outside of breastmilk starting at a year, I think it’s a far cry from the norm.  In fact, food-related insecurities plague parents of Western nations perhaps like no other thanks to our vast amounts of fast food and cheap, unhealthy food sources.  Though this is completely anecdotal and I have not a shred of evidence to back it up, I would be curious to see the link between full-term breastfeeding and diet as many women I’ve come into contact with don’t use breastmilk to compensate for an unhealthy diet, but rather to compliment a healthy one.  Regardless, if 35% of toddlers are deemed picky eaters and even more are only eating a bit at each meal, it seems that a suggestion that more women should consider full-term breastfeeding (and thus work to normalize it in our society) is not out of sorts or lacking forethought.  And I think it goes without saying that the majority of children in Western cultures are eating diets that are processed and lacking many of the nutrients we would expect them to obtain if they were eating whole foods like fruits and vegetables.

Other Health Factors

One of the reasons to believe that infections and other health benefits are conferred into the second year of breastfeeding is from research showing that the immunological factors in human breast milk are stable in the first two years[8].  If the immunological factors remain constant, it follows to reason that there will be other health benefits, though arguably they will not be as strong as in the first year as the child’s own immune system is stronger in the second year.  However, many people mistakenly assume that the immune system is fully developed at an early age and that’s simply not the case – in fact, while the immune system is always improving in childhood, it is not until adolescence that it’s fully developed.  However, in Western societies there are fewer diseases to contend with which allows individuals to argue that the benefits of breastmilk are fewer.  And there is some truth to this, but there are still myriad diseases that toddlers are exposed to for which the immunology of breastmilk may confer protection.  For example, depending on when your child is introduced to gluten, there’s evidence that breastfeeding at the time of introduction (which can be after a year in some cases, as it was for my daughter) is related to a 52% reduction in risk of developing Celiac Disease[9].

Conclusion

Where I most disagree with Good Enough Mummy is the interpretation that the evidence is against the idea of health benefits of breastfeeding beyond a year in Western societies.  Instead I would say that we simply don’t have the research to make any conclusions, though I believe that the research on toddler diets and immunology would suggest there would be benefits if thoroughly examined.  They won’t be as large as the benefits in the first year of life, but no one is claiming that they would be (as far as I’ve heard).  Whether it be immunological protection or simply supplementing diets that are probably less than ideal in getting children the nutrients they need, there are some benefits to breastfeeding beyond a year.  As for the rest?  Only time and research will tell.

[1] Collaborative Group on Hormonal Factors in Breast Cancer.  Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease.  The Lancet 2002; 360: 187-95.

[2] The Cancer and Steroid Hormone Study Group.  The independent associations of parity, age at first full term pregnancy, and duration of breastfeeding with the risk of breast cancer.  Journal of Clinical Epidemiology 1989; 42: 963-73.

[3] Piovanetti Y.  Breastfeeding beyond 12 months: an historical perspective.  Pediatric Clinics of North America 2001; 48: 199-206.

[4] Reau NR, Senturia YD, Lebailly SA, Christoffel KK.  Infant and toddler feeding patterns and problems: normative data and a new direction.  Journal of Developmental and Behavioral Pediatrics 1996; 17: 149-53.

[5] Horodynski O, Mildred A, Hoerr S, Coleman G.  Nutrition education aimed at toddlers: a pilot program for rural, low-income families.  Family & Community Health 2004; 27: 103-113.

[6] Montague MC. The physiology of obesity.  ABNF Journal  2003; 14: 5660.

[7] Vozoris NT, Tarasuk VS.  Household food insufficiency is associated with poorer health. The Journal of Nutrition 2003; 133: 120-6.

[8] Goldman AS.  Immunological components in human milk during the second year of lactation.  Acta Pediatrica Scandinavia 1983; 72: 461-2.

[9] Akobeng AK, Ramanan AV, Buchan I, Heller RF.  Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies.  Archives of Disease in Childhood 2006; 91: 39-43.