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Breastfeeding Toddlers

Barbara Higham Ilkley
West Yorkshire, Great Britain
From: NEW BEGINNINGS, Vol. 23 No. 3, May-June 2006, pp. 100-105.

Although it may seem out of the ordinary in some cultures, during most periods of history and in most parts of the world babies have been breastfed for years rather than months (Mead and Newton 1967). In much of the world today, weaning doesn't occur until at least two years of age (Bengson 1999). The World Health Organization's infant-feeding recommendation as stated in the Global Strategy on Infant and Young Child Feeding states:

As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production.

A breastfed baby is dependent on his mother for both food and comfort. This may frighten people in cultures that place a high value on self-sufficiency. A breastfed baby will not be satisfied with anyone other than his mother, and therefore may be regarded by some as a liability, when in fact, a baby simply knows what he needs for his own good.

Some cultures fear that continuing to breastfeed until a child weans on his own will make him more dependent on his mother. Instead of viewing extended nursing as something to question, perhaps the real query should be, "What is there to be gained by abruptly putting an end to the breastfeeding relationship?" It's interesting that some people think that a child won't grow out of breastfeeding unless he is forced. In reality, it's a natural process for children to outgrow breastfeeding on their own. Independence, not dependence, is one outstanding trait that breastfed children who self-wean have in common (Ferguson 1987).

Natural weaning allows for differences in children by letting them grow at their own pace. Independence can't be forced upon a child before he is ready to assume it. A child who weans gradually is able to maintain his emotional attachment to his mother, rather than being forced to switch to an inanimate object such as a cuddly toy or blanket. I can vouch for this; I speak from personal experience.

My Story, Part 1

In 1998 when my first son, Felix, was born, I was determined to breastfeed him. It was an uphill struggle in which my perseverance eventually paid off. When we reached the six-month mark, it seemed as though we'd only just got into the swing of things. To my surprise, I was enjoying my new social circle of mums and babies and getting out and about with a breastfeeding baby was surprisingly simple. But I hadn't realized just how helpless and dependent a six-month-old baby was. We certainly couldn't have managed life easily without breastfeeding.

When Felix celebrated his first birthday, he still clearly exhibited a need to breastfeed even though he was eating several meals a day. He didn't like cows' milk and my milk was readily available. Nursing was quick and easy and had become a natural part of mothering to me. There seemed to be no need to stop just yet.

Of course, there were some ups and downs with nursing into toddlerhood. There were times when I felt judged by others for whom breastfeeding had been more of a fleeting experience or from those who couldn't appreciate my child's need to be nursed to sleep. Breastfeeding an older child can be an isolating experience (especially if you haven't discovered the existence of La Leche League, as I hadn't then). I was fortunate to have a supportive partner who appreciated the importance of breastfeeding. He also valued a good night's sleep, which can be something of a boon for the father of a breastfed child.

Handling Criticism

Understandably, some mothers find it difficult to deal with pressure to wean, whether that pressure comes from family, friends, or complete strangers. Choosing to do things differently than other mothers who initiate weaning after a few months calls for courage, self-assurance, and a good support system. Katherine Dettwyler, anthropologist, states that major contributors to premature weaning are cultural. Early weaning often occurs in cultures that promote breastfeeding as mainly nutrition for infants, view breasts as sexual objects, and don't accept nursing in public. Get support where ever you can find it -- ideally, it will come from your partner, family, and friends. Naturally, La Leche League meetings are a great source of support and encouragement, too!

If you find yourself facing criticism from people close to you, keep in mind that they are most likely voicing their opinions out of concern and based on their own experiences. If the person expressing doubt is your partner, listen to what he has to say carefully and thoughtfully. Acknowledge his concerns, acknowledge your personal concerns about doing what is best for your child, and express any doubts you may have. This may help him realize how much you've thought about your decision to continue breastfeeding your child.

If you're facing criticism from family members or friends, remember that they may simply be uninformed about the benefits of extended breastfeeding or perhaps they feel guilt about their own parenting choices. Consider responding to unwelcome comments by:

Ignoring: walking away or changing the subject.

Informing: sharing books, articles, or a medical professional's thoughts on extended nursing.

Using Humor: making a joke about the situation or yourself, not the other person.

Acknowledging: recognizing the person's viewpoint and asking further questions without agreeing or disagreeing

Empathizing: being empathetic to demonstrate that you understand the other person's feeling and meaning (Vakiener 1999).

Breastfeeding in Public

With young babies, it's much easier to be inconspicuous while nursing in public or around others. Toddlers, on the other hand, can choose some pretty awkward situations to decide they want to nurse. A lot of mothers have found themselves in situations where their toddler has lifted their shirt or demanded "boobie" on the spot.

Before going out on the town with your nursing toddler, be aware when choosing your wardrobe. Does your top have fasteners, zippers, or clasps that your child has recently discovered how to operate? You might want to consider not wearing these items out of the house for a while! In MOTHERING YOUR NURSING TODDLER, author Norma Jane Bumgarner writes:

It can be cute when little Lucy asks for "titty" or "boobie juice" at home. Think, however, whether you are comfortable having her make the same request with perfect pronunciation at the supermarket....This is not to say that your nursing relationship must be secret or that there is anything wrong with any term whatsoever that you may want to use for nursing. I just want to alert you to the fact that the word you use in the first or second year will usually the word your child continues to use, and the pronunciation will become increasingly distinct.

Setting Limits

Sometimes a mother may feel "touched out" or manipulated and long to have her body back to herself. Perhaps she is burned-out or overwhelmed and is seeking ways to gain back some control through weaning. As author Diane Bengson states in HOW WEANING HAPPENS, these feelings are common, and the intensity comes and goes. Some mothers choose to continue breastfeeding and work through the negative feelings by finding ways to satisfy their own needs.

If you are experiencing challenges or negative feelings about nursing your toddler, consider using your child's naptime for an activity that you enjoy. Reading, working on a project, or volunteering can all be stress relievers. Even just getting out of the house for a while will brighten your mood. If possible, plan a regular event where your partner (or other trusted person) stays with your child while you enjoy a few hours out on your own.

Breastfeeding a toddler is not something a mother does on demand in the same way she would nurse a newborn. Rather, toddler nursing is a two-way relationship. Mothers can and do choose to examine their own comfort levels and impose restrictions on an older child. As Hilary Flower, author of ADVENTURES IN TANDEM NURSING, says, "Setting limits that take your own feelings into account can keep breastfeeding positive....A gentle 'No' when nursing feels wrong creates the possibility of a clear 'Yes' for a session when you are truly up for it. Taking your own feelings seriously and allowing yourself to freely choose when to offer breastfeeding can maintain the openness of breastfeeding for both you and your nursling."

Limits range from disallowing your child to fiddle with your body while nursing, dropping some feedings, and going longer between feedings. Cutting down on the number or length of feeds can be done gently and gradually, progressing with the child's readiness to defer breastfeeding or be distracted with other things and is easily reversible if the pace is moving too fast for a child. Weaning is not an "all or nothing" act.

"Your child needs generosity from you, but just as much, your child needs you to honor your bottom-line limits. Particularly if nursing is for comfort, the emotional quality of the exchange is of great importance" (Flower 2004).

My Story, Part 2

There were times when I experienced my share of embarrassment in front of others at my verbal child's requests for nursing. It made me glad that -- most of the time -- my son used a code word for nursing. When he requested "niktoo," no one else knew what he meant!

There were definitely moments when I wanted my own space, too. What had once been special quiet nursing sessions with my baby during the night became what felt like uncomfortable, tiring maulings. Once I became pregnant again, my son's nipple twiddling, which used to be mildly irritating on occasion, became excruciating for me. By the time my belly had swelled I felt there was no longer room for this large child in our bed and gradually initiated weaning. At first it seemed impossible because continued breastfeeding was a vital tool in easing the transition from waking to sleeping at naps and bedtimes. But with time, routines including bedtime stories and cuddles took the place of nursing sessions. There were a few occasions when Felix asked to nurse, but I was able to distract him. I have no recollection of the last time he breastfed because it was something that slowed down and he left off doing.

When I was pregnant with my third child, Amelia, and nursing my second son, who was three, I was again physically uncomfortable breastfeeding and keen to introduce restrictions. Edgar, however, was not to be put off with stories and cuddles and I struggled with my feelings. At times (in the night, especially) I wanted to push him away. The only thing that made his night nursing acceptable was to restrict it by telling him it was hurting me and that he would have to stop after I had counted to 60!

Edgar did gradually cut back his nursing sessions and although at four years old he still asks for milk most days, he only has a token suck that lasts about 30 seconds. I'm glad that I didn't wean him abruptly (though I have encouraged him to cut back) because I've avoided having to cope with an unhappy child resisting my efforts to wean him. As stated by Diane Bengson, "Often [the process of weaning] is a matter of waiting while a child matures."

Advantages for Mother

Parenting is an exhausting business. When a mother says how tired or stressed she is, some people may point to breastfeeding as the culprit. In reality, there are many benefits of extended nursing to mothers, some of which include:

Stress relieving qualities: Breast-feeding suppresses the nervous system's hormonal response to stress, which is why many mothers recognize that they feel calmer and better able to cope with whatever comes along while nursing.

A few guaranteed calm moments in a day: Parenting can be hectic. Toddlers are bursting with energy and find a lot of interesting things to keep them busy. There are times -- however brief -- when a mother can count on breastfeeding to provide soothing quality time to calm an upset toddler or to reconnect and bond with her child.

Decreased risk of diseases: One study found a decreased risk of breast cancer among breastfeeding mothers, with the greatest risk reduction seen in women whose total amount of breastfeeding for one or more children totals several years (Collaborative Group on Hormonal Factors in Breast Cancer 2002). A mother's risk of osteoporosis (and other diseases) is also reduced by extended breastfeeding (Gwinn et al. 1990; Hartge et al. 1989; Rosenblatt, Thomas, and WHO 1993).

Amenorrhea: The amount of natural infertility experienced while breastfeeding is known as lactational amenorrhea. Many mothers experience reduced fertility when nursing past a year, with some women going as long as two years or more without menstruating.

Even after the time during which nursing alone is a reliable contraceptive has passed, many mothers continue to enjoy freedom from menstruation and from the physical and emotional effects of ovulation and menstruation" (Bumgarner 2000).

Advantages for Toddlers

Human milk is the primary source of nutrition during a baby's first year. It becomes a supplement to solids during the second year, but it maintains nutritional value, as well emotional benefits for toddlers.

Immune system: It takes between two and six years for a child's immune system to fully mature. Human milk continues to complement and boost the immune system for as long as it is offered (AAP 1997; Goldman 1983; Gulick 1986; Mohrbacher and Stock 2003; Saarinen 1982). Research on the incidence of illness in breastfed or weaned toddlers reflects these dynamics. Breastfeeding toddlers between 16 and 30 months old have been found to have fewer types and shorter duration of illness and to require less medical care than their non-breastfeeding peers (Gulick 1986).

Oral development: Breastfeeding provides a natural outlet for non-nutritive sucking that promotes proper oral development, which has been found to improve speech (Davis 1991; Labbok and Hendershot 1987; Broad and Duganzich 1983).

IQ score: Extensive research on the relationship between cognitive achievement (IQ scores, grades in school) and breastfeeding has shown the greatest gains for those children breastfed the longest (van den Bogaard 1991).

Independence: The process that children go through while growing toward independence is a difficult one. Breastfeeding can provide feelings of love, comfort, and protection. When a mother makes herself available to nurse her child through a situation that he can't handle alone, he will likely develop independence based on faith that mother will be there to help. As a child gets older, there are fewer and fewer such situations. Provided a child isn't prevented from exercising his developing capabilities, independence comes with his increasing competence (Bumgarner 2000).

Self-Esteem: Babies and young children nurse when they are lonely, frightened, or in pain and responsive mothering through breastfeeding leads to enhanced bonding. Allowing a toddler to nurse (or wean) at his own pace is an expression of trust that contributes to his self-esteem.

My Story, Part 3

Once Felix was in "big boy's" shoes he was a bit more of an acrobat during our breastfeeding sessions, but he was obviously still a baby. When he tumbled over and hurt himself and cried, offering the breast was so much more efficient than rocking or soothing with other methods. A few minutes of nursing worked wonders no matter what the upset was.

By the time he reached his second birthday, Felix was steadier on his feet but emotionally still a bit wobbly. Nursing was a great way to calm a fractious, tired, or over-stimulated toddler, and it soothed me, too! As time went by -- he was three before I knew it -- breastfeeding had become something familiar in a world so full of new experiences. It was special for both of us: a way of connecting, relaxing, drifting to sleep, forgiving, reconnecting after separations, and a way of grounding. Breastfeeding was a source of comfort and nourishment when Felix was ill and could take no other food. As stated in a handout by Canadian pediatrician and breastfeeding expert Dr. Jack Newman (can be downloaded from www.drjacknewman.com), "The mother comforts the sick child with breastfeeding, and the child comforts the mother by breastfeeding."

I've been able to enjoy these benefits of extended breastfeeding with my second born, Edgar, too. I look forward to extended breastfeeding with my daughter, Amelia, who is eight months old.

Conclusion

At La Leche League meetings, I found the support of other mothers who understand that it's both normal and healthy for toddlers to sustain breastfeeding, but also that a child moves on from breastfeeding and can use his mother's help to do so. Weaning is a gradual process that starts the moment a baby is introduced to solids and follows a unique timetable that is set by a child and his mother.

There are no prizes to be won for breastfeeding the longest -- all mothers and babies are different. Ideally the nursing relationship continues until the child outgrows the need.

References

American Academy of Pediatrics Policy Statement on Breastfeeding and the Use of Human Milk. Pediatrics 2005; 115(2):496-506.
Bengson, D. HOW WEANING HAPPENS. Schaumburg, IL: LLLI, 1999.
Broad, F. and Duganzich, D. The effects of infant feeding, birth order, occupation and socio-economic status on speech in six-year-old children. NZ Med J 1983; 483-86.
Bumgarner, N. MOTHERING YOUR NURSING TODDLER. Schaumburg, IL: LLLI, 1999.
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 50302 women with breast cancer and 96973 women without the disease. Lancet 2002 Jul; 360(9328):187-95.
Davis, D. et al. Infant Feeding Practices and occlusal outcomes a longitudinal study. J Can Dent Assoc 1991; 57(7):593-594.
Dettwyler, K.A. "Beauty and the Breast: The Cultural Context of Breastfeeding in the United States," in Breastfeeding: Biocultural Perspectives, (New York, Adline de Gruyter, 1995) 167-215.
Ferguson, D.M. et al. Breastfeeding and subsequent social adjustment in six- to eight-year-old children. J Child Psychol Psychiatr Allied Discip 1987; 28:378-86.
Flower, H. ADVENTURES IN TANDEM NURSING. Schaumburg, IL: La Leche League International, 2003.
Goldman, A. Immunologic components in human milk during the second year of lactation. Acta Paediatr Scand 1983; 72:461-62.
Gulick, E. The effects of breastfeeding on toddler health. Ped Nursing 1986; 12:51-54.
Gwinn, M.L. et al. Pregnancy, breastfeeding and oral contraceptives and the risk of epithelial ovarian cancer. J Clin Epidemiol 1990; 43:559-68.
Hartge, P et al. A case control study of epithelial ovarian cancer. Am J Obstet Gynecol 1989; 161:10-6.
Innocenti Declaration on the Protection, Promotion, and Support of Breastfeeding. Ecology of Food and Nutrition 1991; 26:271-73.
Labbok, M. and Hendershot, G. Does breast-feeding protect against malocclusion? Am J Prev Med 1987; 3:227-232.
Mead, M. and Newton, N. Cultural Patterns of Perinatal Behaviour in Childbearing: Its Social and Psychological Aspects. Baltimore, Maryland: Williams & Wilkins Company 1967.
Mohrbacher, N., Stock, J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 2003.
The Optimal Duration of Exclusive Breastfeeding. A Systematic Review. Geneva, World Health Organization, 2001.
Rosenblatt, K.A., Thomas, D.B., and the WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Lactation and the risk of epithelial ovarian cancer. International J Epidemiol 1993; 22:192-9.
Saarinen, U. Prolonged breastfeeding as prophylaxis for recurrent Otitis media. Acta Paediatr Scand 1982; 71:567-71.
Vakiener, M. Responding to criticism. NEW BEGINNINGS 1999; 16(4):116-19.
van den Bogaard, C. et al. The relationship between breast feeding and early childhood morbidity in a general population. Family Med 1991; 23:510-15.
THE WOMANLY ART OF BREASTFEEDING, Seventh edition. Schaumburg, IL: LLLI, 2003.

What if my doctor suggests weaning?

If a physician suggests weaning, it's important to note the context in which it is said. It can be helpful to ask what dangers he or she sees in continuing to nurse, and what documented evidence this is based on. It can also be helpful to let the doctor know how important breastfeeding is to you and your baby.

Some mothers continue to nurse without telling their doctor; some mothers choose to tell their doctor they see no reason to wean now and ask for their support; some mothers prefer to find a more supportive doctor; some choose to share information and research on extended breastfeeding with their physician. Ideally, you and your doctor or other health care provider will find ways to work together to best meet your baby's needs, even if this means the two of you must agree to disagree.

Source: Bengson 1999

 

Myths about Entending Nursing and Late Weaning

Myth: A child will never wean on his own.

Fact: Children grow and change dramatically in the first several years of life, and their interest in nursing changes as they do. Children want to nurse only as long as it fills a need for them. Sometimes this need will last for several years, sometimes far less. A need that is filled will go away.

Myth: A child who is still nursing is too dependent.

Fact: Toddlers have many needs that linger from babyhood, including the need to cuddle, the need to be comforted, and the need for help when falling asleep. These needs are all naturally met through nursing, and it is a wise mother who recognizes and honors her child's need to be dependent. Trusting the child in this way builds self-confidence needed for later independence.

Myth: Extended nursing is a sign of sexual problems.

Fact: Children who nurse for several years do not appear to be affected in any way in their sexual development. They may actually grow up to be more comfortable with their bodies and with relationships.

Myth: An older nursing child won't learn self-comforting skills.

Fact: Giving your child the comfort of breastfeeding is actually the best way to teach self-comforting skills in the long run. It is from this early relationship with you that he learns much about his needs and how to get them met in constructive, self-initiated ways.

Myth: Prolonged nursing is too fatiguing for a mother.

Fact: Many mothers find that nursing is one way they are able to rest, since nursing assures that there are a few times in every day when the mother can put her feet up and relax with her child.

Myth: The longer you wait to wean, the harder it will be.

Fact: As children get older, encouraging weaning often gets easier, not harder, since older children have a greater ability to reason and a wider repertoire of interests. When your child is ready to wean, it will be easy.

Myth: It's better to wean suddenly and get it over with.

Fact: Weaning slowly is one of the many areas in your relationship with your child where going slowly pays off in the long term. There are no instant fixes that don't have a cost. By weaning gradually and employing gentle techniques, you will maintain your child's inner security and trust for you.

Myth: A mother who nurses an older child is doing it to fill some need in herself.

Fact: Many mothers explain that their satisfaction and pleasure in nursing declines as the child gets older, and if they continue to nurse, it is primarily because it is important to their child. Older children are usually not coerced to nurse, they are allowed to nurse.

Source: Bengson 1999

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