Breastfeeding beyond the age of two: What are the benefits?
Mothers who choose to nurse for longer are often criticised - but is this fair? We speak to some key supporters about 'full-term' breastfeeding.
When it comes to breastfeeding, it seems everyone has an opinion, whether they're a parent or not. We're generally told that if we can, then we should breastfeed - but some women who breastfeed past a certain point receive a negative reaction.
The World Health Organisation recommends all babies be exclusively breastfed for six months, then gradually introduced to appropriate foods, while continuing to breastfeed for two years or beyond. Many mothers decide to stop much sooner than the two-year mark however, when their baby develops teeth, or they go back to work, or find that their child loses interest when solid food is introduced. But some choose to continue.
The benefits to breastfeeding are undisputed - it's associated with increased protection from infection and diseases for the infant, and reduced risk of breast and ovarian cancer for the mother, among other things - but there is confusion around how long those benefits continue, and whether breastfeeding 'beyond two years' really is the best approach.
"There is no research which shows that breastfeeding beyond infancy is in any way harmful," says Anna Burbidge, from La Leche League GB. "There is no specific age at which children should wean."
So, what are the potential benefits of what pro-breastfeeding groups call 'full-term' nursing?
Breastfeeding can provide comfort and security, even as a toddler
"Breast milk maintains nutritional value as well emotional benefits, however old a baby is," says Anna. "Although as a child grows, nursing is no longer the main food source for him, he still has a need for the warmth and security and breastfeeding can often meet a child's needs more completely and easily than anything else.
"Breastfeeding can provide feelings of love, comfort and protection," she adds. "Allowing a toddler to nurse (or wean) at his own pace is an expression of trust that contributes to his self-esteem, and children love the comfort and security."
Senior breastfeeding tutor at parent support charity Cuidiiu, Sue Jameson, adds: "Some mums call it their secret weapon - it's emotional nourishment as well as physical nourishment. It continues to reaffirm that a child's needs will be met [even] as they get bigger, at times of worry or upset."
Breastfeeding full-term is the norm in many countries
Clare Morrison, GP at online doctor and pharmacy Med Express, says: "Breastfeeding to between two and four years old, while unusual in Western countries, is the norm in the third world, and was quite natural throughout human civilisation."
Sue says we should look to the example set by Scandinavian countries, where breastfeeding in general is more common: "Denmark, Norway and Sweden all have high initiation figures - 98% [of mothers breastfeed]. That's what we should be looking to replicate."
The physical benefits don't necessarily stop just because a child gets older
"We know from all the research that all breast milk is good at any stage," says Sue. "Breast milk is good and it's normal - it provides a stable base, it builds the immune system, it's about reconnecting. Breastfeeding carries a lifelong health advantage and [the benefits] continue to well past the period of feeding."
She adds: "We're looking for people to acknowledge and accept that breast milk is different [to formula]. There's a lot of talk about women being coerced into breastfeeding [though] and we support all parents, regardless of their breastfeeding choices."
Anna adds: "It is sometimes thought that there is a point where breast milk no longer offers any benefits, but this isn't accurate. Human milk continues to complement and boost the immune system for as long as it is offered. During the weaning process, the composition of human milk adjusts to meet the needs of the growing child so that, although the volume is decreasing, an appropriate level of nutrients remains present and immunological protection is not compromised."
Natural weaning is said to be better than forcing independence before a child is ready
The main issue that charities want to reinforce is that it's all about doing what comes naturally, and letting children and mothers do whatever works for them.
Anna says: "It's sometimes suggested that breastfeeding an older child leads to them being overly dependent on their mother, but we know of no evidence to support this suggestion, whereas there is evidence that it aids in growth towards independence.
"It's a natural process for children to outgrow breastfeeding on their own, letting them grow at their own pace. Independence can't be forced upon a child before he is ready to assume it. Natural weaning allows for differences in children."
Some women only stop breastfeeding early because of societal pressures
"There is definitely societal pressure put on women to stop breastfeeding when everyone else does, rather than do what feels natural and works for them and their child," says Clare. "This is probably because people aren't used to seeing older children being breastfed, particularly beyond the age of two, and more so as the child gets older.
"The length of time a mother breastfeeds is very much a personal decision, and all mums should be supported and encouraged to do what suits them, whether they don't breastfeed at all, or if they do it until the child is a toddler, or even older," she adds.
Anna says: "We hear from women who feel they need to wean, even though they and their child are still happy with nursing, because of perceived disapproval from society or friends and relatives. This often stems from good intentions from others who have parented in a different way, and are genuinely feeling concern due to lack of information about breastfeeding."
Sue says Cuidiiu often hears from women who stopped breastfeeding their first child earlier than they wanted because of negative assumptions, but decide to ignore these pressures when they had a second child.
Every woman and child is unique
The charities won't suggest an age at which women 'should' feed until, because what women don't need is any extra pressure around the issue of breastfeeding, and what works for one person doesn't always work for another.
"Breastfeeding forms part of the unique relationship between a mother and child and will not be the same experience for everyone," Anna says. "Ideally, breastfeeding will continue until both mother and child are ready to stop, but this will differ not only between families but even between siblings in the same family.
"Breastfeeding continues to offer benefits to mother and child, both to their health and mental and emotional wellbeing, for as long as it continues. If a mother is breastfeeding an older child, then it is because it is important to them both and contributes to their relationship, and it is a perfectly normal part of mothering."