BREASTFEEDING BEYOND THE FIRST YEAR

If your breastfeeding journey has lasted beyond six months or a year – congratulations! Whether you think of it as “extended breastfeeding” or feeding “to term”, there’s really no need to stop nursing an older child until you are both ready

Mothers decide to stop breastfeeding for any number of reasons. Less and less milk supply as the child starts eating solid foods. No longer wanting to express milk at work. A lack of interest in the breast from an ever busier toddler. Or maybe you just never really enjoyed it in the first place.

But sometimes, none of these things happens, and no “right” time presents itself. So you carry on… and on… and on. Congratulations, right? Except, the cheerleaders who were encouraging you when your child was three months old have all but disappeared by the time she is three years old. You are quite likely to encounter disbelief, bemusement, or straight-up disapproval the longer you breastfeed. Remember the outcry over Time magazine’s 2013 cover of a mother breastfeeding her three-year-old son?

Almost every educated parent can quote the World Health Organisation’s (WHO) advice about breastfeeding: it’s the best and safest food for babies, and a breastmilk-only diet is recommended for infants up to six months old. This is even true for HIV+ mothers in South Africa, with certain provisos. But how many of us know the rest of the line? It goes: “Thereafter infants should receive complementary foods with continued breastfeeding up to two years of age or beyond.”

BEYOND THE BASICS

How did the WHO come up with the age of two? It’s not a random number, says registered dietician Jane Bentley, whose masters degree thesis focused on infant nutrition, and who has worked extensively in the area of breastfeeding and lactation support in the government and private sectors (as well as practising extended breastfeeding with her own children). “By two, children are becoming more independent physically and emotionally,” she says, “and can wean themselves spontaneously, but psychologically weaning works at this age because of this growing independence and confidence. By two, children do well on healthy homemade meals, and have more interest in exploring the world – and interacting with people other than their mother.”

The composition of breastmilk is unique to an individual, and changes over time and with exposure to microbes in the environment, says Jane. “It does not lose value. But over time, children rely less and less on breastmilk because they eat more and more other foods. If the child is eating a good variety of high quality foods, breastmilk plays a minor role by the age of two. It is more beneficial as an immune-booster, and for emotional reasons such as comfort and bonding.”

“Making breastmilk requires energy and nutrients that the mother could be using for her own nutrition,” says Jane. “If a mother is both pregnant and breastfeeding, her body is sorely taxed, so the WHO recommendation of two years’ breastfeeding works well from the mother’s health perspective as well.”

Most mothers don’t make it to two years – and that’s okay! Given that South Africa has one of the lowest worldwide rates of breastfeeding, even just for the first six months, at only eight percent, mothers should be applauded for participating in the breastfeeding journey, no matter how far they got in it.

All of this does not mean, however, that if you lasted longer, you should feel pressure to stop nursing at two. As long as mother and child are “fulfilled emotionally by the experience of breastfeeding,” says Jane, then choosing when to end nursing can be a mutual decision.

HOW OLD IS TOO OLD?

Like most human behaviours and rituals, breastfeeding happens inside a cultural context. In Western society of the 1950s, breastfeeding took a nosedive when formula was marketed as a superior alternative to breastmilk, which started being seen as a poor person’s food of choice for their infant. We now know better than to believe such nonsense. Yet, how, where and how long we breastfeed is still largely determined by cultural factors.

For instance, a conservative religious woman from any of the major three

monotheistic religions in South Africa might refuse to expose her breast in public to breastfeed. Yet a deeply socially conservative African mother from a rural part of the South Africa will definitely see a bare breast as natural and inoffensive. And if you are breastfeeding your threeyear-old in middle-class Jozi or Durbs, well, it is likely your mother-in-law will have an opinion about it – even though she’d probably be perfectly happy to see her two-year-old grandchild drinking formula milk from a bottle.

As a counterpoint to those who frown at extended breastfeeders, the movement called “Child Led Weaning”, where the decision to stop breastfeeding is left to the child instead of the parent, is currently enjoying popularity. The principle works much like baby led weaning, or BLW, where the child’s decision to try solid food is his own. Norma Jane Bumgartner, author of Mothering Your Nursing Toddler, says in an online article that “mothers in East Bhutan, where nursing well into childhood is socially acceptable, say that self weaning usually occurs between three and five years.” She adds that “research suggests that a completely child led weaning is unlikely to take place before the child turns four.”

“The upper limit for breastfeeding in humans appears to be about age six to seven, when the permanent molars arrive,” says Cape Town La Leche League leader Kim Jurgens, citing research by US anthropologist Kathy Dettwyler, and Harvard scholar Katie Hinde. “This correlates with when most mammals wean. However, it would be extremely rare to see a mother doing this, and in developed countries in particular, this is definitely not the norm.”

“Most toddlers will self wean between about age two to four,” she adds. “A few might go on longer than this, but generally in middle class South Africa, most mothers would have begun a weaning process around then.”

So four to five years old seems to be the age at which the last few nursers generally give up the habit. But you shouldn’t feel rejected (or feel you’ve failed) if your little one decides to give up the boob before that. “From about one-and-a-half to three years of age children naturally become independent and want to explore and separate from their mom, and they should be allowed and encouraged to do this,” says Clare Harvey, a clinical psychologist in private practice in Johannesburg.

“If it’s an emotionally healthy relationship both mom and baby (or toddler) will be able to do this appropriately and breastfeeding will be able to come to a natural end. Before adolescence, when a child is in the formal schooling years, they should developmentally be searching for recognition and affirmation from their peers and not from their mothers and so breastfeeding should not be something the child needs emotionally anymore.” And nursing an adolescent, for example, is completely outside the reaches of what we consider socially acceptable. When a child’s sexual maturity is beginning, breasts take on a sexual meaning and he or she needs to focus on non-family members as sexual objects of desire.

Says Jane: “The longer breastfeeding persists (past a minimum of two years old), the more one should look at psychological issues as to why the mother is not releasing the child, or the child is so emotionally dependent on the mother, while remembering that some people are just happy to have that bond, and will wait for the child to decide to stop.”

And if your child is ready to let go, but you just aren’t? “A mother should be able to ‘hear’ and ‘listen’ to her child and take the lead from them. However, this is often a complex issue when the mother finds it difficult to let her baby naturally wean because of her own conscious and unconscious attitudes (which she isn’t aware of). She may feel she will ‘lose’ her child and the relationship if she stops breastfeeding and this suggests a mother’s own insecurities which should not be dealt with through her child,” explains Clare.

“Holding a child back or forcing something on them can interfere with their development,” agrees Kim, “but this wouldn’t be unique to breastfeeding. A mother who won’t allow her child to do any age appropriate thing – walking through the school gate alone in primary school, refusing to allow your child to learn to ride a bicycle in case they break a bone – can be damaging and needs intervention.”

Breastfeeding to two and beyond can be a sign of a close, trusting bond between mother and child. It can help calm a tantrum, allay a fear, ease a tired child off to bed, ensure less disrupted nights – and suckling helps with jaw and speech development and good teeth placement, too. So breastfeed your older child with pride. It is, after all, nobody’s business but yours. YB