Extended Breastfeeding

I think this is an important topic that isn’t talked about often: Extended Breastfeeding. I am still breastfeeding the twins at 2.5 years old and I’m often asked about it and different questions regarding nutrition, etc. So take a look below, I find it very fascinating how breastmilk changes to meet nutritional needs as your baby grows.

Here is an overview of the blog post, keep reading to get the details and research:

❇️ There is very little information out there about breastfeeding and nutrition past the first year of life and most sources assume you’re no longer breastfeeding.
❇️ You can continue breastfeeding for however long you and your baby would like to!
❇️ There is no reason to give cow’s milk if your baby is breastfeeding 3-4 times a day. (This also includes EP-ers that are pumping and giving milk in cups/bottles!)
❇️ Breastmilk in the second year of life is incredibly nutritious and full of calories, fats, carbs, and protein and not to mention the stuff you can’t get from cow’s milk: immunoglobulins and antibodies.
❇️ Just be mindful about offering nutritious foods throughout the day and remember that toddler’s growth slows significantly after they turn 1 and their need for calories also decreases so they don’t need to eat as much!

What is Extended Breastfeeding?

This definition will change depending on where you live; in the US, it’s considered >12 months.

• The American Academy of Pediatrics (AAP) “recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. “
• The World Health Organization (WHO) also recommends breastfeeding for 12 months, and then continuing to breastfeed for “up to 2 years and beyond.”
• Like the AAP and WHO, the American Academy of Family Physicians (AAFP) recommends continuing to breastfeed for at least 12 months, and says that the health of moms and babies is optimal “when breastfeeding continues for at least 2 years.”

What Changes After 12 months?

• Not a whole lot! You can continue breastfeeding just as you were before, only now, offer solids BEFORE nursing instead of after.
• There is not a recommended amount of number of times/day to nurse a toddler. Some only nurse 1-2 times, while others may nurse more than that.
• As your baby starts eating more solids, the nutritional gaps will be filled in by your milk.
• But remember, as your baby starts to nurse less often, you need to make sure they are getting other nutritious foods throughout the day.

Does my Baby Need Cow’s Milk?

• Short answer: NO.
  • A lot of nursing moms will be told that they HAVE TO introduce cow’s milk at 12 months. HOWEVER, breastmilk is incredibly nutritious and there is no need for cow’s milk as long as your baby is nursing 3-4 times a day.
• Because breastmilk is species-specific, all the nutrients of breastmilk are much more bioavailable than those of cow’s milk – and also all of the immunological benefits in breastmilk that aren’t in cow’s milk.
• You can also supplement your child’s diet with other forms of protein and calcium like cheese or yogurt if they aren’t allergic to dairy.
• From the ages of 1-5, kids’ growth decreases substantially and therefore, so do their calorie needs. So they may not be eating a ton, but as long as their growth continues to go well, all you can do is OFFER the food. Don’t drive yourself crazy or try and force them to eat if they aren’t particularly interested. Continue nursing on demand and your baby will likely slowly get more into solids and in the meantime, your milk will fill in the gaps in their nutrition.

Is Breastmilk Nutitrious After 1 year?

• Short answer: YES.
  • It’s incredibly nutritious. Our milk changes to meet the growing demands of our kids.
• There have been many studies that have looked into the nutritional value of breastmilk past 1 year and it has been shown to have increased fat/calorie content, higher protein, lactoferrin, lysozyme, and immunoglobulin A.
• “In the second year (12-23 months), 448 mL of breastmilk provides:
  • 29% of energy requirements,
  • 43% of protein requirements
  • 36% of calcium requirements
  • 75% of vitamin A requirements
  • 76% of folate requirements
  • 94% of vitamin B12 requirements
  • 60% of vitamin C requirements”

• And I can personally say this is the case for me as well. I sent my breastmilk that I collected over a day to Lactation Lab and my results were very surprising!

How Much Should my Toddler Eat?

• Because growth slows down with toddlers, their need for calories decrease therefore they aren’t eating as much.
• Toddlers also are going through a time where they want to be more independent (aka throw food at you).
• But remind yourself that their slowed growth means they don’t need as much food as they did in the first year of life.
• Offer 3 small meals and 2 snacks throughout the day but remember that most toddlers won’t eat much of that.
• Also, all kids are different and some may be super into solids and not so much milk.
• Here is a look at a normal increase in solids:milk for age:
  • 25% solids at 12 months
  • 50% solids at 18 months
  • 80% solids at 24 months
• Your milk makes up for these nutritional gaps and has everything your baby needs except possibly iron. Just be sure to offer iron-rich foods when you do offer solids.

What if my toddler won’t eat?

• Finger foods are a great option because toddler love to be independent. They can learn to use a fork and spoon themselves as well and many prefer this over being spoonfed.
• Toddlers can eat anything the family is eating and many times when they see everyone else eating the same food, it helps.
  • Just avoid foods like popcorn, hard candies, grapes, etc. because these are choking hazards and always be present and watching when your toddler is eating.
• Offer healthy foods throughout the day that have protein, calcium and iron and also offer lots of fruits and veggies.
• Don’t expect your toddler to eat a lot and don’t force your toddler to eat if they don’t want to. This will play into the power struggle and also make it an unpleasant feeding experience for your child which can lead to more issues.
• Keep meal times happy (even if you’re very frustrated!), you don’t want your child to feel your anxiety around meal times.
• Most children will eat when they are hungry and will meet their nutritional needs over a few days.
• Also, many toddlers graze throughout the day rather than eat in big meals. So give nutrient-dense snacks (ex: yogurt, cheese, fruit, cut up veggies, hard boiled eggs).

Final Thoughts

• I think there is very little information out there about breastfeeding and nutrition past the first year of life and that most sources assume you’re no longer breastfeeding.
• You can continue breastfeeding for however long you and your baby would like to!
• There is no reason to give cow’s milk if your baby is breastfeeding 3-4 times a day. (This also includes EP-ers that are pumping and giving milk in cups!)
• Breastmilk in the second year of life is incredibly nutritious and full of calories, fats, carbs, and protein and not to mention the stuff you can’t get from cow’s milk: immunoglobulins and antibodies.
• Just be mindful about offering nutritious foods throughout the day and remember that toddler’s growth slows significantly after they turn 1 and their need for calories also decreases so they don’t need to eat as much!
• Be patient with your toddler, they want to be independent and mealtime is a perfect time for them to try and exert that!

Resources:

1. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. Mar 1, 2012;129(3): e827 -e841.Lawrence, RA and Lawrence, RM. Breastfeeding : A Guide for the Medical Profession, 7th ed. St. Louis: Elsevier/Mosby, 2011.
2. Joan Younger Meek, Lawrence Noble, Section on  Breastfeeding; Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics July 2022; 150 (1): e2022057988. 10.1542/peds.2022-057988
3. Mandel D, Lubetzky R, Dollberg S, Barak S, Mimouni FB. Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation. Pediatrics. 2005 Sept; 116(3):e432-e435.
4. Perrin MT, Fogleman AD, Newburg DS, Allen JC. A longitudinal study of human milk composition in the second year postpartum: implications for human milk banking. Matern Child Nutr. 2016 Jan 18. doi: 10.1111/mcn.12239.
5. Riordan, J. and Wambach, K. Breastfeeding and Human Lactation, 4th ed. Boston and London: Jones and Bartlett, 2010.
6. Sinnott, A. Breastfeeding Older Children. London: Free Association Books, 2010.