Nursing Beyond One Year
by Sally Kneidel
From: NEW BEGINNINGS
Vol. 6 No. 4, July-August 1990, pp. 99-103
I overheard a conversation at the library the other day between two mothers
with young children. Asked one, "Are you still nursing Ryan?" The other
responded, "No, his doctor told me to wean him at twelve months so I did,
although it nearly broke my heart."
I recalled getting the same advice from my pediatrician when my first- born
reached twelve months. When I pressed for a reason, the answer I got was
"So she can learn to be independent." I was able to ignore the advice only
because my best friend was still nursing her two-year-old with tenderness
and affection and apparently no ill effects. Yet not everyone has an
alternative role model when they are told that it's time to wean. It
saddens me to see so many give up nursing before mother and baby are ready
for weaning, because of advice given arbitrarily.
Why do so many doctors recommend weaning at one year? Recently a woman
wrote to the question-and-answer column of a popular magazine to ask, "When
should I wean my baby?" The answer, from a pediatrician, reflects a common
misconception. The doctor replied, "Wean at one year, because the baby can
take cow's milk then." But babies breastfeed for more than just nutrition,
and mothers don't just nurse their babies out of obligation, but because
they find it deeply fulfilling.
For many mothers, the question is not, "How long must I nurse for the
health of my baby," but rather, "Is there any age at which continued
nursing can be harmful in any way?" If there is not, then why can't the
decision be left to the mother? Is there any evidence to support weaning at
What Research Shows. Research shows that babies may benefit from nursing
beyond one year. One benefit is nutrition. Research has shown that
second-year milk is very similar to the first-year milk nutritionally
(Victora, 1984). Even after two years or more it continues to be a valuable
source of protein, fat, calcium, and vitamins (Jelliffe and Jelliffe,
A second benefit is immunity to disease. The immunities in breast milk have
been shown to increase in concentration as the baby gets older and nurses
less, so older babies still receive lots of immune factors (Goldman et al,
1983). A study from Bangladesh provides a dramatic demonstration of the
effect these immunities can have. In this deprived environment, it was
found that weaning children eighteen to thirty-six months old doubled their
risk of death (Briend et al, 1988). This effect was attributed mostly to
breast milk's immune factors, although nutrition was probably important as
well. Of course in developed countries weaning is not a matter or life and
death, but continued breastfeeding may mean fewer trips to the doctor's
A third health benefit is avoidance of allergies. It is well documented
that the later that cow's milk and other common allergens are introduced
into the diet of a baby, the less likelihood there is of allergic reactions
Psychological Considerations. Any mother who has nursed an older baby knows
the tenderness and feelings of closeness generated by nursing a little one
who is old enough to talk about it. We don't need medical journals to tell
us it's rewarding for mother and baby. But has anything been documented and
published on these benefits?
One paper written by a female psychiatrist (Waletzky, 1979) recommends
natural weaning. She refers to early forced weanings as emotionally
traumatic for the baby and states that most weaning recommendations given
by pediatricians are "based on personal feelings and prejudices and not
medical documentation." In her words: "Suddenly and prematurely taking from
a baby the most emotionally satisfying experience he his ever known could .
. . lead to significant immediate and long-term distress.... Such an
approach considers breastfeeding only as a source of milk and fails to
understand its significance as a means of comfort, pleasure, and
communication for both mother and baby." Well said! Yet Waletzky's paper is
based on her impressions from her psychiatric practice, not on research.
Research reports on the psychological aspects of nursing are scarce. One
study that dealt specifically with babies nursed longer than a year showed
a significant link between the duration of nursing and mothers' and
teachers' ratings of social adjustment in six- to eight-year-old children
(Ferguson et al, 1987). In the words of the researchers, "There are
statistically significant tendencies for conduct disorder scores to decline
with increasing duration of breastfeeding." The authors were cautious in
their interpretation of the results, saying that they did not control for
differences in mother-child interaction between breastfeeders and
bottlefeeders, which could account for the differences they saw in later
social adjustment. But it makes no real difference whether the improvement
in later child behavior is due to breastfeeding per se, or the maternal
behaviors that are typical of women who are open to nursing their babies
for a year or more. The outcome is what matters; the children who nursed
the longest were perceived later to be those with the best social
adjustment. The link between duration of breastfeeding and social
adjustment was stronger and more consistent when the children's behavior
was rated by mothers rather than by teachers (although for both rating
groups the association was significant), suggesting that mothers who
breastfeed for longer periods may tend to view their children in a more
positive light than mothers who do not.
I think most of us would agree that breastfeeding helps us to react to our
children in a more positive way. It helps us to feel close and loving,
which can be especially helpful in weathering the irrational demands and
emotional upheavals of toddlers. No matter how tense I feel when I sit down
to nurse my youngest child, almost invariably we both get up feeling
relaxed and cheerful.
Cultural Attitudes. Do all doctors base their advice about weaning on the
results of medical research? Apparently not, because there is no indication
that nursing beyond one year has any negative effects, and there is ample
evidence of its benefits. Then what is the basis of the often-heard "Wean
at one year"?
There are probably several factors involved. One may be simply cultural
expectations and, as Dr. Waletzky put it, "personal prejudice." Doctors are
subject to trends in cultural thinking like everyone else. And the trend in
parenting these days seems to be toward expecting precocious development
and early independence in children. An emphasis on early weaning seems to
fit in with the overall trend toward encouraging early independence.
Ironically, early forced weaning may actually hinder emotional development
and increase dependency needs, in the opinion of Dr. Waletzky and many
Another influence on attitudes toward weaning may be the hurried pace of
our society. Unrestricted nursing is not thought to be compatible with
modern lifestyles. Many articles on weaning include an implicit assumption
that mothers want to quit breastfeeding as soon as they can without
compromising their babies' nutrition.
Another factor may be that doctors, again like others, are subject to
prejudices based on our culture's fascination with the breast as a sexual
stimulus. A child who is old enough to talk may be considered too old to
find physical comfort at his mother's breast.
The bottom line may be simply that it isn't common in our culture for women
to nurse beyond one year, so most people assume that a mother will want to
wean a baby who is more than one year old.
Medical Misconceptions. Some doctors may feel that nursing will in terfere
with a child's appetite for other foods. Yet there has been no
documentation that nursing children are more likely than weaned children to
refuse supplementary foods. In fact, most researchers in Third World
countries, where a malnourished toddler's appetite may be of critical
importance, recommend continued nursing for even the severely malnourished
(Briend et al, 1988; Rhode, 1988; Shattock and Stephens, 1975; Whitehead,
1985). Most suggest helping the malnourished older nursing child not by
weaning but by supplementing the mother's diet to improve the nutritional
quality of her milk (Ahn and MacLean. 1980; Jelliffe and Jelliffe, 1978)
and by offering the child more varied and more palatable foods to improve
his or her appetite (Rohde, 1988; Tangermann, 1988; Underwood, 1985).
How to Talk to Your Doctor. Because some doctors may feel that mothers
regard nursing as a nuisance rather than as a pleasure, it is especially
important for a mother to tell the doctor that she wants to continue
breastfeeding. The doctor may assume that the mother's only considerations
are the baby's nutrition and her own convenience if she doesn't explicitly
Confidently expressing your point of view is probably the best way to
influence your doctor positively. For example, you might say, "Meg and I
are really enjoying our nursing relationship. It seems to be good for her.
She's a happy baby, and she's growing so well." Compare this to a less
confident approach: "I'm not sure I should wean Meg yet. Nursing doesn't
seem to be doing her any harm really. Do you think it's okay to continue?"
Which approach is more likely to elicit a positive reply about continued
Not all doctors recommend weaning at one year. Those who do may learn
something from mothers who communicate their enthusiasm for natural
weaning. Many of us keep quiet about breastfeeding at the doctor's office
to avoid unwanted advice, but if we were more vocal about our enjoyment of
nursing older babies, perhaps we could change some attitudes in the medical
community. It takes confidence and assertiveness to speak up, but knowing
that research supports natural weaning helped me feel more confident that
it is medically and emotionally sound.
- Ahn, C H and MacLean, W C. Growth of the exclusively breastfed infant. Am J
Clin Nutr 1980; 33:183-92.
- Briend, A. et al. Breast feeding, nutritional state, and child survival in
rural Bangladesh. Br Med J 1988; 296:879-82.
- Ferguson, D. M. et al. Breastfeeding and subsequent social adjustment in
six- to eight-year-old children. J Child Psychol Psychiatr Allied Discip
- Goldman, A. S. et al. Immunologic components in human milk during the
second year of lactation. Acta F'aediatr Scand 1983; 722:133-34.
- Guilick, E. E. Effects of Breastfeeding on Infant Health. Pediatr Nurs
1986; 12(1): 51-54.
- Jelliffe, D. B. and Jelliffe, E. F. P. The volume and composition of human
milk in poorly nourished communities. A review. Am J Clin Nutr 1978;
- Rohde, J. E. Breastfeeding beyond twelve months. Lancet 1988; 2:1016.
- Savilahti, V. M. et al . Prolonged exclusive breast feeding and heredity as
determinants in infantile atopy. Arch Dis Child 1987; 62 269-73.
- Shattock, F M. and Stephens, A. J. H. Duration of breastfeeding. Lancet
- Tangermann, R. H. et al. Breastfeeding beyond twelve months. Lancet 1988;
- Underwood, B. A. Weaning practices in deprived environments: the weaning
dilemma. Pediatr 1985; 75:194-98.
- Victora, C. G. et al. Is prolonged breastfeeding associated with
malnutrition? Am J Clin Nutr 1984; 39:307-14.
- Waletzky, L. R. Breastfeeding and weaning: some psychological
considerations. Primary Care 1979; 6:341-55.
- Whitehead, R. G. The human weaning process. Pediatr 1985; 75: 189-93.
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