breastfeeding for how many months?

[Zerub]

Does anyone know when the benefits of breastfeeding really start to tail off? The NHS say "at least 6 weeks" and the WHO say "at least two years" and La Leche League would probably say about 5 years. But presumably there is a point when the health benefits to the baby of b'feeding over formula (or cow's milk or lots of yoghurt!) starts to be very small? Does anybody know of any research / statistics / opinion on this? Not that my 5-month-old bottle-refusnik dd looks likely to give up the breast, but you never know...

I think after 6(?)months you have to make sure they get enough iron?

Breastmilk is always nutritious and always contains antibodies, so it's always a 'healthy' drink.

But once a baby starts having other things to eat and drink - after about six months - alongside breastmilk, then it becomes less easy to 'prove' that healthy breastfed toddlers are that way because of breastmilk. You can't really do a scientific, controlled investigation.

Babies' own immune systems start to mature in later babyhood and toddlerhood as well, so breastmilk's protection against infection is not 'needed' as much.

However, the WHO studies conclude that at least two years is measurably beneficial, especially in cultures where the risk of death or illness from diarrhoea is high. This doesn't apply in the West, by and large, so the concrete health benefits are not so great.

There are papers which show that bf for two years is protective to the mother, from breast cancer.

Most mothers of babies who bf beyond six months or a year are not really 'doing it' for the health benefits, or the health thing isn't at the forefront of their mind. They're doing it 'cos they like it and so do the babies, and because it can be a convenient way to soothe and nourish the baby/toddler.

Where does the NHS say 'six weeks' Zerub??

OK, "6 weeks" probably isn't the official NHS line, just that the staff on the postnatal ward were pushing everyone to "try it" for at least 6 weeks. Although possibly they knew that if we survived 6 weeks of breastfeeding we'd probably have got to like it by that stage and so would carry on!

Zerub - I don't think you can put it in terms of 'benefits tailing off' ... seems a bit odd to say it like this. However I assume you are asking how long to do it, and what difference it makes over and above other forms of milk. Well breast milk is specially adapted for the baby and is easier to digest and so best for it to have that when milk is its main source of nutrition. This is about a year. After that baby doesn't need so much milk in any form.

Breastmilk provides antibodies - other milks don't so for as long as you decide to breast feed (be it months or years) you will give your child protection against illnesses. It is up to you really how long you want to do it. Indeed we don't have serious illnesses in the west but on the whole breastfed babies have fewer illnesses such as stomach upsets/ear infections. The immunological protection of breastmilk doesn't lessen at all - the milk for a 6 week baby provides the same protection than that of a 2 year old. The point is that the child's immune system develops. No-one knows exactly when a child's immunity is mature - it is a gradual thing but probably takes around 6/7 years.

I asked two different paediatric consultants this ( dd was involved in a breast feeding v bottle study so I ahd plenty of access!) and the both said between 4 and 6 months - definitely after 6 months if I wanted to carry on great but only if it suited me as it wasn't doing dd any significant 'good' over bottle feeding by that point.

This is an excerpt from an article on the page of Dr Dettwyler (Professor of Anthropology and Nutrition) www.prairienet.org/laleche/dettwyler.html

A Natural Age of Weaning
by Katherine Dettwyler, PhD

In terms of the benefits of extended breastfeeding, there have been a number of studies comparing breastfed and bottlefed babies in terms of the frequency of various diseases, and also IQ achievement. In every case, the breastfed babies had lower risk of disease and higher IQs than the bottle-fed babies. In those studies that divided breastfed babies into categories based on length of breastfeeding, the babies breastfed the longest did better in terms of both lower disease and higher IQ. In other words, if the categories were 0-6 months of breastfeeding, 6-12 months, 12-18 months and 18-24+ months, then the 18-24+ month babies did the best, and the 12-18 month babies did the next best, and the 6-12 months babies did the next best, and the 0-6 months babies did the worst of the breastfed groups, but still much better than the bottlefeeding group. This has been shown for gastrointestinal illness, upper respiratory illness, multiple sclerosis, diabetes, heart disease, and on and on and on. Likewise, the babies nursed the longest scored the highest on the IQ tests. One important point to notice is that none of these studies looked at children who had nursed longer than 2 years. Anyone 18-24 month or longer was lumped into big category. Presumably, the benefits continue to accrue, as your body doesn't know that the baby has bad a birth day and suddenly start producing nutritionally and immunologically worthless milk.

However, no one has yet proved, either way, that the benefits of breastfeeding either continue or stop at two years of age, because the appropriate studies have not been done. The trend during the first two years is clearly for continuing benefits the longer you nurse. Clearly the phenomenon of dimishing returns is at work here -- the first six months of breastfeeding are clearly much more important in terms of the baby's nutrition and immunological development than the six months from 3.5 to 4.0 years. That doesn't mean that you shouldn't continue to provide breast milk if your baby wants and you don't mind.

Clearly, babies born in the U.S. don't have to contend with all the diseases and parasites and contaminated water that babies in Third World countries do. We have more supplementary foods that we can generally trust to be safe and clean. We can get our children immunized, and get them antibiotics for infections when necessary. The fact that we can does not mean that breastfeeding is unimportant. Breastfed babies still have the "edge" over bottlefed babies, even in a squeaky clean environment with wonderful medical care. They get sick less often, they are smarter, they are happier. Another important consideration for the older child is that they are able to maintain their emotional attachment to a person, rather than being forced to switch to an inanimate object such as a teddy bear or blanket. I think this sets the stage for a life of people-orientation, rather than materialism, and I think that is a good thing. I also can't imagine living through the toddler years without that close loving connection to a child going through enormous changes, some of which are very frustrating to the child.

bayleaf - I don't understand how a paediatric consultant could say this! I am rather shocked -I am not saying that giving them bottles after this time is bad but surely wrong to imply it makes no difference.

Quite, Eulalia. A very interesting article, sets out the facts as I have always understood them.

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I was told when I had ds that there had been a study done at the hospital that had shown in addition to the expected benefits of b/f re immunity etc, there was an unexpected correlation with fewer Ear Nose and Throat problems. I think the theory was the the sucking motion of b/f babies has beneficial effects on the whole development of the nasal etc cavities. I don't know if they did any research into length of b/f though.

I know the article you mean robinw - it was a poor study and was effectively rubbished at the time.

No-one has come up with any conclusive evidence that breastfeeding for any length of time is bad for you. On the face ot it (ecologically speaking), it would be a bit daft. Obviously for a newborn breastmilk is vital but for a 5 year old it's mostly just comfort but there is no need to suddenly stop because the calendar says so.

By the time there are any concerns about iron and vitamins most babies are onto solid food and getting these nutrients fine if they have a balanced diet. You only need about 15 mins exposure to strong light per day and some stores will gather during winter.

JanZ - interesting, although mostly ENT problems are less in b/fed babies due to less infections, particularly 'glue ear'.

Eulalia I've no idea! At the time I'd not ready widely on the subject but was keen to do ''my best'' by dd despite the fact that it had been sooooo painful for the fist couple of months that I'd never been a great fan ( after it stopped hurting I felt neutral about it but I was not going to carry on indefintely unless there was some definite benefit to dd as I wanted to try for another child and had no periods whilst feeding)
I didn't get into an in depth discussion with either consultant as I wasn't well enough informed - I just asked a straigtforward question and got a pretty clear cut answer both times...

i personally have decided to bf until Dillon is able to drink normal milk, not formula. So about a year. I would feel uncomfortable bfing a toddler of walking age but thats just me. i have nothing against extended bfing.
the reason why i never wish to give formula is because although rare it has been known to be contaminated with bacteria. In March this year a 5 day old baby contracted meningitis from the bacteria in his powdered milk. This was in belgium, not a 3rd world country. I also don't wish to use a bottle anyway. My eldest gave his up at 10 months so i imagine Dillon will be more than capable with a cup by a year too!

tracy
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tracyhay, re what you say about not feeling comfortable breastfeeding a toddler, I felt like this until my d.s. (3rd child) started to walk last month. He has now just turned 1 and despite a few problems recently with painful feeding, I don't feel at all ready to give up. Strange how you change

I never thought I'd breastfeed much past 1 yo, and now I'm gutted that my 1yo doesn't want to nurse more often... LOL.

ROBINW: are you referring to the study in the BMJ that was funded by a formula manufacturerer? That found that babies breastfed at least 4 months had slightly higher levels of a certain fat in their blood in the mid 20s, and that certain fat is thought to be associated with heart disease?

Just that I found that study really unconvincing; or inconclusive, at best. I think you could pick on the asthma link (or rather, the contradictory evidence about whether breastfeeding increases or decreases the risk for asthma) -- to point out that breast may not always be best.

Breastmilk for toddlers is still packed with antibodies to help them with illness; and any one who has breastfed a toddler with a terrible tummy bug will be grateful to get at least some nutrition into them (breastmilk is often the only non-water calorie source a vomitting child can keep down).

And the greatest health benefits to the mother all seem to come with breastfeeding for longer periods.

ROBINW (sorry to pick on you!)
But the thing about essential fatty acids... didn't a US study just find that giving babies the new formulas with the extra fatty acids (DHAs?) in them... seems to lead to lower weight gains than in breastfed or ordinary formula fed babies??

Oh well, maybe I'm making it up. Can't find it on dejanews, but sure I've seen mention of something like that.

oxocube, i have thought that i may change my mind in the future. i know i'll miss it.
I feel bad sometimes for dp as he is left out so I'm sending him to baby massage classes so he can have something of his own to do with Dillon that is enjoyable for both of them too!

A friend of mine researched this and decided that after six months, the health benefits of BF were not significantly greater than formula. But she felt the convenience might still make it worthwhile. After a year, when you don't have to sterilise and can give them milk in a cup, this is probably less likely to be true. This ignores the emotional aspects which IMO are likely to be the key determinants of how long you keep going. We are still going at 11mths and can't see DS giving it up any time soon.

PS Tracyhay, how old is your baby? IME after your baby learns to roll on the mat, the chances of them staying still for a massage are very small.

Zebra, from what I've read, the research linking bf and asthma is pretty poor, too. Although it purported to compare bf with ff babies, in fact some of the bf babies had been given ff at some stage, therefore were not exclusivly bf and also there was no standardisation of how long the babies had been bfed. A week of bfing could be enoguh for them to count as a bf baby.

florenceuk - babies are exposed to many infections in their first couple of years. The difference between b/milk and formula is that formula has no antibodies so breastfeeding after 6 months will still protect your baby. This is why it is recommended to breastfeed for "up to 2 years". I would have thought that if anyone was to breastfeed at all then why not do it for at least a year and then you don't have the expense of any formula.

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Eulalia, I think because your baby starts to manufacture its own antibodies, that becomes a bit less of an issue after six months. Have to admit I'm confused over the issue because I have read that up to six months they have an "open" gut and your antibodies just go straight into their bloodstream - but after that period have no idea what happens. I think it depends a lot on what you're willing to trade off - a bit more freedom for mum vs a higher risk of infections for baby. Said friend is a vet, and did do quite a bit work on this topic, so I tend to trust her judgement. But obviously there are continuing benefits from BF, just a question of how big they are relative to the perceived benefits to the mum from weaning - esp if you are going back to work. Have to say, expressing was total nightmare until I bought an electric pump - I would have given up within a month of going back to work otherwise.

Another thing - I'd be very surprised if it came out that it was definitely better to give up from a health point of view, given that BM is after all, human milk, and we should have evolved to live off it. But then again, I read somewhere that in Iceland, they gave up BF for two centuries!! And used chewed fish as a substitute.

This question is not designed to prove any point, but in people's experience, do b/fed babies develop fewer infections than bottle fed ones? I mean, based on actual examples from your own circle of friends & relatives. It's just that I find that all the b/fed babies I know of seem to be permanently ill! They catch every bug going. The thing that makes a difference seems to be not breast vs formula but being mainly stay-at-home versus going to nursery/playgroups.

I b/fed exclusively for 4 months so am not trying to justify early use of formula, but it just seems odd that the much publicised benefits never seem visible in real life... If I'm missing the point, I'm sure someone will put me right.

DS caught his first cold at 3 weeks having been exclusively breast fed and having come into contact with no other children. This lasted 3 weeks. He has since at loads of colds etc which may have been made worse by starting nursery at 15 weeks - this roughly coincided with introducing formula so who knows. He got his first tummy upset 2 days after starting nursery. I definitely put this down to nursery.

I tend to think that he is susceptible to colds etc which breast feeding, avoiding children may help but not prevent. Whereas he has a reasonably strong stomach and would probably not have had many upsets if he hadn't gone to nursery. That first upset 2 days after starting nursery he passed on to both DH and me so I don't think breast feeding would have prevented it.

Several months after starting nursery he stopped getting tummy upsets- built up immunity? but still gets frequent colds and has a glue ear issue.

Good point Catt, like Bozza with us it was definitely the mixing with other babies that started the colds etc.

dd first went to nursery at 5 months (still b/f) and immediately caught everything going.

The worst of it was she always puked when she had a cold at that age - but only after a breastmilk feed - straight off the nipple, straight down me. I got puked on at 4am so many times I had to sit on a towel to b/f. ahhh, happy days...