How long should I breastfeed?

It seems like a simple question, but not one I feel I can answer with an exact time frame.

The World Health Organization and UNICEF recommend breastfeeding for two years, while the American Academy of Pediatrics (AAP) suggest “one year or longer.” Though these seem slightly varied, all agree that exclusive breastfeeding is best practiced until 6 months when solids are added. None offer an upper limit to the duration stated.

A recent study in Pediatrics states, “increased duration of breastfeeding… protects against infections requiring hospitalization in the first year of life but not hospitalizations or symptoms of infection at home beyond the first year.”

But this duration of breastfeeding may not be possible or sustainable for some families.

So how long do I recommend?

Short answer: For as long as you can... until you no longer feel served, available, able, or mutually fulfilled. Until you’re done.

Breastfeeding is certainly a labor. It doesn’t come easy to everyone. Some actually hate it and look forward to the day they can close the chapter and move on.

For those moms, the time may be now, because in the U.S., we do have alternative-milk options that do a great job in growing our kids.

But it is important to understand that breastfeeding doesn’t have to be all or nothing. Any is better than none. A week is better than a day. And there are benefits to two years that will exceed the benefits of a year.

So on the other end, when should we call it quits?

The answer for me is the same: For as long as you can... until you no longer feel served, available, able, or mutually fulfilled. Until you’re done.

And if it feels like you have to stand up for your feeding journey, because you buck the cultural norm here in America, the AAP has your back:

“Data on the scientific foundation for an age above which is appropriate or harmful to the child to continue breastfeeding do not exist. Nor are there reported risks to this method of social/nutritional interactions.”

Breastfeeding a toddler isn’t weird.

As always, I stand firm in my word.

If the baby is growing, if the momma is happy, and if the baby is happy then we are doing things right-breastfeeding, formula feeding, some of both.

Please reach out to me for coaching, encouragement, and ongoing support, so I can help you to meet whatever goal you have made to feed your child.

• No sensation of a let down
• No longer leaking milk
• Mom’s breast do not feel full (or engorged) anymore
• Unable to produce milk with a pump
• Baby does not stay at the breast as long as mom would like

Though some of these things may cause reason to look further, none are indicative of a poor milk supply.

The best way to gauge adequate supply is growth.

In the first few months of life, we expect babies to gain close to an ounce per day, and double their birth weight by 5 months.

Since you may not always have a scale handy, ask yourself questions like:

• Do you hear swallows during the feed?
• Does your baby seem content after the feed?
• Is your baby pooping 4 or more times per day? (this number falls around 3 months)
• Is your baby having 6 or more pale wet diapers per day?

If you answered these questions “yes”, then it is likely the baby’s weight is climbing as well. If some or many of the answers were “no”, then you should follow up with your child’s pediatrician for a weight check and/or evaluation.

Most mothers eat a varied diet with fortified foods (usually milk) containing Vitamin D, take prenatal vitamins, and have some exposure to sunlight while pregnant and have plenty of Vitamin D to pass on to their babies.

However, due to an increase in vitamin D deficient babies, the American Academy of Pediatrics published guidelines in 2003, recommending that all breastfed babies receive 400 mgs IU of Vitamin D drops each day.

The increased number of vitamin D deficient babies is likely due to the less amount of time today’s moms and babies spend in the sun. Darker skin tones, vegan diets, babies born in northern regions and those who cover completely (like religious veils) are at a higher risk for deficiency.

Talk with your child’s health care provider about vitamin D options for your child.

Related Topic:

• How Much Calcium and Vitamin D Does My Child Need?
• Do Your Kids Need Vitamins or Supplements?
• Let's Learn About ... Giving Your Kids Vitamins
• The life-saving reason your baby needs vitamin K

As a lactation consultant, I often hear regret from moms when they state that they “only nursed for ...” (insert perceived short time here.)

That always bothers me, because any distance that a mom makes in her breastfeeding journey, is a win to me.

New research also agrees, showing that moms who breastfed for just a couple of months, may have a significant reduction in the risk of SIDS.

In the United States, more than 80 percent of mother’s begin breastfeeding in some capacity at birth, but the number drops to about 22 percent for exclusive breastfeeding at 6 months.

Statistics like this may beg the question to some moms, is it worth doing at all, if you don’t plan to go the distance? And new research says, yes! Absolutely!

It does not have to be an all or nothing type of decision.

Realistically, I know that some mothers have no interest in breastfeeding from the start, while others find themselves at barriers that seem impossible to overcome, and decide that formula is a better option.

The truth still remains, the longer you breastfeed, the greater the benefits will be to you and your baby, but this new study shows that breastfeeding for at least two months cuts a baby's risk of Sudden Infant Death Syndrome almost in half!

SIDS is the leading cause of death in babies between 1 and 12 months, so this is not information to take lightly.

Interestingly, this study also showed that partial or combination feeding (breastfeeding and formula feeding) was also beneficial in lowering the risks, which was great news for the mommas that were not able to sustain their infant 100 percent from their breastmilk. However, exclusive breastfeeding, and longer durations did in fact decrease the risk of SIDS even lower.

At the end of the day, babies need to eat — and ultimately that’s our entire goal. Regardless if they are fed from the breast or the bottle, we believe we will get to the same outcome; beautiful, smart, thriving kiddos.

That said, breastmilk has many exciting benefits to mom and baby both. And if it is part of your plan, I am here to help you and baby reach whatever goals that you have set for yourself!

About the Author

Holly Erwin, LVN, IBCLC, is the virtual lactation consultation at Cook Children's. As a mom of three boys and has worked as a pediatric nurse for over 11 years within the Cook Children's Health Care System. When not working, she spends her time running to and from sports for her boys, being outside with her family and dreaming of traveling with her husband of 10 years. For now, she settles for their bi-annual date-night! Click here to learn more about the Virtual Lactation Consultant Program.

Through her own children and the thousands of moms that she has helped over the years, Holly found a special interest in infants and breastfeeding. In 2015, she became internationally board certified as a lactation consultant and now works as an IBCLC virtually through the Cook Children's telemedicine department.

Often, moms perceive that they do not make enough milk because they do not make “extra” milk.

Other times they think the baby is eating too often, or the breasts feel too soft, or the baby is fussy at certain times of the day, or they are unable to pump much milk.

Many complain they do not leak, that their baby nurses quicker than he or she once did, or that they are unable to feel a letdown.

Reality is, that none of these things mean that a mom has inadequate supply.

As the virtual lacation consult at Cook Children's, I ask questions like:

• Is the baby is growing?
• Are they having plentiful output (poops and urine diapers) each day?
• Are they waking often to feed and seeming satisfied after?

Since breastmilk is easily digested, breastfed babies may eat more often than bottlefed babies at somewhere between 8-12 times in a 24 hour period. The baby will be described as alert and active, and seems satisfied after feedings; often times with relaxed hands. Mom will also report hearing swallows during the feed.

The greatest indicator of sufficient milk intake is weight gain, though an initial loss is normal and expected as they shed the extra fluid in their tissues. Once the milk supply is in, we expect most babies to gain close to an ounce per day. After 3-4 months, the number will gradually slow down.

Another reliable indicator is output. By day 6 we expect to have 6 pale and mild smelling wet diapers and >4 bowel movements that have transitioned to the yellow, mustard, seedy stools. Over time, the number of stools will fluctuate and breastfed babies may go many days without a BM as their body is absorbing all of the nutrients. Even then, we expect soft and profuse stools.

The older the baby gets, the more adequate they feed, therefor spend less time at the breast and since many mothers do not feel their letdowns, that nor the firmness of the breast tell us how well the infant is being fed.

Virtual Lacation Consultation Program

Connect to an International Board Certified Lactation Consultant (IBLC) from the comfort of your own home. When caring for a newborn, it is important to have support for successful breastfeeding and nutrition. Cook Children's now offers that to you and your baby when and where you need it: in the comfort of your home. Click here to learn more about the program.

Schedule an appointment now

Consultation topics include:

• Correct latching
• Milk supply
• Feeding schedules
• Pump options and supplies
• Pumping routines/schedules
• Return to work planning
• Nutrition and skin care
• Newborn positioning
• Milk storage
• Pain or possible infection

Meet our Lacation Consultant

 

Holly Erwin, LVN, IBCLC, is a mom of three boys and has worked as a pediatric nurse for over 11 years within the Cook Children's Health Care System. When not working, she spends her time running to and from sports for her boys, being outside with her family and dreaming of traveling with her husband of 10 years. For now, she settles for their bi-annual date-night!

Through her own children and the thousands of moms that she has helped over the years, Holly found a special interest in infants and breastfeeding. In 2015, she became internationally board certified as a lactation consultant and now works as an IBCLC virtually through the Cook Children's telemedicine department.

If you don’t know her name, you more than likely have seen her photo because she has blown up the Internet with a photo of her breastfeeding her own son and the son of a friend.

For some it’s a beautiful expression of what’s perfectly natural. For others, it’s caused a range of emotion from “yuck” to outrage.

And for our lactation experts at Cook Children’s, well, they look at it as an opportunity to educate the public.

The lactation nurses at Cook Children’s have been busy working and had not seen the photo making the Internet rounds until called for this story. They realize that it makes many of us uncomfortable in the United States to see such a bold expression of a natural process. But they say it’s a common practice in many other countries around the world and accepted and sometimes expected culturally.

From a medical aspect, the lactation experts say milk sharing is becoming a more common practice but not without risks. There are numerous transmittable diseases that can be passed on through a mother's milk as well as many medications that will be passed on through milk too. As milk sharing is becoming more common there are even websites out there where people can share breastmilk with one another. Again, caution must be used when sharing breast milk.

To be perfectly safe, for those babies that have a medical need and prescription for breastmilk, they recommend a place like Mothers’ Milk Bank of North Texas, which allows moms to donate breastmilk. The mothers go through a screening process and is then the milk is pasteurized to make sure there’s no harmful bacteria.

The consultants hope that people don’t focus on the photo as much as they do the benefits of breastfeeding.

And for those of you wondering, “Aren’t those kids a little old to be breastfeeding?” Come on. We know a lot of you are. The World Health Organization recommends breastfeeding babies until at least 2 years of age.

The lactation nurses aren’t willing to weigh in as far as the emotional aspect of the picture or how it impacts them developmentally. Breastfeeding in a personal choice and one that we hope every mother will attempt. How long to feed your baby is personal and will be very different for each mother. At the end of the day, breastfeeding is supported by the World Health Organization, Center for Disease Control, the American Academy of Pediatrics just to name a few.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a baby’s life, “followed by breastfeeding in combination with the introduction of complimentary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.”

About the source

Because research shows that breast feeding helps improve babies' health and helps moms bond with their little ones, Cook Children's has full-time lactation specialists on staff to assist mothers with pumping and breastfeeding. We offer breast pumps in every room and have an on-site milk bank available for safety and storage. There are numerous resources available through lactation services for moms that are having difficulty with nursing/pumping. While other nurses are focusing on the baby's care, the lactation consultant can provide extra attention to mom.

The anger and subsequent anxiety I felt after hearing about “The Newborn Sleep Book” surprised me. I am not a “crunchy” pediatrician by any means. I have taught families to sleep. This is why the feeling I got in my stomach is unexpected.

The book is written by two pediatricians in New York who happen to be brothers, Lewis and Jonathan Jassey. The premise is that, through proper training, you can space a newborn’s feeds out to every 4 hours, resulting in them being able to sleep through the night. Their recommendations include: allowing them to cry until their scheduled feeding time, using Benadryl^® for sleep disruptions and increasing feeding volumes during the day to enable skipping nighttime feeds. It’s not the fact that they recommend sleep training; it’s their method that I find upsetting.

This goes against everything you are likely to hear from your pediatrician (certainly me), including the American Academy of Pediatrics. The AAP says some newborns feed as often as every 1.5 hours, while others about every 3 hours. The AAP also says breastfed newborns will feed 8-12 or more times per 24 hours once a mom’s milk has come in.

Oh and here’s something else important from the AAP: “If your baby isn't waking on his own during the first few weeks, wake him if 3-4 hours have passed since the last feeding.”

So that’s a group of 62,000 pediatricians’ recommendations who I tend to agree with on most things and two pediatricians who I couldn’t agree with less.  But I’m not finished making my case. Here are 8 myths I found particularly bothersome in the book:

1. MYTH: The authors have “continually researched and practiced (their) method, adjusted, and practiced some more.”

FACT: The best report of their results is this: a “ballpark estimate is that, since we started coaching parents …over 15 years ago, nine out of 10 parents who have followed through have been successful.” My scientific mind is not satisfied and neither should yours. I am not asking for a randomized, double-blind placebo trial, a simple survey would have been better than a “ballpark” estimate.Very few things in medicine have a 95 percent success rate. So, if you have the research, prove it … if not, it would not be that hard to get.

2. MYTH: Their method is the best way to get your child to sleep through the night.

FACT: The results I do see reported in the book are underwhelming. Their testimonials of patients who began to sleep through the night, included children with ages ranging from 6 weeks to 3 months.  A 2010 study in Pediatricsshowed that 37 of 75 babies were sleeping through the night during their third month. If you took testimonials of parents from that study (which are often the best case scenario), I would imagine you would find plenty of babies who would be sleeping through the night just as early as the Jassey families, many with no fancy plan.

3. MYTH: The authors are Ok with saying that their method may not work for everyone.

FACT: They go on to say later, “sleep training is by no means selfish on the part of the parents. In fact, since its benefits to both baby and family are undeniable, we might say that not sleep training…is a more selfish choice.” First of all, “undeniable?” Not so fast. That is still up for debate. I guess everyone has the right to make their own choices, even if they don’t mind making selfish choices, by not sleep training their children. It’s like saying; there really are no dumb questions, unless you ask a dumb question.

4. MYTH: Scheduling, even from a very early age poses no risk to babies.

FACT: Scheduling from birth as they suggest is dangerous and puts babies at risk, period. Not feeding on demand puts moms at risk for lactation failure. Their recommended 8-12 feedings (for 1-2 days) on demand is not enough for many moms to establish good milk supply. Ask any lactation consultant or pediatrician who understands milk production and they will either laugh or cry at the suggestion that scheduling this early will not affect milk production. In addition, infrequent feeding places babies at risk for increased weight loss and more severe jaundice, which requires further treatment and testing. If you are my patient, please do not schedule your baby from birth!

5. FACT: Crying babies are not all hungry (I actually agree with them, up to a  point …)

MYTH: You should never feed a baby before the time you have scheduled for them.

FACT: The authors state that our first response to a crying baby should not always be to feed them (again, I agree). However, I feel that we can go through our usual steps to comfort them (change diaper, pacifier (if a family chooses), rocking, etc.) and if they do not work, it is reasonable to attempt to feed.

6. MYTH: The authors state that they do not endorse formula feeding over breastfeeding.

FACT: Their method involves careful measuring of volume to ensure your baby gets enough each day don’t “have” to feed at night. Breast feeding simply does not work this way. A breastfeeding mom can’t simply feed a little bit longer… when the breasts are empty, they’re empty. So, while they may not endorse formula feeding, their method could push families toward formula feeding.

7. MYTH: If your baby’s sleep is disrupted for any reason (teething, vaccines, etc.), a combination of Tylenol^®, Benadryl^® and Motrin^® will help to “reset their clock.”

FACT: Uhhh, not for my patients. If your baby is fussy and you think it might be pain from teething, I am Ok with giving a dose of Tylenol or Motrin, but not along with Benadryl. The benefit is slim and the risk of an adverse event (whether appropriately or inappropriately dosed) is too high. Of course, they also mention using teething gels and you should know how I feel about them. There is no reason to treat a normal developmental stage with medicine.

8. MYTH: Feeding your child on their schedule means they will not “become hungry at inconvenient times-like 2 a.m.”

FACT: Parenting is about facing inconveniences. are ways to help your child fit into your life better than others, the very premise of this statement offends me. I’m sorry if your little baby woke up and tried to bother you at night for something to eat. I hope it wasn’t too much of an inconvenience.

The authors do address a concern in their book. It happens to be about co-sleeping, but that’s not important to them:

“We are inherently suspicious of any parenting technique that is so obviously weighted to the parents’ wants over the potential benefits to the child.”

Huh? Me too. This is why I would never recommend their book to my parents.