About 24 hours ago I balked at the idea of breastfeeding my daughter for longer than the 6-12 months I’d first had in mind. My sister even posted a humoristic point of view on extended breastfeeding yesterday.
I currently breastfeed almost exclusively (except for a bottle of expressed milk during dream feeds). I personally enjoy the experience: the oxytocin release, the pheromone exchange, the ease and accessibility, the lack of dishes associated to it, the cuddle time… on top of all the benefits for my baby. I’m not your flame throwing “lactivist” though, and for some time I strongly believed that extended breastfeeding (in my mind, that was past the age of 18 months) was actually detrimental to a child’s development and just plain weird. I even slightly lashed out at a blogger who shared her struggles with weaning her 5 year old daughter (which I still find excessive and not my personal taste, but to each their own, right?) The blogpost garnered a lot of heated discussion about the preconceptions about extended breastfeeding and some even attempted to state that it could be detrimental to the mental and emotional development of a child.
That got me wondering… Are the myths about extended breastfeeding true? Does it really help increase a child’s IQ; does it help counter childhood depression; does it help Mom fight postpartum depression; is the average worldwide weaning age really 4 years old?!
From The Long-Term Effects of Breastfeeding on Development** research paper, which I actually liked compared to the others I read because it referred to 26 previous studies and attempted to weed out methodological errors (see bibliographical info below):
“Breastfeeding for a longer duration appears to have significant benefits for the development, cognitive IQ, educational attainment and mental health of the child into adolescence. Our study has demonstrated that following adjustment for socioeconomic, psychological and maternal exposures in early life, a longer duration of breastfeeding was positively associated with the developmental, cognitive, educational and psychological health and wellbeing of children and adolescents.”
So what does that mean concretely? Here’s what they had to say, summarized.
- (…) children breastfed for longer performed better on tests of cognition, verbal ability and school performance.
- Breastfeeding may influence children’s academic achievement by promoting brain development and general health. Nutrients in breast milk that are essential for optimum brain growth, such as long-chain polyunsaturated fatty acids (LCPUFA), may not be contained in formula milk (Larque, Demmelmair et al. 2006).
- Gender differences are apparent in the effect of breastfeeding on early development whereby girls appear to be less responsive to extended breastfeeding than boys. A longer duration of breastfeeding remained predictive for academic achievement in ten-year-old boys for mathematics and spelling with a small but insignificant benefit for reading in girls.
- The effect of breastfeeding on speech and reading in boys was reported in a later follow-up, suggesting that breastfeeding accelerates the rate of maturation of boys (Broad 1972; Broad 1975).
- In particular, we observed that the developmental domains of adaptability and communication were most responsive to the effects of breastfeeding duration, with children breastfed for longer than four months being more likely to have higher scores in these domains. Our findings pertaining to the communication domain of early development are consistent with a previous study that has found a link between an increased length of breastfeeding and mastery of developmental milestones including polysyllabic babbling (Vestergaard, Obel et al. 1999).
- Breastfeeding may have long-term consequences for child mental health outcomes because of the maternal fatty acids and other bioactive components essential for neurodevelopment (Keating and Hertzman 1999; McCain and Mustard 1999; Yehuda, Rabinovitz et al. 1999). Further, breast milk may contain elements relevant to the stress response. For example, the hormone leptin in breast milk may reduce stress in infants through its action on the hippocampus, hypothalamus, pituitary gland, and adrenal gland (Montgomery, Ehlin et al. 2006), whereas formula milk may have a depressant effect on newborn behavior (DiPietro, Larson et al. 1987).
- In humans the pattern of mother-infant interaction differs between breastfeeding and bottle-feeding. The amount of mutual touch, tactile stimulation and mother’s gaze to infant were significantly elevated during breastfeeding compared with bottle-feeding (Lavelli and Poli 1998). Breastfeeding helps promote attachment between the mother and the infant which is known to have a positive influence on the child’s psychological development into adulthood (Crowell and Waters 2005).
- A very interesting point was on the effects of stress on the child caused by divorce: Later childhood outcomes in breastfed children include greater resilience against stress and anxiety associated with parental separation and divorce at ten years in a study of 8958 children (Montgomery, Ehlin et al. 2006).
“According to Statistics Canada, more than 62% of babies are weaned before they are six months old. (…) the Canadian Pediatric Society breastfeeding goals of exclusive breastfeeding [is] six months (their average age of introducing other food or drink is 6.5 months) and continued breastfeeding to one year or longer (their average age of weaning is 19 months).”
The results from this review suggest that women with depressive symptomatology in the early postpartum period may be at increased risk for negative infant feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy.
Similarly, the AHRQ report on breastfeeding and maternal and infant health outcomes concludes:
It is plausible that postpartum depression led to early cessation of breastfeeding, as opposed to breastfeeding altering the risk of depression. Both effects might occur concurrently.
SO! ALL OF THAT BEING SAID!!! (That was a lot of friggin info!) It’s now pretty clear to me that I will go forward with breastfeeding for as long as possible considering my own lifestyle and return to work (planned for when my daughter reaches 11 months). Though exclusive breastfeeding will not be possible at that point, I will breastfeed her until perhaps 18 months and I will continue to feed her expressed milk for longer, until as long as I can no longer stand pumping breast milk. Hopefully past the age of 2 years.
*NOTE: Although the papers differentiated breastfeeding from bottle feeding formula, they did not seem to factor in bottle feeding expressed milk.
**Main Source: Wendy H. Oddy, Jianghong Li, Monique Robinson and Andrew J.O. Whitehouse (2012). The Long-Term Effects of Breastfeeding on Development, Contemporary Pediatrics, Dr. Öner Özdemir (Ed.), ISBN: 978-953- 51-0154-3, InTech, Available from: http://www.intechopen.com/books/contemporary-pediatrics/the-long-term- effects-of-breastfeeding-on-development
***Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine.