Benefits for children over one year of age

Why should I breastfeed my baby past the first year?

The benefits of breastfeeding do not stop when the baby becomes a toddler or older child but continue for as long as the child breastfeeds. Extended breastfeeding (breastfeeding after the child has reached one year of age) has been shown to decrease malnutrition and illness, prevent infections, and reduce the risk of the child developing health problems like heart disease or stroke later in life. Breastfeeding benefits mothers too, reducing the risk of disease and promoting weight loss. There is no evidence of developmental or psychological harm from breastfeeding into the third year of life or longer. Rather this practice is recommended and is normal in many areas of the world.

A) Recommendations

Breastfeeding a child after the child has reached one year of age is sometimes called extended breastfeeding and is part of the normal breastfeeding continuum.

Nearly all organizations that aim to help mothers and children recommend that children breastfeed for two or more years. As many of the benefits of breastfeeding are related to how long babies and children breastfeed, no organization has recommended a limit on the duration of breastfeeding.

B) Breastfeeding children over one year of age

Mothers can face cultural barriers when breastfeeding a toddler or older child, yet there are many benefits and no evidence of developmental or psychological harm from breastfeeding into the third year of life or longer (Delgado 2017; Dettwyler 1995).

Mothers can breastfeed while pregnant if they are not at an increased risk of premature delivery and are gaining enough weight. After birth, they can continue to breastfeed an older child along with a new one. This is called tandem breastfeeding and has benefits for the mother and both children.

C) Benefits for children

Some mothers of toddlers and older children believe they are not producing much milk because their breasts don’t feel full anymore and they only express small amounts and therefore assume there is no point in breastfeeding. These are normal changes, as the breast becomes more efficient at making milk and the amount of milk made after one year slowly decreases (Kent 1999). 

1) Providing nutrients

Extended breastfeeding protects toddlers and older children from malnutrition (Lackey 2021; Prentice 1994).

At two years, mothers still produce between 95 millilitres (3 U.S. fluid ounces) and 730 ml (25  oz) of milk per day. Breast milk can provide one-third of a toddler’s calories (Onyango  2002; Scott 2016). Breast milk also provides significant amounts of other nutrients such as protein, vitamins, and iodine.

Table: Percent of Daily Nutrients Provided by Breast Milk Between 12 and 24 Months (Dewey 2001)

Nutrient

Percent (%) of Daily Requirement Provided by Breast Milk

Energy (calories)

30

Protein

43

Vitamin A

75

Folate

76

Vitamin B12

95

Vitamin C

60

Calcium

35

Copper

28

Iodine

70

Selenium

66

Mature breast milk is relatively consistent in its makeup, even after one year of breastfeeding. For example, it provides a regular source of health-promoting bacteria.

There are small changes in some components. For example, carbohydrates decrease and the following increase:  

2) Protection from infection

Toddlers and older children who breastfeed have fewer ear, eye, throat, stomach, and overall infections (Ardıç andYavuz 2018; Bowatte et al. 2015; Frank et al. 2019; Rowland 2020).

For example, one study (Kørvel-Hanquist 2018) showed that breastfeeding for more than 18 months reduced the risk of ear infections by 23% compared with breastfeeding for less than 6 months.

3) Protection from chronic diseases

Extended breastfeeding reduces the child’s risk of later  diabetes, heart disease, or stroke by reducing the child’s  waist circumference and blood pressure (Wong 2018). 

Extended breastfeeding reduces the child’s risk of obesity (Bell 2018; Kong 2020; Zheng 2020) and supports heathy body development (Gridneva 2020).

Breastfeeding past 12 months of age appears to decrease the risk of hay fever (environmental allergies), Crohn’s disease, and constipation (Agakisiyeva 2020; Han et al. 2019; Ng et al. 2015; Xu et al. 2017).

4) Benefiting brain development

Extended breastfeeding provides nutrients that allow for normal brain growth and prevents infection. Breastfeeding reduces a child's stress by calming them when hungry, thirsty, lonely, sad, in pain, tired, cold, and even bored. These effects probably combine to reduce inflammation and harmful stress and thereby optimize brain growth and development.

Studies have shown that extended breastfeeding improves the child’s motor skills, communication skills, and brain development (Grace 2017; Lee 2016;  Plunkett 2021; Victora 2015).

Long-term breastfeeding promotes bonding (Tharner 2012; Weaver  2017)  and supports mental health and relationships during the teen years (Fergusson 1999; Oddy 2010). 

5) Facilitating the transition into child care

If the mother is returning to work, continued breastfeeding can (Franco-Antonio 2021):

  • Minimize the number of changes for a child and continue to provide a familiar, warm, and safe environment.
  • Protect the child from infections resulting from exposure to other children in child care.
  • Protect the child from stresses caused by new child care arrangements.

D) Benefits for mothers

Breastfeeding has many benefits for mothers, and longer breastfeeding provides more benefits. Extended breastfeeding has been shown to  decrease the mother’s risk of the following:

  • Breast, ovarian, endometrial, and thyroid cancer (Cao 2015; Jeong 2017; Kim 2018) 
  • Breast cancer returning (Baglia 2019)
  • Type 2 diabetes (Gunderson 2018)
  • Endometriosis  (Farland 2017)
  • Rheumatoid arthritis  (Chen 2015)
  • High blood pressure (hypertension) (Qu 2018) 
  • High levels of unhealthy fats in the blood (Schwarz 2002)
  • Disease of the blood vessels of the heart and body (cardiovascular disease) (Ley et al. 2020; Schwarz 2002) 

Extended breastfeeding:

Parenting is easier when:

  • The child is healthier. 
  • The child can be quickly and easily calmed. 
  • Families have food security.

References

Ardıç C and Yavuz W. Effect of breastfeeding on common pediatric infections: a 5-year prospective cohort study. Arch Argent Pediatr 2018:116(2):126-132 

Agakisiyeva G, Yildirim D, Hizarcioglu-Gulsen H, et al. Nutritional characteristics of patients with functional constipation aged 4 years and older. Minerva Pediatr. 2020 Sep 22

Baglia ML, Tang MC, Malone KE, et al. Reproductive and menopausal factors and risk of second primary breast cancer after in situ breast carcinoma. Cancer Causes Control. 2019 Jan;30(1):113-120
 
Bell S, Yew SSY, Devenish G, et al. Duration of Breastfeeding, but Not Timing of Solid Food, Reduces the Risk of Overweight and Obesity in Children Aged 24 to 36 Months: Findings from an Australian Cohort Study. Int J Environ Res Public Health.  2018 Mar 26;15(4). pii: E599 
 
Bowatte G, Tham R, Allen KJ, et al. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatr. 2015 Dec;104(467):85-95
 
Cao Y, Wang Z, Gu J, et al. Reproductive Factors but Not Hormonal Factors Associated with Thyroid Cancer Risk: A Systematic Review and Meta-Analysis. Biomed Res Int. 2015;2015:103515

Chen H, Wang J, Zhou W, et al. Breastfeeding and Risk of Rheumatoid Arthritis: A Systematic Review and Metaanalysis. J Rheumatol. 2015 Sep;42(9):1563-9

Delgado C, Munhoz T, Santos I, et al. Prolonged breastfeeding for 24 months or more and mental health at 6 years of age: Evidence from the 2004 Pelotas Birth Cohort Study, Brazil. Child & Adolescent Mental Health  [serial online]. November 2017;22(4):209-215 
 
Dettwyler KA. A time to wean: the hominid blueprint for the natural age of weaning in modern human populations. In: Stuart-Macadam P, Dettwyler KA, eds. Breastfeeding: Biocultural Perspectives. Hawthorne, NY: Aldine de Gruyter; 1995:39-73 

Dewey KG. Nutrition, growth, and complementary feeding of the breastfed infant. Pediatr Clin North Am. 2001 Feb;48(1):87-104

Farland LV, Eliassen AH, Tamimi RM, et al. History of breast feeding and risk of incident endometriosis: prospective cohort study. BMJ. 2017 Aug 29;358:j3778  

Fergusson DM, Woodward LJ. Breast feeding and later psychosocial adjustment. Paediatric and Perinatal Epidemiology 1999;13(2):144-157 

Franco-Antonio C, Santano-Mogena E, Cordovilla-Guardia S. Influence of Breastfeeding in the Adaptation of and Absenteeism of Infants in Early Childhood Centers: A Preliminary Study. Int J Environ Res Public Health. 2021 Jan 12;18(2):602

Frank NM, Lynch KF, Uusitalo U, et al. The relationship between breastfeeding and reported respiratory and gastrointestinal infection rates in young children. BMC Pediatr. 2019 Sep 18;19(1):339
 
Grace T, Oddy W, Bulsara M, et al. Breastfeeding and motor development: A longitudinal cohort study. Hum Mov Sci. 2017 Jan;51:9-16 

Gridneva Z, Lai CT, Rea A, et al. Human milk immunomodulatory proteins are related to development of infant body composition during the first year of lactation. Pediatr Res. 2020 May 21

Gunderson EP, Lewis CE, Lin Y, et al. Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years: The 30-Year CARDIA Study. JAMA Intern Med. 2018 Mar 1;178(3):328-337
 
Han DH, Shin JM, An S, et al. Long-term Breastfeeding in the Prevention of Allergic Rhinitis: Allergic Rhinitis Cohort Study for Kids (ARCO-Kids Study). Clin Exp Otorhinolaryngol. 2019 Aug;12(3):301-307

Jeong SH, An YS, Choi JY, et al. Risk Reduction of Breast Cancer by Childbirth, Breastfeeding, and Their Interaction in Korean Women: Heterogeneous Effects Across Menopausal Status, Hormone Receptor Status, and Pathological Subtypes.  J Prev Med Public Health.  2017 Nov;50(6):401-410 
 
Kent JC, Mitoulas L, Cox DB. Breast volume and milk production during extended lactation in women. Exp. Physiol. 1999 Mar;84(2):435-47

Kim H, Kim KY, Baek JH, et al. Are Pregnancy, Parity, Menstruation and Breastfeeding Risk Factors for Thyroid Cancer? Results from the Korea National Health and Nutrition Examination Survey, 2010 to 2015. Clin Endocrinol (Oxf). 2018 May 28

Kong KL, Burgess B, Morris KS, et al. High intake of added sugars is linked to rapid weight gain in infancy, breastfeeding ≥12 months may protect against this: A preliminary investigation. Pediatr Obes. 2020 Sep 23:e12728
 
Kørvel-Hanquist A, Koch A, Lous J, et al. Risk of childhood otitis media with focus on potentially modifiable factors: A Danish follow-up cohort study. Int J Pediatr Otorhinolaryngol. 2018 Mar;106:1-9 

Lackey KA, Fehrenkamp BD, Pace RM, et al. Breastfeeding Beyond 12 Months: Is There Evidence for Health Impacts? Annu Rev Nutr. 2021 Jun 11

Ley SH, Chavarro JE, Hinkle SN, et al. Lifetime duration of lactation and chronic inflammation among middle-aged women with a history of gestational diabetes. BMJ Open Diabetes Res Care. 2020 Oct;8(2):e001229

Marquis GS, Habicht JP, Lanata CF, et al. Breast milk or animal-product foods improve linear growth of Peruvian toddlers consuming marginal diets. Am J Clin Nutr. 1997 Nov;66(5):1102-9 
 
Ng SC, Tang W, Leong RW, et al. Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific. Gut. 2015;64(7):1063–1071
 
Oddy WH, Kendall GE, Li J, et al. The long-term effects of breastfeeding on child and adolescent mental health: a pregnancy cohort study followed for 14 years. Journal of Pediatrics 2010;156(4):568-574

Onyango AW, Receveur O, Esrey SA. The contribution of breast milk to toddler diets in western Kenya. Bull World Health Organ. 2002;80(4):292-9   

Lee H, Park H, Ha E, et al. Effect of Breastfeeding Duration on Cognitive Development in Infants: 3-Year Follow-up Study. J Korean Med Sci. 2016 Apr;31(4):579-84

Plunkett BA, Mele L, Casey BM, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Association of Breastfeeding and Child IQ Score at Age 5 Years. Obstet Gynecol. 2021 Mar 10

Prentice A. Extended breast-feeding and growth in rural China. Nutr Rev. 1994 Apr;52(4):144-6 

 Qu G, Wang L, Tang X, et al.  Association Between Duration of Breastfeeding and Maternal Hypertension: A Systematic Review and Meta-Analysis. Breastfeed Med. 2018 Apr 26 

Rowland R, Sass Z, Ponsonby AL, et al.; Barwon Infant Study Investigator Group. Burden of infection in Australian infants. J Paediatr Child Health. 2020 Sep 23

Scott J, Davey K, Ahwong E, et al. A Comparison by Milk Feeding Method of the Nutrient Intake of a Cohort of Australian Toddlers. Nutrients.  2016 Aug 16;8(8) 

Schwarz EB, Ray RM, Stuebe AM, et al. Duration of lactation and risk factors for maternal cardiovascular disease. Obstet Gynecol. 2009 May;113(5):974-82

Taren D, Chen J. A positive association between extended breast-feeding and nutritional status in rural Hubei Province, People's Republic of China.  Am J Clin Nutr. 1993 Dec;58(6):862-7 

Tharner A, Luijk MP, Raat H, et al. Breastfeeding and its relation to maternal sensitivity and infant attachment. J Dev Behav Pediatr. 2012 Jun;33(5):396-404 
 
Victora CG, Horta BL, Loret de Mola C, et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil.  Lancet Glob Health.  2015 Apr;3(4):e199-205 

Weaver JM, Schofield TJ, Papp LM. Breastfeeding Duration Predicts Greater Maternal Sensitivity Over the Next Decade. Dev Psychol. 2017 Oct 30 

Wong P, Anderson L, Dai D, et al. The Association of Breastfeeding Duration and Early Childhood Cardiometabolic Risk.  Journal Of Pediatrics [serial online]. January 2018;192:80
 
Xu L, Lochhead P, Ko Y, et al. Systematic review with meta-analysis: breastfeeding and the risk of Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther. 2017;46(9):780–789

Zheng M, Cameron AJ, Birken CS, et al. Early Infant Feeding and BMI Trajectories in the First 5 Years of Life. Obesity (Silver Spring). 2020 Feb;28(2):339-346