In the first updated guidance on breastfeeding in a decade, the American Academy of Pediatrics released a policy statement on June 27 that encourages the support of breastfeeding for up to two years and beyond. The AAP also identified stigma, lack of support, and workplace barriers as factors that prevent continued breastfeeding.
The AAP currently recommends people breastfeed exclusively for only six months, and then start introducing solids while continuing to nurse. The organization previously recommended people breastfeed their infants for one year or more, but the new guidelines make it clear that parents can (and should) breastfeed their infant up to and past age 2, if they want.
Why? Research says that breastfeeding for longer has more health benefits for mom and baby. The benefits for breastfed babies include decreased rates of lower respiratory infections, severe diarrhea, and ear infections, to name a few. And it's not just the baby who benefits from breastfeeding. Data show that mothers who breastfed appeared to have lower rates of cardiovascular disease, breast cancer, and even diabetes compared to women who hadn't breastfed.
In the statement, Joan Younger Meek, MD, lead author of the new recommendations, says,"The health benefits are vast and can be viewed as a long-term investment not only in a child's development, but to public health as a whole."
But don't dismay if you don't make it that long. Even just a few days of breastfeeding your baby provides enormous benefit. If you breastfeed right after birth, along with your colostrum (the nutrient-dense milk your body produces first during pregnancy), your baby will receive important antibodies that help their digestive system work more easily. However, breastfeeding is a personal decision that is made depending on each individual woman's circumstance and perspective. It may not work out for everyone, and that's OK; you're not a better or worse parent for being able to (or not being able to) breastfeed your child.
The CDC's latest data found that roughly 84 percent of women in the US breastfed their child at some point, but only about 35 percent continued to do so up until the recommended 12-month mark. This means that the majority of infants are weaned long before their second birthdays.
The truth is, there are a lot of factors that dictate whether or not someone is able or willing to breastfeed for that long — and many of the barriers are built into our society. For that reason, in their guidelines, the AAP pushes for policies that protect breastfeeding, such as universal paid family leave; the right to breastfeed in public; insurance coverage for lactation support and breast pumps; on-site child care; universal workplace break time with a clean, private location for expressing milk; and the right to breastfeed in child care centers and lactation rooms in schools. These are "all essential to supporting families in sustaining breastfeeding," per the report.
Social stigma is also important to note as a reason people generally stop breastfeeding after a certain age. In fact, research shows that a parent's perception of social stigma while breastfeeding increases dramatically as the child gets older.
The new recommendations also acknowledge how implicit bias, structural bias, and structural racism continue to disproportionally impact some parents more than others, specifically those with low income (participants in the Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]). "The AAP views breastfeeding as a public health imperative and also as an equity issue," says Lawrence Noble, MD, coauthor of the policy statement and technical report, in the statement. "Pediatricians and other medical professionals can help mothers meet their intended goals for breastfeeding and provide care that is inclusive, equitable, and culturally sensitive."
Notably, the policy also notes that gender-diverse parents may have difficulty accessing human milk "because of both social and biological constraints." The AAP suggests providers ask families what terms they use (such as "chestfeeding," which may be more accurate and inclusive).
The release of these recommendations coincides with the current baby formula shortage; however, Dr. Meek clarified to the New York Times that this research has been in the works for years and that it's completely unrelated to the shortage. That said, the timing only further highlights the need to improve the systematic and social support available for families. Dr. Meek emphasized that if there is to be a significant shift in breastfeeding practices, society will need to adapt, starting with paid leave, more support for breastfeeding in public, and support in the workplace. But first, it needs to be normalized in the medical community — specifically in pediatrics.
The AAP also advocates for hospitals to implement maternity care practices that improve breastfeeding initiation, duration, and exclusivity. According to the Center for Disease Control's 2020 Breastfeeding Report Card, comprehensive hospital practices and policies that support breastfeeding reduce medically unnecessary formula supplementation, reduce disparities in breastfeeding, and help give infants the best start in life.
"Not everyone can breastfeed or continue breastfeeding for as long as desired for various reasons," Dr. Meek says in AAP's statement. "Families deserve nonjudgmental support, information and help to guide them in feeding their infant."
Knowing when to wean your baby will depend on your child, your doctor, and you. Typically, if you're producing less milk than the baby requires, your doctor may ask you to supplement with formula. And once solid foods are introduced to your baby's palate, they may not be as keen on nursing anymore. Your work responsibilities may increase, and you may not have the time to pump or nurse as regularly anymore. Whatever the circumstance, the decision of when to wean should be catered to what suits your family best, and you should feel confident about whatever choice you make.
— Additional reporting by Melanie Whyte