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I think that if you breastfeed for a year you deserve a trophy. So I give one, in the form of a t-shirt, that may not fit mom, but may fit her baby. I've given out more shirts than I can count now and the "babies" who received the first shirts are now in college.
With all these moms in my practice reaching that one -year goal, I began to consider doing something to recognize those mothers who continued to breastfeed to 18 months. Early on, some of those wonderful moms, who took the shirt and the congrats at a year said "no thank you" when I mentioned what I was thinking about- they didn't want people to know. The would breastfeed, but they didn't want public acknowledgement. Now I am finding that more and more mothers would take that extra recognition if I offered it. My answer has been to start buying the shirts in bigger sizes now, so they will fit the kids when they are 18 months and 2 years old.
The one year visit is not just a time for t-shirt giving, it is also an opportunity to talk about the benefits of continuing to breastfeed after a year. I'm going to try not to call it "extended breastfeeding" since that reveals a cultural bias that exists where I live, but maybe not where you do. Worldwide, breastfeeding two to four years is normal. And before cultural biases interrupt the discussion, one AAP policy statement on "Breastfeeding and the Use of Human Milk" says that there "is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer." That statement was not in the 2012 version of that same policy statement. We put it in our book.
So what happens at a year? Well, according to popular belief, as your beautiful breastfed child is sleeping the evening before their first birthday, their world gets rocked: the next day, they will discover that breastmilk serves no purpose. We have found a cow that makes better milk than mom.
How do you make a non-verbal one year old understand that? They are counting on that same warmth, expression of love and wonderful nutrition that they got the day before. What's magic about that 366th day of their life?
Now really, I know that doesn't make sense and the one- year -old is probably confused, but I know some wonderful women who believe that even if they are continuing to breastfeed, that the child still needs supplemental cow's milk "to get enough nutrients." I may live in America's Dairyland where we wear cheeseheads in public, but cow's milk is for cows. And since I'm usually having this conversation at a well visit, with the child right there, I can do a reasonable job of convincing the family that my physical exam suggests that their child is not a cow. Children getting human milk do not need milk from a cow (or a goat, or an almond).
Human milk after 12 months has lower levels of protein, calcium and long chain fatty acids when compared to the milk given to a 3 month old, but that makes sense: 3 month olds are getting breastmilk exclusively. A toddler is getting foods which complement the breastmilk by adding extra protein, calcium and fatty acids to the child's diet. Infection fighting cells are present for the duration of breastfeeding; lactoferrin, lysozyme, immunoglobulin A and oligosaccharides increase in concentration in human milk from 11- 17 months of age. The benefits of breastfeeding longer than a year are not just for the baby: we know that moms who nurse longer lower their risk of breast and other reproductive cancers.
I get it. Many people, including most healthcare providers, don't understand why you'd want to breastfeed for more than a year. But they aren't the ones trying to explain the cultural issues surrounding prolonged breastfeeding to a non-verbal, often upset 15- month -old who just wants to drink milk from a human and not a cow. Given the the massive increase in my t-shirt budget, we are making progress in my little slice of the world. Pretty soon it won't just be the kids that know that human milk does not lose its value at day 366.
Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM
Because of multiple requests, "the" shirts and one that now says "Yes, I'm still breastfeeding" are available here. Or create your own. The point is to celebrate the journey!!!
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