Breastfeeding for One Year and Beyond

Here’s a question I wish I had to answer every day:  What do I do once I make it a year of nursing my baby?  According to statistics from the Center for Disease Control’s 2022 Breastfeeding Report Card, only 33% of Rhode Island women achieve this milestone despite the recommendations of the American Academy of Pediatrics (AAP). Happily, that rate has gone up 5% in the last 10 years. The AAP endorses exclusive breastfeeding for the first 6 months, then introduction of complementary foods and continued breastfeeding as long as is mutually desirable.  I could, and probably will write a whole newsletter someday on why that just doesn’t happen in America!  But for those of you who have made it this far, or hope to, here is a little anticipatory guidance on what’s next.

First, I want to give a little encouragement for those who are hoping to make it to nursing for a full year.  In the beginning, this seems like quite a daunting task.  When you are nursing 8-12 times in 24 hours, you can’t help but think, seriously? I can’t do this for a whole year!  But what I always want new moms to remember is that things change rapidly with babies, and you will not be doing at six months what you were doing at six weeks.  In fact, at six months, when you begin to introduce solid food, you are essentially beginning the weaning process with your baby.  You will work up to three meals a day, so that by nine months, you are nursing only three to four times per day. Seems significantly more manageable than nursing every two hours doesn’t it?  And that routine lasts until a year, when it’s time to make some more changes.

My first recommendation at a year is that you no longer give your baby anything in a bottle.  At this age, all liquid nutrition should come from the breast or a cup.  This is fairly easy to do if you have been good about offering the cup at mealtime, and helps prevent both tooth decay and obesity. Then, most pediatricians will encourage the introduction of cow’s milk into a baby’s diet. You don’t have to give cow’s milk, and your baby can have breast milk as long as you can provide it! However, if you introduce cow’s milk, it should be done gradually and with a cup.  It is recommended that baby’s at this age drink whole milk, as they need the extra fat for neurological development.   The best plan is a combination of expressed breast milk and cow’s milk given over the course of a few days.  Gradually increase the proportion of cow’s milk and decrease the amount of breast milk, until the baby is taking just cow’s milk in the cup.  While doing this, observe your toddler for signs of dairy intolerance (eczema, nasal congestion, diarrhea or bloody stools) and contact your pediatrician if any of those occur.  The best part about this change is that it usually eliminates the need for pumping, which many moms are happy to give up! 

The next thing to think about is how long you want to nurse.  In my experience, toddlers that aren’t weaned by 14-15 months tend to nurse until sometime after they are three years old and will then naturally wean themselves.  So think about what you want to do and have a plan of how to achieve it.  Regardless of how long you want to nurse, I have some advice about how to do it so that it is manageable.  

First, set limits on where and when you nurse.  Most kids at this age need three meals a day and three snacks a day.  Nursing replaces the need for a snack.  Most mothers will nurse their toddler before the morning and afternoon naps, and then again at bedtime.  My advice is that this nursing should be done in the same place each time-the baby’s room in a rocker perhaps? If a child gets used to this routine, they will rarely ask to nurse elsewhere. This also prevents your child from demanding to nurse at times that might be uncomfortable for you. If he asks you can tell him that “we will nurse when we get home to your room.” Most toddlers are fine with that response, especially if that has been the routine all along.  Occasionally, your toddler might need to nurse for comfort, for example after a fall or a visit to the doctor. I wholeheartedly encourage this.  I just want to help you prevent all day snacking at the breast and the toddler temper tantrum that might ensue if your child is denied that privilege.  Setting limits at this age is appropriate and will make the times that you do nurse all the more special.

If you are looking to wean at this age or later, start by setting the limits I mentioned previously. Then, practice the policy of not offering, but not refusing.  So when getting your toddler ready for nap or bed time, follow your usual routine but don’t offer the breast. If he doesn’t ask for it, don’t offer it and off to bed he goes! You might find that this is easier initially if you provide a cup of milk and small snack before one nursing session.  He might drop that session daily and then you can do the same at another time, until he is no longer nursing.  If your toddler does ask to nurse, nurse him but only within the established limits.  Distraction works wonders at this age, and if you pull out a book or something else, you might be able to help him forget about his initial request.  By practicing this policy of not offering but not refusing, weaning usually goes smoothly and is accomplished within about two weeks, and without a battle!

There are two more things that nursing moms need to know after a year. The first is that your body might not respond to a pump at all.  You might leave for a weekend or business trip, plan to pump while away, and panic when nothing or little comes out with the pump, fearing that you have ended that breastfeeding relationship prematurely.  And oddly enough, while away, you won’t be uncomfortable. This is very common but will further convince you that your supply has dried up! Amazingly, when you get home, you and your toddler will pick up right where you left off! If he wants to nurse, there will be milk there.

The other thing is that when weaning, your toddler may go for days or weeks without nursing, and then suddenly want to nurse again.  When he does, there will be milk there for him and in the interim; you won’t be at all uncomfortable.   When weaning is done as advised above, it really is very smooth.  There is not a battle, and you remain comfortable throughout.

I hope this newsletter makes nursing for a year seem like an achievable goal. Rhode Island moms were able to increase the proportion of children who are breastfed at 12 months to just shy of the goal of the Department of Health and Human Services Healthy People 2020 Initiative, which was 34.1%. Hopefully, with a little information about how to do it, it will feel like something you can easily accomplish and Rhode Island can surpass that goal.