Breast is best for older babies too: Rebecca McQuillan tackles a persistent taboo

But not everyone is comfortable with my decision. By the time she turned one, I was breastfeeding her two or three times a day, usually at home. When I mentioned to other people that I was still doing it, I was met with silence. Lips were pursed, glances exchanged. “Are you going to stop soon?” someone asked. “No,” I said, “I’m going to try and continue until she is two.” There was that awkward silence again, that silence that says: "Oh God, she’s gone all Earth Mother on us. What next? Unshaven body hair? Dungarees?"

Since then, I’ve been informed that my daughter is too old to be breastfed and even that it’s “weird”, given that she is starting to talk and can ask for a feed. None of this has made me waver (it helps that I have a supportive husband and family), but it has surprised me how awkward some people seem to feel about the idea of extended breastfeeding.

Breastfeeding into toddlerhood isn’t for everyone. Lots of women struggle to breastfeed at all; others stop during the child’s first six or 12 months for a range of good reasons.

But there are also good reasons why people continue. In fact, the World Health Organisation encourages women to breastfeed until their children are two or more. Yet a very small proportion of women in the UK do. Which is perfectly fine – provided they are stopping because they want to. But we know that many women still report being criticised for breastfeeding in public (even though it is illegal to make a woman stop) and that many feel unsupported in their choice to breastfeed. We know too that those negative attitudes, particularly when they come from a woman’s nearest and dearest, have a major influence on whether she perseveres.

Millions of pounds have been spent on breastfeeding promotion campaigns aimed at informing new mothers of the benefits. Today marks the end of World Breastfeeding Week, part of an international effort to encourage the practice. But perhaps now is the time to start widening out promotional efforts from mothers to society as a whole. We need to normalise breastfeeding both babies and toddlers, and dispel some of the misconceptions that persist about it. It should be every mother’s choice whether she breastfeeds and for how long, but it’s not really a free choice if she feels inhibited about continuing for fear of being labelled needy, odd or brainwashed.

How should you even define “extended breastfeeding”? The phrase is widely used to describe anyone who breastfeeds for longer than society in its infinite wisdom deems normal. Most commonly it is defined as more than one year, though some would say more than six months and others more than two years. Dr Alison McFadden, a midwife and breastfeeding expert at the University of Dundee, believes the term immediately creates negativity around the notion of breastfeeding older babies and we should just say “breastfeeding”. But for the sake of clarity, I am using it here to mean breastfeeding for more than a year. One woman on Mumsnet quips: “I think that after a year, your breasts are extended enough for it to be called extended breastfeeding." Speak for yourself, love.

It’s pretty clear that breastfeeding beyond a year in the UK makes you as rare as a new episode of the Teletubbies. So unusual is it in high-income countries that most don’t even collate statistics on women who breastfeed for two years. In January, The Lancet published findings showing that in Japan, 60 per cent of women breastfeed until their child is one, in Norway 35 per cent, in the United States 27 per cent, and in high-income countries generally, about 20 per cent, but in the UK? Only 0.5 per cent. The UK has the lowest rates of breastfeeding, for any duration, in the world. Although 81 per cent try breastfeeding at some point, 34 per cent are doing it at six months and the numbers rapidly diminish after that.

In developing countries, particularly in Africa and the Indian subcontinent, it’s a very different story: in Malawi, 98 per cent of women breastfeed until their child is one and 75 per cent until aged two. In fact, the majority of mothers worldwide breastfeed for at least a year: Unicef figures show 74 per cent of children are still being breastfed aged one and 46 per cent aged two. It’s pretty clear that comparing women worldwide, it’s we Brits who are the unusual ones, for stopping so early.

There are huge variations worldwide in when women wean, and while I intend to stop when my daughter is two, the professionals see no harm in continuing beyond that; the WHO says breastfeeding should continue until a child is two “or beyond”. Women typically decide for themselves how old is too old and there is cultural conditioning involved in that, so breastfeeding a four-year-old might seem highly unusual to many in the UK (and many women would presumably fear that if they breastfed for too long, they could be opening their child up to teasing), but not so much in Mali.

The World Health Organisation and Unicef say: “The most critical time for good nutrition is in the brief 1,000 day period from the start of a woman’s pregnancy until a child’s second birthday. Breast milk is the best food for children’s health and development during this critical window.”

Breastfeeding beyond a year helps prevent dehydration and provides nutrition to sick children. Disease protection (thanks to immunity passed on from mother to child) continues for as long as a child is breastfed. Doing any breastfeeding at all helps protect against sudden infant death, and about half of all diarrhoea episodes and a third of respiratory infections would be avoided by breastfeeding, according to The Lancet, which estimates that – given how dangerous these illnesses are in some countries – 800,000 children’s lives a year could be saved by near universal levels of breastfeeding babies and young children. Meanwhile, across all income levels, continued breastfeeding is consistently associated with higher performance in intelligence tests among children and adolescents, which translates into improved educational attainment and increased long-term earnings, with those children breastfed longer than 12 months benefiting most.

The Lancet stresses that the benefits apply regardless of wealth, and adds that breastfeeding probably helps reduce diabetes and a tendency to be overweight. For nursing women, it gives protection against breast cancer (for every 12 months of breastfeeding in a woman’s lifetime, there is a six per cent reduction in the risk of the disease) and might also protect against ovarian cancer and type-two diabetes.

Dr Jack Newman, a Canadian paediatrician and world-renowned authority on breastfeeding, adds that that some biologically active factors affecting the immune system in breastmilk are actually present in greater amounts in the second year of life (when a lot of children are in daycare).

For him, however, its greatest benefit is the reaffirmation of the bond between mother and child. He suggest that, far from making children less independent, it can help make them more confident by enhancing their sense of security.

That is quite a fistful of good reasons. Yet British women often report feeling adversely judged if they do it. “I am finding all the comments very hard,” says one contributor to Mumsnet. “Someone asked how my daughter was the other day and I said she was teething again. Cue another 10-minute discussion on how it's just 'wrong' to feed once they've got teeth. I feel very sad about it. Up until now, I'd been proudly feeding in public. Now I feel like the freaky breastfeedy lady.” Another comments: “People seem to be fine with some extended breastfeeding but everyone has a strange internal cut-off point of acceptability, 'It's OK as long as they're not walking', for example.” And as she notes, the TV show Little Britain made a big joke of squeamishness about breastfeeding with their sketch about a thirtysomething man who still breastfeeds from his mother by asking for “bitty”. Undeniably funny, but not helpful.

Of course it is not just breastfeeding toddlers that people object to. My cousin Fiona Nesom, from Sussex, breastfed her two children for two years. She found that breastfeeding her son (now at primary school) helped reaffirm their bond after a working day apart. “I looked forward to having that time together,” she says. But even when he was just nine months, she was told by a café owner that she could only breastfeed as long as she did it at the back of the premises.

It can get a lot worse than that. One woman on Mumsnet last month reported an astonishing exchange at a baby and toddler group in which another mother called her a pervert for breastfeeding her small baby son. Needless to say, other mothers online were incredulous at this decidedly odd remark. What on earth does this woman think breasts are for? “What a weirdo!” “She really needs counselling”, came the replies. “Would love to ask whether she felt like a pervert pushing a baby out of her vagina,” retorted one commenter. Fair point.

No wonder women brace themselves for disapproval at breastfeeding older babies. Lizzy Cooper, 23, from South Wales, breastfed her son until he was 19 months. She chose to do it because her mother and grandmother had breastfed for long periods, her grandmother even feeding one child until he was five. Cooper loved the closeness of it and found it particularly useful for comforting her son if he was sad.

But she had her fair share of “funny looks” and was asked “are you still breastfeeding?” with depressing regularity. What made the difference for her was the support of her mother and husband.

Familial attitudes are critical, says Jenny Paterson, 52, a midwife and breastfeeding counsellor from Edinburgh. Breastfeeding counsellors are often pilloried as the “Brestapo” but Paterson is nothing of the sort. I know, because she was very supportive of my decision with my husband to introduce formula alongside breastfeeding when my daughter was three weeks old (I had wanted to breastfeed exclusively for six months, but it went badly at first and she was not thriving). Paterson breastfed her first two sons until aged one and her third and fourth until they were both two, even tandem-feeding the youngest two for a time.

She still hears women tell her they have been asked disapprovingly by strangers why they are breastfeeding in public. But the key figures in a woman’s life tend to be her mother and partner. Paterson wholeheartedly believes that more women would choose to breastfeed for longer if society at large were more accepting of it.

“Societal attitudes have a huge impact on whether women decide to breastfeed or not and how long they continue,” says McFadden. “Family and friends can be very supportive, or they can undermine. The older the baby gets, the more stark these reactions become.” She believes the “invisibility” of women breastfeeding older babies means that it is outside most people’s experience. “If lots of people were visibly breastfeeding their babies until two years, it would be completely normal.” (She also thinks the “aggressive promotion” by infant formula companies of so-called follow-on milk aimed at older babies undermines breastfeeding.)

She believes breastfeeding promotion campaigns have had some impact, but notes that the debate has become very polarised.

Well, no-one likes to be made to feel a failure. I remember being told by one midwife that absolutely everyone could breastfeed if they tried hard enough. It was not what a struggling breastfeeder needed to hear.

Obviously it is important to inform women of the advantages of breastfeeding, reassure them it can take time to get right and support them to persevere. But what if it wasn’t all on mothers? What if some of the multimillion-pound promotional budget was spent on raising awareness of the benefits of breastfeeding in society as a whole? Positive education campaigns around mental illness have been well received; how about something similar for breastfeeding?

McFadden agrees. “There are some studies showing that the partner is the most influential person so we need to direct campaigns at them,” she says. Mothers and mothers-in-law tend also to loom large, and many have no experience of breastfeeding, so it would help to give them the facts too.

Is it harder to stop breastfeeding an older baby? It’s hard to get a clear answer on this because experiences vary. Some children just stop by themselves – Jenny Paterson’s eldest son did – and if they don't, weaning apparently requires the same techniques as stopping at an earlier age, such as offering distractions and having dad put the baby to bed to break the bedtime breastfeeding habit.

So to be clear: toddlers are not too old to be breastfed. Breastfeeding a baby who has started walking and talking is not weird. What’s weird is the level of prurience and squeamishness around breastfeeding.

(And for the record, I don’t own a pair of dungarees.)

www.worldbreastfeedingweek.org