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How Long To Breastfeed: What the Guidelines Say and What To Consider
Recommendations encourage breast milk exclusively for baby’s first six months and continuing to provide human milk until age 2 and beyond
How and what you feed your baby is probably one of the most basic — and yet deeply personal — decisions you’ll face when you become a parent.
You’ll hear things like “breast is best.” As in, breastfeeding (chestfeeding) is the absolute best way to nourish your baby.
And then you’ll hear the retort, “fed is best.” Meaning breast milk (human milk) and formula are both fine. As long as your baby is getting nutrients in their belly, all is well.
Then come the opinions on how long you should breastfeed. (You’re still breastfeeding? You gave up on nursing already? You fed your baby formula?)
It can feel like there’s no right way to do it. And there’s some truth to that.
Because what works for one family may not be feasible for another. But that’s OK.
Breast milk can provide certain benefits that formula can’t mimic. But breastfeeding, especially for long periods of time, might not work for everyone. Or you may have been given the impression that you’ve continued providing human milk long after others think you “should.”
No one should feel guilt, shame or otherwise crummy about how they feed their baby. Let’s face it, mom guilt is tough enough as it is.
So, we talked with board-certified breastfeeding medicine physician Heidi Szugye, DO, about breastfeeding recommendations.
How long to breastfeed
Science shows that if you can give your baby human milk (either your own or a donor’s), it has its benefits. And the longer, the better, experts recommend.
12 months to 24 months (and beyond): Mostly solid foods with some human milk, as mutually desired by parent and child.
Previous recommendations called for providing breast milk until age 1. But these newer guidelines (implemented in 2022) are based on the understanding that human milk has benefits that continue long after baby’s first birthday. And they help to remove stigmas associated with people who choose to extend breastfeeding into toddlerhood.
“These recommendations are a call to action for everyone, and that includes hospitals, pediatricians and all physicians that are taking care of families,” Dr. Szugye states. “We want to make sure our practices and policies are set up to support people who choose to breastfeed beyond the first year of their child’s life.”
Think of the guidelines as the best-case scenario. If it works for you, your family, your child, your body and your life to breastfeed for two years or longer, you’re doing a great thing. And there’s no reason to stop until you and your child are ready.
If it doesn’t work for you, that’s OK, too. Your worth as a parent and your love for your child can’t be measured in ounces of milk.
Benefits of extended breastfeeding
The recommendations are based on research showing that human milk has some big benefits. And those perks continue for as long as you continue to supply it.
“Breastfeeding offers tremendous benefits — from custom-made nutrition and increased immunity to protecting you against some forms of cancer. And those benefits don’t go away as your baby ages,” Dr. Szugye shares. “We have more and more data supporting that there are benefits to breastfeeding for more than one year when possible.”
Breastfeeding can offer both you and your baby some big benefits:
Benefits for lactating parents
Benefits for baby
Lower risk of developing conditions like Type 2 diabetes, high blood pressure, cardiovascular disease, breast cancer and ovarian cancer.
Decreased risk for ear infections, respiratory infections, gastrointestinal illnesses, SIDS, leukemia, diabetes, obesity, asthma and eczema.
“There are a lot of immunologic factors and components to human milk,” Dr. Szugye says. “One big advantage to human milk is that you pass antibodies to the baby. So, if you’re exposed to a respiratory illness or GI illness, those antibodies are passed on to the baby and then that makes them less likely to get sick. And if they do get sick, it’s less severe. It’s almost like a built-in immunity.”
Keeping up milk supply for the long haul
Some people can make enough milk to breastfeed for as long as they and their babies choose. But some don’t. At least not without taking some steps to keep it up.
If you suspect your supply is dwindling as your child gets older, there are ways to help promote more milk production if you want.
“Many people notice their supply drop and mistakenly assume it won’t return,” Dr. Szugye notes. “But if you want to continue to breastfeed, there are options that could help.”
If a supply boost is in order, you can try:
Nursing more often — Add sessions as long as your child will nurse. If you’re away from them during the day, try early evenings, mornings or weekends.
Pumping strategies — An extra session or several short “power pumping” sessions (think five to 10 minutes throughout the day) for several days in a row can trigger your body to make more milk.
Breast massage and compression — Easy-to-learn techniques can improve drainage when nursing or pumping.
Take care of yourself — Reduce stress, rest when possible, hydrate and eat a balanced diet with an extra 500 calories a day to support breastfeeding.
Not an ‘all-or-nothing’
If two or more years of breastfeeding seems daunting, remember that you have options.
For starters, giving your child human milk doesn’t always mean latching them to your breast and nursing. That’s just one way to do it. Pumping milk and putting it in a bottle, cup or spoon are also options.
And you may find that a donor bank could be a route to explore if you don’t lactate or if you have concerns about a low milk supply. Donor milk is pasteurized, screened for drugs, medications and infections, and tested for bacterial contamination before it’s stored and made available for purchase.
“Reach out to your pediatrician or women’s healthcare provider if you’re interested in obtaining donor milk. You may need a prescription from a healthcare provider,” Dr. Szugye suggests.
Remember, too, that any amount of human milk can be a benefit. If keeping up with your baby’s breastfeeding demands becomes too high a burden, there are alternatives.
Some parents may find that supplementing with formula (or other foods and milk after baby turns 1) can help give your child some human milk, while keeping up with their nutritional needs — and not burning yourself out in the process.
“It’s not an all-or-nothing thing,” Dr. Szugye reassures. “Any amount of human milk you can give is a benefit. If it doesn’t work for you to constantly supply human milk, that’s OK. We’re all just doing our best.”
If breastfeeding is going well for both you and your child, there’s no reason to give it up until you’re both ready to.
Feeding a baby is tough work, no matter how you do it. And chances are, you’re doing a fantastic job.
Multiple cardiac benefits result from frequent consumption of dark chocolates rich in flavanols, including our response to stress.
Recently when talking with my 7-year-old daughter, I asked her what was the best food she could eat for a snack. As the daughter of a cardiologist you may imagine that she would have been taught the enduring virtues of eating fruits and vegetables and how these are the best foods to use as snacks. She told me that my question was easy and replied, “the best snack is chocolate.” I asked her where she learned that and she told me her mother told her so. How can you really argue against that logic?
This question posed to my daughter then led to more investigation during my clinic. I asked many patients informally what were their favorite snacks. Since they were in a cardiologist’s office they would often say some sort of fruit or vegetable and then add they only consume it in a small quantity.
I then would ask, “now what really is your favorite snack?”
I particularly enjoyed the response of a couple in their mid 70s. I have seen both of them both for atrial fibrillation for over 5 years. She said, “my true favorite snack is chocolate.” Then almost immediately after, as if there was a sense of guilt in admitting this, she said, “but chocolate is healthy right? I try to eat dark chocolate.” Her husband laughed at her and said she eats more than dark chocolate. He then replied, “my favorite snack is anything you put in front of me.” In my informal poll of true favorite snacks, chocolate was mentioned in about two thirds of my patients. Most of my patients felt dark chocolate in particular was healthy.
Dark chocolate and other cocoa products have gained a lot of attention worldwide as dietary supplements to improve heath. These products are rich in in flavanols. Flavanols are felt to mediate some of the heart healthy properties of chocolate. Flavanols are also found in many other food sources felt to be heart healthy such as grapes, apples, blackberries, legumes, red wine, and green tea. But of all of these food sources, the relative concentration of flavanols is highest in chocolate. As you may have guessed, dark chocolate contains much higher concentrations of flavanols compared to milk or white chocolate. In some chocolates the production process all but eliminates flavanols.
What Are the Heart and Vascular Benefits of Eating Dark Chocolate?
Lower Blood Pressure. Consumption of cocoa increases nitric oxide, studies show. For a good review of benefits, see Cocoa and Cardiovascular Health. Nitric oxide is a naturally occurring chemical in our bodies. Nitric oxide acts on small receptors in our blood vessels and prompts the vessels to dilate. This process lowers blood pressure. High blood pressure as discussed in many of my prior columns is associated with many types of heart disease including heart failure, atrial fibrillation, and atherosclerosis. High blood pressure is also associated with cognitive decline, dementia, and stroke.
Coronary Artery Health and Stability. As our arteries become diseased from atherosclerosis, plaques grow and over time begin to impair blood flow. If the surface of these plaques becomes disrupted or inflamed the plaques may ulcerate. The body responds to the ulceration by forming a clot in an effort to heal the wound. This process can lead to a heart attack. Cocoa may help stabilize plaques and minimize their risk of rupture by reducing smooth muscle cell proliferation (a process that causes plaques to grow), platelet adhesion (a process that results in clot formation in the artery), and preventing leukocyte adhesion and migration (processes that causes these plaques to become inflamed and unstable).
Lower Cholesterol. People with elevated total cholesterol with increased levels of low-density lipoprotein (LDL) cholesterol have a higher risk of cardiac disease, in particular coronary atherosclerosis and heart attacks. Flavanols reduce cholesterol absorption in our gastrointestinal track and also the synthesis of LDL cholesterol, research shows. They may also help raise high-density lipoprotein (HDL) cholesterol, the part of our cholesterol that is felt to be protective of heart disease, a clinical trial reported. Lower LDL and higher HDL levels after cocoa consumption were seen in people with both normal cholesterol levels to begin with and those with elevated levels that needed treatment. Multiple medications reduce LDL cholesterol, but very few things and essentially no medications raise HDL cholesterol consistently.
Dark Chocolate Changes Our Body’s Response to Stress
My wife often says, “I eat chocolate when I am stressed.” As I mentioned in a prior column, stress and our response to it can be a very potent risks of heart disease. In this regard, what if chocolate can improve how we respond to stress?
This brings me to the newest study regarding dark chocolate that I found very interesting. When we are stressed our body signals out chemicals that raise our blood pressure and help us fight the stressor. These chemicals or hormones are stored in the brain (pituitary gland), the adrenal glands, and other parts of the nervous system. A rececent study looked at how the body responded to stress by measuring these chemicals (cortisol, epinephrine, adrenocorticotropic hormone [ACTH], and norepinephrine) in 31 men consuming dark chocolate (“Noir 72 percent”; Chocolat Frey AG, Buchs/Aargau, Switzerland) versus 34 men that received a placebo chocolate that did not contain flavanols. The men then underwent a significant stress.
The stress was a 5-minute mock job interview and then a 5-minute mental arithmetic task in front of an audience. It is probably easy for most of us to imagine feeling very stressed if we had to try to solve a complex math problem in our head in 5 minutes while others watched, or we had to receive an intense job interview.
What these researchers found about the effect of chocolate was significant. Those men consuming dark chocolate had lower levels of cortisol and epinephrine after the stress. Although their brain response to stress was similar (ACTH levels were identical in both groups) the body’s response to the brain signals of stress was blunted. In particular, the response of the adrenal gland, which produces cortisol, was much less. Less released cortisol and epinephrine with stress is important as these are strong stimulants of the heart and blood vessels. With repetitive stress over time, both the heart and blood pressure have be negatively effected. Finally, since the body response was less significant, men consuming dark chocolate reported having less feelings of stress during the process.
My daughter was right, dark chocolate or chocolate rich in flavanols is a healthy food choice. The benefits of dark chocolate need to be carefully considered with the calories consumed, but in general there are multiple heart-related advantages with frequent consumption. In addition, as my wife mentioned to me, dark chocolate also may help you deal with stress, not only how you perceive it mentally, but also how your body responds to it.
Wearing glasses doesn’t make your eyes weaker. Your eyes are already headed in that direction anyway, thanks to age. Glasses are one of our best tools to help you see more clearly. 👓🤓 pic.twitter.com/YToLhFOmuu
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