Positive Health Online

While some medical opinion suggests the optimum time to introduce solids is between four and six months, there is no reason why you can't breastfeed exclusively for much longer than this – and keep going long after solids have been introduced.

The author, Mary Nondé, with her daughter,Céline (aged 2 years 8 months)

At six months old, my daughter (Céline) and I were already out on a limb among pre-natal contemporaries in continuing to breastfeed. Not only was everyone well and truly into solids, but also breastfeeding (if considered at all), had fallen by the wayside too. On an earlier visit to the doctor, it had been a different story. He was very encouraging about breastfeeding and said that traditionally mothers breastfed exclusively for a year.

The myth about iron and other nutrients

The health visitor voiced a different opinion. On hearing that Céline was taking breast milk alone, she thrust a handful of leaflets at me about foods containing iron and told me to give her these foods right away. I was puzzled. She only had to look at Céline's complexion and posture to see that her health wasn't suffering. And where on earth Céline had found the strength to crawl at five months and to later walk at eight months, without iron, beats me. The health visitor recorded "advanced development" but insisted that Céline's iron reserves (transferred in the blood at birth via the umbilical cord), were exhausted.

I wanted more information to support my maternal instincts and joined La Leche League, the international organisation dedicated to supporting breastfeeding mothers. La Leche League believes that an exclusively breastfed baby can survive very well until well into the second half-year of life. On iron in particular they state that: "Iron in mother's milk, while low in quantity, is just enough since the baby can absorb it very well. Up to fifty percent of the iron in breast milk is absorbed compared to four percent when fortified infant formula milk is given."[1]

Another example of vital nutrients available in breast milk in unique combinations are polyunsaturated fats. Those in breast milk are readily utilised by a baby yet cannot be manufactured in any other form. When fat isn't absorbed, it robs the body of calcium, vital for the development of strong bones and teeth. Lack of fat can also be counter-productive to the optimal development of the baby's brain and central nervous system. The presence of lactose in breast milk is another case in point – and a known requirement of species with bigger brains, with humans at the top of the tree. In breast milk there is one and a half times more lactose than in cows milk. Lactose also happens to facilitate the fight against unfriendly bacteria in the gut; babies ingesting more lactose through breast milk are less likely to get diarrhoea and stomach disorders. And if this isn't sufficient evidence, smell the stools! The stools of breast fed babies are characterised as lacking in strong odour, indicative of good and efficient digestion.

The superior infant food

The point that the health visitor and others often forget is that mother's milk is uniquely designed for babies. Breast milk is rich in proteins, which break down into amino acids, the essential building blocks of body tissue. Mother's milk has all the essential amino acids, in exactly the right proportions her baby needs, with no wastage. Cow's milk, uniquely designed for calves, has everything a calf needs. For instance, the amino acid Taurine is virtually absent in cow's milk, and yet it is proven to be vital for the optimum development of a human brain and nervous system. The longer a mother gives her infant this superior food, the likelihood she is of setting him or her up for life.

First-class protection against infection and allergies

The nutrients in breast milk are specifically designed to destroy harmful bacteria that a baby is likely to encounter in a human environment.

Extended breastfeeding prolongs the period of resistance to colds, coughs and flu until the infant's immune system is sufficiently developed that it can take over easily. Dr John W Gerrard, a Canadian researcher, wrote: "We assumed that the function of breast milk was little more than the provision of nourishment. We now know that breast milk also provides effective protection, more effective than antibiotics ... and that it can also be expected to provide relative freedom in infancy from allergic disease, a growing problem of modern feeding habits."[2] The Department of Health has produced a document that lists the benefits of breastfeeding as: "...reduces the risk of babies developing gastro-intestinal illness, in particular gastroenteritis, infections of the middle ear, respiratory system, and urinary tract."3 Breastfeeding is also associated with a reduced risk of later childhood disease notably insulin-dependent diabetes mellitus and allergies, such as eczema. The conclusion? Babies milk is totally compatible with babies for as long as the mother chooses to supply it.

Food or drink?

Knowing all this, why don't more mothers extend breastfeeding? Part of the reluctance may lie in an inherent misunderstanding about breast milk. Just because it's liquid, doesn't mean it's just a drink. In fact, breast milk is a complete food and drink all rolled into one. Nature is very efficient that way! It can also be demonstrated that every time a baby feeds – and even at different times during a feed – the content of breast milk varies. The mother's "milk manufacturing unit" takes its cues from her baby, producing precisely the right quality and quantity of nutrients required each time. How exquisite! You don't have to plan a "balanced diet"; it's taken care of for you. Moreover, if your baby picks up a virus or infection, they relay this information to the mother's immune system via the breast. Then her body goes to work to produce the necessary antibodies and return them via the breast milk.

Another reason for foregoing breastfeeding early, in favour of solid food, may hinge around a concern to give the baby nutritional variety.

Certainly this is a concern with formula milk, whose constituents stay the same feed in feed out. But since a mother's diet varies from meal to meal, so the raw material from which breast milk is made constantly changes too. You don't need a scientific study to confirm this. You only have to look at stools in nappies to see that every one is different. Breast milk, by its very nature, is already "varied". In fact, it's a "live" product like blood and contains white cells, which are the body's chief defence against infection. It's also fresh and sterilised. What a great way of introducing the baby gently to the family diet!

Meanwhile, the less energy a baby has to expend digesting formula or solid food (since breast milk is the most easily absorbed food there is), the more energy they will have for other social, physical and psychological developments. Giving them breast milk substitutes may fill them up more and encourage them to sleep through the night (because their body is consumed with digesting it) but this takes away energy from other things. Since we live in a society that believes children should be "independent" as quickly as possible, substituting breast milk for solids early, may work contrary to this. The baby could gain weight quicker and that's about it – in itself not such a valid indicator of "infant progress". In fact, you frequently read the opposite. Breastfed babies are often more advanced in all ways – physically, emotionally and intellectually. Not only is breast milk best from a nutritional and immunological point of view, there are other developmental benefits too. For instance, a nursing baby requires extremely active cheek muscles, which enhances facial development in a way no artificial nipple can. This early hard work prepares their tongue and month to make sounds clearly. A study in New Zealand4 among children between five and six showed improved speech and reading abilities among the breastfed population – and a dramatic improvement among boys, notably slower developers. Clear speech also depends on good hearing. We've already seen that repeated ear infections are inhibited when breast-feeding occurs.

Running out of breast milk

May be we would be more willing to extend breast-feeding but believe we can't. Why? Again, according to La Leche League, if left undisturbed (by not introducing supplementary water, formula milk or solids into a baby's diet), a woman is capable of feeding her baby exclusively for as long as her baby is happy. Introducing other foods and drinks too early in life undermines the delicate milk production balance: as a baby takes more solid food, the mother's milk supply automatically decreases. This is the more likely reason why some mothers "run out of milk" or "can't keep up with the demands of the baby". In fact, the notion that a mother can't continue to produce milk indefinitely – and even suffers lactation failure – is almost exclusively a Western phenomenon. If "undernourished" mothers in third-world countries can breast-feed, then surely we can. The challenge a mother faces is not a nutritional one but a social/cultural resistance to longer-term breastfeeding. This manifests through subtle messaging that "she can't do it", which undermines her self-confidence, and then her body plays this out. Or the social pressures to go back to work are too great that the four/six month cut off appears to be quite "natural". The irony is that, when the baby needs more milk than the mother is currently supplying, that's the time to keep going – not to stop. Only by continuing to suckle, will her body get the message to produce more milk. This accounts for the wonderful stories we hear of mothers who are unable to give milk at birth, but are able to start further down the line (with support).

The changeover

My own personal experience is that Céline made it clear to me around 11 months that she was really ready for solid food. The changeover then was a gradual process. It was well after Céline's first birthday that she really got underway with solid food – and showed no sign of difficulty eating it (another popular myth). By this time we didn't have to prepare mushy food or spoon-feed her either. Two and a half years on, Céline enjoys a wide range of solid food and she still has breast milk whenever she wants it. A lot! She has never suffered from diarrhoea, ear or throat infections, or any allergies and has only been sick twice in her life. She's had about a half- a-dozen colds, two coughs and chickenpox (passed on from her father!). Consequently, she's not needed any antibiotics and has not received any allopathic medicines – not even Calpol.

Before pregnancy, I decided to give up a very well-paid career and retrain in something that was closer to my heart and would allow me to be operate from home. I have always travelled a lot overseas and have found that with extended breast feeding, it's been an absolute doddle. There's always plenty of sterilised food and comfort on tap. On the development side, Céline understands two languages (French and English) and speaks the latter well, started walking at eight months, potty training at one and a half years, and dressing herself well before her second birthday. Society's fear that "breastfeeding" results in a protracted dependence on mother is a fallacy, in my view. I believe extended breastfeeding is promoting natural independence for Céline, while being one of the most exciting and rewarding relationships of my life.

References:

1 La Leche League (35th Anniversary Edition) 1996 The Womanly Art of Breastfeeding. 346 La Leche League International 1996
2 Dr Gerrard, JW Pediatrics 61:13-20 1988
3 The Department of Health Breastfeeding: Good Practice Guidance to the NHS. 1995
4 Dr Broad, F Further studies on the effects of infant feeding and speech quality. N Z Med J 82:373-376 1975