I always wonder about the term “toddler”. When does a baby become a toddler, and when does a kid cease to be one? I assume the term came from the propensity of the early childhood set to toddling, since most babies don’t perfect their gait until close to two years of age. But two year olds are still considered toddlers, right? Am I the only one who is confused about this? Or the only one who wastes time even thinking about it?
Confusing label as it may be, there is one thing that is clear when it comes to toddlers: they no longer need infant formula. Once our kids hit the magic 12 month mark, we can throw out those $5 formula checks and do a little dance of joy. If you’re doing extended bottle feeding, you can fill the bottle with cow’s milk or a milk substitute of your choice- any of these options will be a welcome change to your bank account. Some parents choose to switch to a toddler formula (especially if their child is a super picky eater, or has been diagnosed as failure to thrive or with another feeding or nutritional issue), and for those of us with kids cursed by the dreaded dairy allergy, we might be forced to remain on hypoallergenic infant formula for awhile longer to make up for the lack of fat and protein most kids get from cow’s milk (the substitutes do a bang-up job of providing calcium, vitamin D and a myriad of other nutrients these days, but they can’t compete with the fat and protein profile produced by the dairy industry). But for the vast majority of formula feeding parents, the first year birthday party is made up of presents, cake, and a ceremonial dumping of Enfamil down the kitchen sink.
And yet, as FFF Abigail pointed out on the Facebook page today, breastfeeding moms are encouraged to nurse for two years by WHO, UNICEF, the AAFP, and other major medical organizations. One would therefore assume that there would be a nutritional or medical reason for this recommendation; since formula has been created to fill in for breastmilk, wouldn’t it stand to reason that the toddler nutritional needs that necessitate breastmilk would also benefit from formula over plain old cow’s milk?
In some ways, the answer is pretty simple: the reason we don’t use cow’s milk prior to a year of age is because our systems aren’t developed enough to process it. By the age of one, human digestive organs are capable of handling dairy, and cow’s milk provides a good amount of the protein, fat, and vitamin content that young kids need to thrive. Obviously, breastmilk does as well – and it has the added advantage of being made specifically for human babies. Breastfeeding moms can keep nursing, and provide a good source of protein and fat; in this case, there is no need to include cow’s milk or a milk substitute into a toddler’s diet. (This is not to say that breastmilk should replace solids or a diverse range of foods for kids over 6 months- from the research I’ve seen, there is a strong case that breastmilk, formula or regular milk should always be part of a toddler’s diet, not all of it.)
It’s easy to see why someone might be confused about this, though. The American Academy of Family Physicians does not really explain why a baby should be breastfed for two years; WHO and UNICEF lean heavily on arguments about lack of sufficient nutrition and risks of bacterial contamination in the developing world, which are not all that relevant in resource-rich nations – although I do suppose one could argue that Americans living in abject poverty may reap some of the same benefits, given the difficulty of obtaining quality nutrition. If you search “benefits of breastfeeding past one year”, the Google Gods will hand you vague blog posts based on opinion rather than fact, which make bizarre and unfounded claims about the more “supple skin” and “shiny hair” of the breastfed toddler. There are some citation-based claims about how the immunological benefits of breastfeeding continue into toddlerhood; comments from well-known breastfeeding advocates about how beneficial extended nursing is, without much research to back it up; and articles which explain a dose-response effect of breastmilk (meaning that the longer a woman breastfeeds, the better the effect), but most studies do not look at Western, nursing children over a year old in terms of health outcomes.
I am not trying to belittle extended breastfeeding in any way, or to suggest that there aren’t plenty of advantages to breastmilk later in childhood (as I said before, it is a far more appropriate drink than cow’s milk, from a biological and evolutionary perspective). I am a strong proponent of nursing as long as it feels right to you and your child. But I also think it’s fair to ask the question: if the nutritional benefits reaped from a 2-year nursing relationship are so vital that WHO views 2 years of nursing as ideal, even in the developed world, wouldn’t that necessitate some sort of substitute or supplement for those who aren’t meeting that recommendation? We’ve been told that toddler formula is just a ploy of the formula companies, so something doesn’t seem quite kosher here. (Ha! Like how I said kosher? And we’re talking about milk?)
I fear that these organizations are confusing people with their recommendations, as they are turning what should be a personal decision into a monitored, medicalized act. Using risk-based rhetoric to support every breastfeeding recommendation they make has the negative side effect (among many others) of making us expect such reasoning. So, when these organizations encourage us to breastfeed for two years, we assume there is a risk to not doing so. I can’t find a significant body of research on this subject, and when even the most ardent lactivist sites are relying on claims about toddler beauty to support the superiority of longer-term nursing, it makes me wonder if maybe there aren’t enough proven benefits to justify the WHO recommendations.
There may in fact be numerous and vital health benefits to nursing through the second year of life; I don’t doubt that there are emotional ones, because I believe that there are emotional benefits to gently and intuitively responding to your child’s individual needs. But if babies truly need some nutritional aspect of breastmilk beyond the immunological properties (which, while certainly a nice feature, are probably not going to make a significant difference if kids are in daycare or have an older sibling – i.e., exposed to germs – according to this study), then there very well might be a basis for all those follow-on formula ads, which would make me feel like a dumbass for scoffing at them and screaming that they were a dumb marketing ploy). Or at the very least, pediatricians should be recommending a supplement of some sort to add to dairy/almond/soy/rice/hemp/flaxseed/coconut milk.
Going back to the original question, I don’t think that there is any medical or nutritional reason to remain on formula longer than a year, provided the child has a somewhat well-rounded diet and is growing well. Then again, I’m not a huge proponent of cow’s milk in general, and I’m certainly not a medical professional, so my opinion means squat anyway. But considering the scarcity of good studies on breastfeeding past year one, I’m not sure the AAFP or WHO’s opinion should mean all that much in this case, either.
Bottom line? Breastfeed as long as you want, but do it because it feels right to you and your child; breastmilk has tremendous nutritional value and there sure as hell isn’t a reason to stop if you don’t want to. Just don’t feel like you are sacrificing your child’s health if you do decide to wean at a year, because from a nutritional, health, and risk standpoint, it appears you have as much right to throw your frozen breastmilk down the drain as your formula feeding sister has to pitch the formula, and vice versa.
Two excellent reviews of this subject: