How Long Should You Breastfeed and When To Wean

When it comes to feeding your baby, they say breast milk is best — but it isn’t always easy. Even if you’ve tried a variety of breastfeeding positions and you’ve been nursing for three, six or nine months, it’s not always smooth sailing. And if you’ve stopped breastfeeding (chestfeeding) and are considering relactation, that comes with its own challenges, too.

You could be dealing with potential supply issues, time constraints and a fussy baby who’s tired, hungry and irritable. After so many attempts, you may be wondering when enough is enough and whether or not you should try formula instead. But according to Ob/Gyn Sara Wiswell, DO, there are some ways around the challenges you’re facing, and the benefits of breastfeeding far outweigh the benefits of formula.

“Since breastfeeding offers tremendous benefits — from custom-made nutrition and increased immunity to helping you lose weight and protecting you against breast cancer — it’s worth trying to overcome any hurdles with a few strategies,” says Dr. Wiswell.

Pediatrician and breastfeeding medicine specialist Heidi Szugye, DO, IBCLC, joins Dr. Wiswell to explain how long you should breastfeed and why it’s beneficial for moms and babies alike.

How long should you breastfeed?

The American Academy of Pediatrics (AAP) recommends breastfeeding newborns exclusively for the first six months. After six months, the AAP now recommends breastfeeding children up to 2 years old and beyond alongside complementary foods. The World Health Organization (WHO) has been advocating for these same recommendations for quite some time. These updated guidelines from AAP are what Dr. Szugye calls an effort to overcome the stigma of extended breastfeeding.

“This policy is really a call to action for everyone, and that includes hospitals, pediatricians and all physicians that are taking care of moms and babies,” says Dr. Szugye. “We want to make sure our practices and policies are set up to support moms who choose to breastfeed.”

A deep dive into AAP’s policy and recommendations shows pediatricians are called upon to advocate to employers to make sure they’re supporting new moms in the workforce by providing adequate, paid maternity leave, providing insurance coverage for lactation support, breast pumps and on-site childcare.

“We want to make sure that our employers are providing break time for moms to pump when they return to work, that they have a private, clean place for expressing milk,” says Dr. Szugye. “Moms shouldn’t feel shy about advocating for those things. That’s their right.”

And Dr. Wiswell agrees: Working moms are faced with additional challenges if they want to breastfeed, especially if they’re following the recommendations to breastfeed an older child.

“It’s absolutely vital to prepare thoroughly, especially figuring out where you’ll pump and how you’ll need to adjust your schedule,” says Dr. Wiswell.

With the Affordable Healthcare Act, insurance now covers breast pumps, so it’s easier to get one that’s effective and fast. Workplaces with more than 50 hourly employees must provide both the time and a place to pump. You can use hands-free nursing bras, smartphones or tablets if you must work while pumping. After all, stress and milk are natural enemies.

“When stress levels go up, usually milk levels go down,” notes Dr. Wiswell.

The new policy and recommendations also highlight a number of disparities seen with breastfeeding.

“We know non-Hispanic Black mothers, low-income mothers, especially those on WIC, younger women less than 20 years old and those with high school education or less have lower rates of breastfeeding,” says Dr. Szugye. “The new policy really makes a point of making sure we’re targeting those populations and providing support, education and hospital policy change that counteracts these inequalities.”

Benefits of extended breastfeeding

“The new recommendation to extend breastfeeding from one year to two years came about because we have more and more data supporting that there are benefits to both mom and baby breastfeeding for more than one year,” says Dr. Szugye.

Benefits of breastfeeding include a decreased risk of developing:

• Type 2 diabetes.
• High blood pressure.
• Cardiovascular disease.
• Breast cancer.
• Ovarian cancer.

“We think a lot of the benefits have to do with hormone changes that moms experience when they’re breastfeeding,” says Dr. Szugye.

Benefits of breastfeeding for your baby include a decrease in:

• Ear infections.
• Respiratory infections.
• Gastrointestinal illnesses that cause diarrhea, vomiting and stomach bugs.
• Sudden infant death syndrome.
• Leukemia.
• Diabetes.
• Obesity.
• Asthma.
• Eczema.

“There are a lot of immunologic factors and components to breast milk,” explains Dr. Szugye. “Throughout the breastfeeding journey, moms are continually passing antibodies to the baby. So, if mom is 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 system.”

Finding support for breastfeeding a toddler

If you see your breast milk supply dwindling as your child gets older, don’t despair. Take action.

“Many moms see their supplies drop and mistakenly assume it won’t return,” Dr. Wiswell notes. “Learn how supply works so false alarms won’t rile you. Talk to a lactation consultant because they can explain supply’s natural ebbs and flows, including during growth spurts and how your body adjusts over time.”

If a supply boost is needed, you have some options:

• Nursing more – Add sessions as long as your child will nurse. If you work outside the home, try early evenings, mornings or weekends.
• Pumping strategies – An extra session or several short power pumping sessions of five to 10 minutes throughout the day for several days in a row will tell your body that more milk is needed.
• 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. Don’t lose more than 1 pound weekly if you’re still trying to shed baby weight.
• Galactagogues – These supply helpers, such as oats, fenugreek, blessed thistle and alfalfa, can increase milk output. Speak to a lactation consultant to see which one or combination is right for you.​

Parents who have a hard time breastfeeding or relactating can also turn to breast milk donor banks where breast milk is pasteurized, screened for drugs, medications and infections, and tested for bacterial contamination before its stored and made available for purchase. This resource has become incredibly important in response to the baby formula shortage.

“Reach out to your pediatrician or obstetrician if you are interested in obtaining donor breast milk because they often need a prescription from your physician,” suggests Dr. Szugye.

Deciding to wean

You can supplement breast milk with complementary foods starting at 6 months. This process, known as weaning, doesn’t happen all at once. Instead, you’ll want to introduce different foods slowly over time.

“We want to make sure that foods are presented to them in a way that is safe and that they’re not going to choke on them, and we really want to introduce a variety of foods,” advises Dr. Szugye. “We usually recommend introducing them one at a time so if your child does develop an allergy, we know what the allergy is.”

So, if you want to introduce them to peanut butter or eggs, that’s OK — but do it one food at a time.

Do what works for you and your baby

As a mom, it’s best to do what works. If you can’t exclusively breastfeed, you’ll still boost your baby’s immunity by combining breastfeeding with formula.

“There’s not one way written in stone,” says Dr. Wiswell. “Even working moms who can’t pump at work can still partially breastfeed. Your body will regulate its supply to be available when you’re with your baby.”

Likewise, nursing moms need to be open-minded about their breastfeeding goals. Don’t let others discourage you from extended nursing, or nursing longer than a year. “If you’re surprised with how well it’s going, continue as long it works for both you and your child and for however long you want,” encourages Dr. Wiswell.