Recommended Duration of Breastfeeding
The American Academy of Pediatrics recommends exclusive breastfeeding for about 6 months, followed by continued breastfeeding along with appropriate complementary foods until 2 years of age or beyond, as mutually desired by mother and child. 1
Exclusive Breastfeeding Period
Exclusive breastfeeding means providing only breast milk to the infant, without any additional food or drink (not even water), with the exception of oral rehydration solutions, drops, or syrups consisting of vitamins, minerals, or medicines when medically indicated.
The evidence-based recommendations for exclusive breastfeeding include:
Introduction of Complementary Foods
Complementary foods should be introduced at about 6 months of age, while continuing breastfeeding. When introducing complementary foods:
- Focus on foods rich in protein, iron, and zinc (such as finely ground meats, chicken, or fish) 1
- Breast milk should remain the major component of the infant's diet 1
- Gradually introduce foods from the family's diet with appropriate modification of texture 1
- Avoid added sugar and fat 1
Continued Breastfeeding Beyond 6 Months
After introducing complementary foods at about 6 months:
- Continue breastfeeding along with appropriate complementary foods until 2 years or beyond, as mutually desired by mother and child 1, 2
- This recommendation aligns with the World Health Organization (WHO) guidelines 1, 4
Health Benefits of Extended Breastfeeding
Benefits for Infants and Children:
- Reduced risk of lower respiratory tract infections 1
- Decreased rates of severe diarrhea 1
- Lower incidence of otitis media 1
- Reduced risk of obesity 1
- Reduced risk of Sudden Infant Death Syndrome (SIDS) 1
Benefits for Mothers:
- Decreased risk of type 2 diabetes mellitus 1, 4
- Lower rates of hypertension 1, 4
- Reduced risk of breast cancer 1, 4
- Reduced risk of ovarian cancer 1, 4
- Lower risk of hip fracture due to osteoporosis later in life 1
Common Challenges and Solutions
Support for Extended Breastfeeding
Many mothers who breastfeed beyond the first year report feeling ridiculed or alienated in their choice 1. Healthcare providers should:
- Provide supportive, non-judgmental care for mothers who choose to breastfeed beyond one year 1
- Discuss breastfeeding during prenatal visits and at each well-child visit 1
- Provide appropriate anticipatory guidance that supports continuation of breastfeeding as long as desired 1
Nutritional Considerations
- Vitamin D supplementation: All breastfed infants consuming less than 28 ounces of commercial infant formula per day should receive an oral supplement of vitamin D 400 IU per day 1
- Iron supplementation: Consider iron supplementation, especially in developing countries where iron stores may be suboptimal 3
Key Pitfalls to Avoid
Premature introduction of complementary foods: Introducing foods before 6 months may increase the risk of gastrointestinal infections and does not improve growth or development 3
Discouraging extended breastfeeding: Evidence shows that 38% of women who reported that their provider was unsupportive of breastfeeding past the first year elected to change their pediatric primary care provider 1
Inconsistent advice: Particularly regarding medication use during breastfeeding, which may lead to unnecessary interruption of breastfeeding 1
Failure to monitor growth: While exclusive breastfeeding for 6 months is recommended, infants should still be managed individually to ensure sufficient growth 3
By following these evidence-based recommendations, healthcare providers can support optimal infant nutrition and maternal health through appropriate breastfeeding practices.