Ideal Duration of Breastfeeding
The American Academy of Pediatrics recommends exclusive breastfeeding for approximately 6 months, followed by continued breastfeeding along with complementary foods for 2 years or beyond as mutually desired by mother and child. 1, 2
Evidence-Based Recommendations for Breastfeeding Duration
Exclusive Breastfeeding Period
- Exclusive breastfeeding (breast milk only, no other foods or liquids) should be maintained for approximately the first 6 months of life 3, 1
- Around 6 months, infants require additional nutrients beyond what breast milk provides, necessitating the introduction of complementary foods 1
- This recommendation is consistent with those of the World Health Organization 2
Continued Breastfeeding Period
- After introducing complementary foods at around 6 months, breastfeeding should continue for 2 years or beyond as mutually desired by mother and child 3, 1
- The two-year recommendation aligns with key developmental milestones in feeding skills and digestive maturity 1
Health Benefits Supporting These Recommendations
Infant Health Benefits
- Reduced rates of:
- Respiratory infections (22% reduction) 1
- Otitis media (39-61% reduction) 1
- Gastroenteritis (40% reduction) 1
- Diarrhea (30% reduction with exclusive breastfeeding for 6 months) 1
- Lower respiratory tract infections (19% reduction) 1
- Atopic dermatitis (46% reduction) 1
- Childhood obesity 3, 1
- Type 2 diabetes 1
- Improved cognitive development outcomes 1
- Reduced infant mortality (19-26% overall reduction) 1
Maternal Health Benefits
- Decreased risk of:
- Studies and meta-analyses confirm that breastfeeding longer than 12 months decreases maternal type 2 diabetes, hypertension, breast cancer, and ovarian cancer rates 3
Common Challenges and Solutions
Barriers to Extended Breastfeeding
- Mothers who breastfeed beyond one year often report feeling stigmatized or pressured to wean earlier 3, 1
- Only about half of mothers who breastfeed past one year discuss this decision with their healthcare provider 3
- Full-time employment without adequate support is consistently associated with shorter breastfeeding duration 1
- 38% of women who reported their provider was unsupportive of breastfeeding past the first year elected to change their pediatric primary care provider 3
Supporting Extended Breastfeeding
- Healthcare providers should offer nonjudgmental conversations about the family's personal goals for breastfeeding 3
- Workplace accommodations are critical for continued breastfeeding success 1
- Policies that protect breastfeeding, including universal paid maternity leave, insurance coverage for lactation support, on-site childcare, and workplace break time with private locations for expressing milk are essential 3
Special Considerations
Contraindications to Breastfeeding
Absolute contraindications include:
- Classic galactosemia in the infant
- Maternal HIV infection
- Human T-cell lymphotropic virus type I or II infection
- Untreated brucellosis
- Current alcohol and drug use/dependence
- Certain medications 1
Complementary Food Introduction
- Appropriate complementary foods should be introduced at about 6 months 3, 2
- Breast milk remains the major component of the infant's diet as foods from the family's diet are gradually introduced 3
- An expert panel has advised peanut introduction as early as 4 to 6 months for infants at high risk of peanut allergy 3
In summary, the evidence strongly supports exclusive breastfeeding for approximately 6 months followed by continued breastfeeding with complementary foods for 2 years or beyond, based on the significant health benefits for both infants and mothers.