Breastfeeding Basics - Part VI: Over One Year

I hope you've been able to keep up with my Breastfeeding Basics series and have found it helpful in some way. If you haven't been following, here are the previous parts: Intro, Part I, Part II, Part III, Part IV, Part V.

Just by chance, this final post in the series coincides with World Breastfeeding Week, so happy WBW to all the current, future, and past nursing moms out there. Keep up the good work!

If you're reading this, it's because you've reached or will soon reach that magical one-year mark, that first birthday, that amazing milestone that says, "We're still alive after a year! We survived infanthood!" Now you've got a toddler on your hands. Maybe she's not walking yet, or maybe she's been walking for a few months, but a one-year-old is, as I'm sure you've noticed, very different from a six-month-old or a three-month-old!

I'm going to call the period from one year to three years "toddlerhood" for simplicity.

Let me start by saying, "You did it!" You did it! You made it to a year!

Toddlers are busy little creatures. They're mobile, they're curious, and they want to get out there and explore. This means that during the day, they likely don't want to sit on you and nurse for long periods of time. Your toddler will be more of a snacker when she's busy, stopping by for a quick cuddle and some yummy milk, then off to find new ways to try to hurt herself or destroy your house. When she's sleepy or unhappy or missing you, she'll probably want to cuddle longer, and at times you'll love it and at other times you'll just want her to go away and leave you alone for a bit.

The difficulty with nursing a toddler is that toddlers tend to be busy even when they're nursing. They try out strange and uncomfortable positions. Many of them have the annoying habit of "twiddling," which is when they play with one nipple while nursing on the other. This can be very annoying. You don't have to let your child annoy you. If your toddler is displaying nursing behaviors that you don't like, it is absolutely your right as the mother to discourage that behavior.

This is the time to introduce "nursing manners." Just as you are beginning to teach your toddler about the right way to act in other situations, you can let her know that she needs to be respectful of you when she nurses. I highly recommend getting her in the habit of treating you nicely when she nurses, or you'll start to resent nursing her.

You may want to start to teach her how to request to nurse, if you haven't already, either by introducing a hand sign such as the ASL sign for "milk" (opening and closing the fingers as if milking a cow), or by teaching her a word to use for nursing. Some kids pick up on the word "boob" or "breast," while others come up with their own term. My son called it "nu" or "nur." I guess he was trying to say "nurse." It's probably smart to come up with a term that wouldn't be embarrassing if it were, for example, yelled at the top of someone's lungs in a busy restaurant. Hearing "baba! baba!" is far less humiliating than having your 18-month-old yell "boobs!!!" in the middle of dinner.

You may also decide that now is the time to cut back on nursing sessions, since breastmilk is no longer your toddler's only source of nutrition. I discussed weaning in the previous post. You may find that your toddler naturally starts cutting back on his own, since he's so busy much of the day learning and exploring. He will probably go through phases of deep attachment, wanting to nurse often, almost like a newborn, and other phases where you'll swear he's ready to wean completely. Both are normal developments of toddlerhood. You can take advantage of the slower periods to start weaning, if you want, or you may want to try offering the breast more often during these slower times to encourage him to keep nursing, if you are not yet ready to wean.

At this point, you'll want to assess your goals. By now, you probably have a good sense of whether you want to keep nursing for a long time or whether you've really had it. If you're not sure, I encourage you to keep at it for now. The WHO recommends nursing until at least two years of age. This is a good place to stress that the benefits of nursing and breastmilk do not vanish when your child reaches one year old. Breastmilk continues to evolve and change as your child grows, and the milk your body makes for your toddler is specially suited to toddlers' quick nursing sessions and higher caloric needs, and it still provides the antibodies, anti-inflammatory agents, and antibiotic substances that have made it so valuable ever since your baby was born.

There are also benefits to you, the mom, of continuing to nurse. The benefits you gain from nursing a baby are cumulative - that is, the longer you nurse, the lower your risks of certain cancers and other diseases. So it's worth continuing if you want to.

The biggest challenge for many moms nursing toddlers, though, is the judgment from others. Some will say that a child is too old to be breastfeeding once he can "ask" for it. Others may tell you that you are doing some kind of harm to your child by continuing to nurse. You may hear that breastfeeding has no benefits after one year, or that you'll never get the baby off the breast if you don't wean, or some other such "wisdom." None of this is true. In fact, around the world, many mothers continue to nurse their children even until four years (and some even longer than that!), and there is absolutely no evidence that it causes any psychological harm. Most children will "self-wean" (choose to stop nursing on their own) between two and four years of age, and it's up to you and your child (and no one else) when it's time to stop.

Lastly, if you plan to have more children, you may start thinking about it while you're still nursing your toddler. While breastfeeding does have contraceptive properties, it's far from 100%, and the less you nurse, the less pregnancy protection you get. If your period has returned, likely so has your fertility.

If you do conceive while you're still nursing, don't feel pressured to wean. It is safe to continue to nurse during pregnancy as long as it doesn't cause contractions or preterm labor. Your OB or midwife will let you know if she thinks it's dangerous for you to continue nursing. The flavor of your milk may change and become unpleasant to your toddler, and he may decide to wean on his own because he doesn't like the taste. Some women find that their milk dries up when they are pregnant, although some continue to allow their toddler to "nurse," even when there's no milk, just for comfort. Many women find that nursing while pregnant is very uncomfortable, either because of breast and nipple soreness caused by the hormonal changes of pregnancy, or just because they generally don't feel well. If your toddler does continue to nurse through your pregnancy, your milk will change back to colostrum sometime late in the pregnancy. Your toddler will likely enjoy this new milk very much. You can even continue to nurse both your toddler and your newborn after the birth. This is called "tandem nursing." Remember that milk production is based on demand, so if you have two children demanding milk, your body will make enough for both. Be forewarned that newborn milk may have laxative properties for your toddler!

Nursing a toddler can be both rewarding and frustrating. The frustration may be in the nursing gymnastics, the twiddling, the demands. But the reward is in the special cuddles, the smile, and, when he starts talking, the compliments! Older toddlers may even tell you what your milk tastes like to them (ice cream?), although whenever I asked my son, he always said my milk tasted like milk. Can't argue with that!

That concludes this Breastfeeding Basics series. I'm happy to answer any questions you have in the comments. Also, remember to check out my new book, The "Yes, It's Normal!" Guide to Breastfeeding!