Source of Support

As Leaders we are important sources of information and support for these mothers. We can help them to overcome the feelings of isolation and doubt that come with making a choice that is different. We can help them see the broader picture: there are mothers all over the world who nurse their children for years rather than the few weeks or months that are common in Western culture. We can remind them that many mothers before them, throughout human history, have had nursing relationships with their children throughout the early childhood years. We can make sure these mothers have the information they need to counter the criticism and judgmental attitudes that they may encounter. We can help support their self esteem so they may confidently follow their inner voice and feel comfortable making the choices that are right for them.

Since Series Meetings are designed to meet the needs of new mothers, a special forum may be needed to give mothers of older children the opportunity to share their experiences and concerns about nursing through the toddler years and beyond. A special meeting of this type gives a mother the opportunity to build a bridge of support and knowledge that can be helpful in overcoming the isolation that she may feel as a mother of an older child who continues to nurse.

At Area Conference workshops on the topic of nursing through toddlerhood and beyond, mothers are clearly grateful to finally have a chance to share their experiences and are eager to ask others the questions that they may have had to face alone. As they recognize the commonality of their experiences and concerns they feel relieved. It is reassuring to hear that others have had similar experiences.

According to the research of Smith (1991), many primates wean their offspring when they are erupting their first permanent molars. First permanent molar eruption occurs around 5.5 to 6.0 years in modern humans. It is interesting to note that achievement of adult immune competence in humans also occurs at approximately six years of age, suggesting that throughout our recent evolutionary past, the active immunities provided by breast milk were normally available to the child until about this age (Frederickson).

Our evolutionary past has produced an organism that relies on breastfeeding to provide the context for physical, cognitive and emotional development. The non-human primate data suggest that human children are designed to receive all of the benefits of breast milk and breastfeeding for an absolute minimum of two and a half years, and an apparent upper limit of around seven years. Natural selection has favored those infants with a strong, genetically coded blueprint that programs them to expect nursing to continue for a number of years after birth and results in the urge to suckle remaining strong for this entire period.

In her book, Breastfeeding: Biocultural Perspectives, Dettwyler theorizes that the six-year nursing practice for humans began to be modified, first by the use of fire for cooking (one-half to one million years ago) and then even more significantly by the domestication and processing of grains via pounding and grinding, both of which provided alternatives to uncooked vegetation and raw animal foods. It is interesting to note that the hunter/gatherer lifestyle represents more than 99.9 percent of human existence on earth and that agricultural societies have existed for only about the last 10,000 years.

Ethnographic studies of hunter/gatherer and other pre- industrial societies show that while the duration of lactation varies considerably between cultures and between individual children within a culture, the average duration is between three and five years of age. Here are some examples from Wickes' 1953 survey of various tribes: Australian aborigines, two to three years; Greenlanders, three to four years; Hawaiians, five years; Inuit, around seven years.

Lactational duration is just one of many cultural variations in breastfeeding practices. Patricia Stuart-Macadam, writing in Breastfeeding: Biocultural Perspectives, informs us that the !Kung San of the Kalahari desert in Southern Africa breastfeed frequently and intensively, "giving the breast about four times an hour during the day and several times at night for at least the first two years of life." This practice has a significant child-spacing effect with conception occurring on average 35 months postpartum, resulting in a birth interval among the !Kung of almost four years.

Nature's Norm

Such frequent suckling may indeed be nature's norm, reports Sheila Kippley in her book, Breastfeeding and Natural Child Spacing, as it is true of both chimps and gorillas as well as representative of a number of human cultures living in natural conditions. The Gainj of New Guinea nurse their infants at an average interval of 24 minutes. For their 3-year-olds, the average interval between nursings is 80 minutes. It is interesting to compare these practices to the standard recommendation given to new mothers today of 8 to 12 nursings in a 24-hour period.

In a thought provoking article, "The Concept of Weaning: Definitions and Their Implications" (Journal of Human Lactation, June 1996), Ted Greiner points to research in northern Bangladesh where children who were breastfed at 3-4 years of age received the breast 9-10 times a day and those who were still breastfed at 4-5 years of age received it 7-9 times a day. Greiner comments, "Although the quantity of breast milk was not measured, this sucking frequency can be assumed to maintain a relatively high level of breast milk production (as indeed it does in women who relactate), and should hardly be termed 'token breastfeeding."' We seem to know so little about what is normal nursing behavior for the four- to five-year-old that this cross-cultural information can be very reassuring to a mother who is wondering about her child's nursing behavior.

In her book, Mothering Your Nursing Toddler, Norma Jane Bumgarner gives us this glimpse into the history of the decline in breastfeeding duration in English-speaking countries. She reports that according to a study of advice given to mothers by doctors from 1550 to 1900:

It was not until 1800 that most of the popular English writings on child care recommended weaning as young as 12 months. Even in 1725, writers commented with disapproval on nursing four- year-olds, an indication that a significant number of eighteenth century four-year-olds were still receiving love and comfort at their mother's breast. By 1850 most "experts" were recommending weaning by 11 months. At this time it was the nursing two-year-olds seen by child-care advisors who drew official frowns. It is enlightening how closely these changes in recommended patterns of child care parallel other changes in family life that accompanied the Industrial Revolution in England and the United States.

Bumgarner reports these other interesting pieces of history:

In ancient India, influenced by the belief that the longer a child nursed the longer he would live, mothers usually nursed their children as long as possible, often seven or even nine years sometimes. In Tsinghai, China, mothers observed in 1956 were still nursing for several years, five years not being unusual, or until another child was born. In Inner Mongolia in 1951, children nursed two or three years, nor was it rare that a six- or seven-year-old would want to nurse for a bit of reassurance.

Kathleen Huggins and Linda Ziedrich, in The Nursing Mother's Guide to Weaning, give an interesting glimpse into weaning practices of other cultures. In one account a Sioux mother "came to school at recess to nurse her eight-year-old boy because he had a cold." And they comment "this wasn't a very remarkable occurrence in her culture; the average nursing period among the Sioux, traditionally, was three to five years."

Within Western cultures there have been significant regional differences in breastfeeding practices. While "experts" in England were recommending weaning as early as 12 months in 1800, Gabrielle Palmer notes in her book, The Politics of Breastfeeding, that "in East Lincolnshire women were reported to suckle their children until they were seven or eight years old even in the 1820s."

Though it is clear that the majority of women worldwide and throughout history have nursed their children into toddlerhood and beyond, women who choose to do so today may face an uninformed and frequently critical audience. Therefore many choose to make sure that they limit who sees and who knows, taking greater care as the child grows older. Given this climate it is a highly select group of mothers who nurse their children beyond toddlerhood.

Social Pressures

Because of the social criticism and resulting secrecy, it is hard to get an accurate picture of just how many children are continuing to nurse this long. Often the last nursings to be given up occur in bed and so are hidden from all but those who share the bedroom. It must be difficult even for the anthropologist in a native tribal village to get an accurate picture of when nursing has completely ended.

Older nursing children as well as mothers feel the social pressures. They are often very aware that other people just don't understand. Privacy may be even more important to the child than it is to the mother. Knowing other children their age who are continuing to nurse is helpful. Reading stories about other nursing children also helps to normalize it. Unfortunately these stories are not widely distributed or well known. My daughter has asked me several times to reread stories of older nursing children from HARVEST, Area Leaders' Letter of LLL New York West, USA. She chose to have a weaning party after being inspired by one of those stories.

Given social criticism, people who are unfamiliar with the practice of nursing beyond infancy may wonder why mothers would want to continue to nurse through toddlerhood and beyond. As Leaders we can help mothers answer this question confidently. Mothers find many practical advantages in nursing. As a parenting tool it is useful when easing the exhausted child into sleep or soothing both mother and child after the storm of a tantrum has passed by. During illness, breast milk may be the only food or drink that a child will take or can keep down and digest. It can make the difference between a dehydrated child needing hospitalization and a sick, but well-hydrated, child at home in mother's arms nursing through a potentially serious illness.

Health Benefits

The adverse health effects of weaning a child before or during toddlerhood are well documented for Third World countries such as Guinea-Bissau, where children who were no longer breastfed at ages 12 to 35 months had a 3.5 times higher mortality than did their peers who continued to breastfeed. There is a lack of this type of comparative research between breastfeeding toddlers and preschoolers and their already weaned peers in economically advanced countries. The negative impact of early weaning on children's health is not as dramatically evident but in time it may prove to be significant.

The scientific evidence on extended breastfeeding is just now beginning to accumulate. A number of the health benefits are now being found to be related to the length of nursing with an increasing amount of benefit correlating with increased duration. This is the case, research has indicated, with breastfeeding's protective effect in maternal breast cancer, osteoporosis, childhood ear infections and malocclusion anomalies (misaligned teeth).

Katherine Dettwyler reports that "a wealth of scientific evidence exists documenting that the benefits of breastfeeding (and the risks of artificial feeding) continue for as long as the infant nurses. Aside from the health concerns, there is now evidence that the longer a child breastfeeds, the higher that child's IQ score and school grades will be in later years, with a dose effect evident even beyond two years of nursing."

The word "benefit" is perhaps misleading here, for these "benefits" are what nature intended to be the human norm. Breastfeeding is normal. It is artificial feeding substitutes and premature weaning that are, in fact, abnormal from a biological viewpoint. It is these abnormal practices that place the child at increased risk of illness and compromised intelligence.

For many nursing couples, by the time the child reaches toddlerhood, nursing is a well-established part of their relationship. We can help mothers to feel confident in acknowledging that their breastfeeding relationship is mutually satisfying: highly cherished by the child and often by the mother as well. For mothers it is a mode of giving both nurturance and sustenance. For both mother and child nursing is a momentary retreat from the increasing separateness of their lives, back to the closeness they shared when the two were one.

Nursing Through Toddlerhood and Beyond

Special meeting discussion questions:

• While it is clear that nursing a child beyond the first 12 months of life is something we have in common with the majority of mothers throughout history, in many cultures we stand out as different. While we have been able to find support, we also may face criticism. How do you feel about this criticism? How do you deal with it?

• We want to meet our child's needs and we want to promote the normalcy and healthfulness of nursing without offending others or becoming a target of criticism. It is a tricky balance to achieve and we each need to find our own comfort level. How do you handle the issue of nursing a toddler in public?

• Sometimes our partners or other close relatives have a different outlook on continued nursing. How do you manage these differences?

• Children can be demanding. At times it may feel that your child's demands to nurse are excessive or inappropriately interrupting your activities. How do you balance your child's needs and wants with your own?

• When we choose to limit nursing or decide to wean completely, how can we help our children handle their feelings of loss?

• The nursing child may be keenly aware that peers or adults disapprove of continued nursing. How can we protect our child from social disapproval and help him/her handle the situation constructively?

• What do you see as the benefits of nursing through toddlerhood and beyond?

An Anthropological Look at Nursing Beyond Toddlerhood

Natural Reassurance

When reading a children's book about chimpanzees by Jane Goodall to my then five-year-old daughter, I learned that mother's milk remains a chimp's most important food until about three years of age. The book described Goodall's field observation of a chimpanzee mother named Fifi and her four-year-old daughter Flossi.

"Flossi starts to suckle. She will not be able to do this for many more months. Fifis milk is drying up and she often prevents Flossi from nursing these days. Then Flossi pouts and utters sad crying sounds until Fifi relents and lets her suckle for just a little while. In about a year Fifi will probably have another infant."