AAP now recommends breastfeeding beyond age 2 due to benefits for both baby and mother

For the first time in a decade, The American Academy of Pediatrics (AAP) has updated their guidance on breastfeeding. In a new policy statement, the organization continues to recommend exclusive breastfeeding for up to 6 months of age (unchanged from their 2012 guidelines), but newly supports continuing to breastfeed for two years or more, “as mutually desired by mother and child.” 

On an empathetic note, AAP also recognizes that more social and workplace support is needed to make that happen—and that pediatricians can play a key role in advocating for better policies for breastfeeding parents.

​​“We need societal changes that will help to support this, such as paid leave, more support for breastfeeding in public and child care facilities and workplace support,” says Joan Younger Meek, MD, MS, RD, FAAP, FABM, IBCLC, lead author of the new recommendations, to The New York Times.

Previous guidelines suggested that breastfeeding should be continued for one year or longer. The new recommendations for longer breastfeeding are in line with those of the American Academy of Family Physicians and Canadian Paediatric Society, and the shift comes as a result of recent evidence showing more benefits from longer breastfeeding not just for the baby—but also for the mother. 

Benefits of breastfeeding longer than 2 years

“Human milk is all a baby needs for the first six months of life,” says Dr. Meek in a statement. “Breast milk is unique in its nutrients and protective effects, and really quite remarkable when you look at what it does for a child’s developing immune system.”

But in the second year of a baby’s life, early data show that breast milk continues to be a major source of macronutrients and immunologic factors, helping toddlers’ immune development. 

Children who were breastfed tend to have fewer illnesses in general, including lower rates of ear infections, severe diarrhea, lower respiratory illnesses, sudden infant death syndrome (SIDS), inflammatory bowel disease (IBD), childhood leukemia, diabetes, obesity, asthma and atopic dermatitis. 

Related: Any amount of breastfeeding for 2 months can cut SIDS risk in half

Studies also reveal that breastfeeding beyond one year has big benefits for mothers, too, in terms of decreasing the risk of type 2 diabetes, high blood pressure, breast cancer and ovarian cancer. 

“In the medical community, there has often been this tendency to support breastfeeding up until a child’s first birthday,” Dr. Meek said to The Times. “After that, it’s like, ‘Well, there’s no reason to continue breastfeeding.’” The new research proves otherwise.

Breastfeeding mothers need more support

Even still, most babies aren’t meeting that initial 6-month goal. According to AAP, more than 80% of U.S. mothers initiate breastfeeding, but by 6 months, 58% are still breastfeeding in combination with formula feeding, and just 25.8% are still exclusively breastfeeding. Only 35% of babies are still breastfed at 1 year. 

It’s clear that more support is desperately needed to help encourage breastfeeding rates by the 6 month mark—and well beyond. That starts with pediatricians, whom the AAP suggests should have “nonjudgmental conversations” with parents about the benefits of breastfeeding, while also acknowledging that exclusive breastfeeding is not always possible for every parent/child dyad. 

Related: AAP releases new 2022 safe sleep guidelines: Here’s what parents and caregivers need to know

Pediatricians are encouraged to support any decision parents make around breastfeeding, as children can thrive on a combination of breastfeeding and formula feeding, or solely on formula feeding alone. 

We also can’t ignore the fact that outside of pediatrician support, breastfeeding parents need more workplace flexibility and social support to help meet this milestone. 

In the new policy statement, AAP encourages pediatricians to advocate for parents, supporting universal paid leave, insurance coverage for lactation support, the right to breastfeed in public, remote work and flex-work opportunities, on-site childcare, and the ability to work around a breastfeeding or pumping schedule, all of which are integral to breastfeeding success for working parents. 

Establishing better breastfeeding support in the early months will have major dividends in terms of later breastfeeding success—and both baby and mother’s future health. 

“Breastfeeding can be challenging for new parents, and support from their families, doctors and work places is essential,” Dr. Meek says. “The health benefits are vast and can be viewed as a long-term investment not only in a child’s development, but to public health as a whole.”

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New 2022 AAP breastfeeding recommendations

The organization’s additional breastfeeding guidelines are outlined as follows.

AAP recommends:

• Exclusive breastfeeding for the first 6 months. After 6 months, maintain breastfeeding alongside the introduction of solid foods.
• Hospitals and birth centers should implement maternity care practices to improve breastfeeding initiation and duration and exclusivity.
• Recognizing that long-term breastfeeding offers continued benefits even beyond 1 year and up to 2 years especially in the mother.
• Additional support for mothers who choose to breastfeed beyond the first year from their healthcare providers, as well as protection against workplace barriers.
• Policies that protect breastfeeding, such as paid leave and insurance coverage for lactation support, are essential to supporting sustained breastfeeding in all families.
• Recognizing that most maternal conditions, medications and vaccinations are compatible with breastfeeding. AAP directs pediatricians to the LactMed database for more information.
• Assisting parents who have given birth to preterm and other vulnerable infants to establish a full supply of milk by working with hospital staff to facilitate early, frequent milk expression. Pasteurized donor human milk is recommended for very low birth weight infants when the mother’s milk is not available or as a supplement to it.
• Discouraging maternal marijuana use when breastfeeding due to lack of data on infants’ exposure. Mothers should be informed of the significant risks of smoking and secondhand smoke exposure for infants.
• Sharing that up to one drink per day (moderate alcohol consumption) is not known to be harmful to the infant.

How to self-advocate for longer breastfeeding

If you’re seeking information to best support your breastfeeding journey, here are a few ways to set yourself up for success.

• If you’re currently pregnant and interviewing prospective pediatricians, ask them about how they support breastfeeding parents. Do they have a lactation consultant on staff to help troubleshoot breastfeeding issues?
• If you’re currently pregnant and choosing a hospital in which to give birth, ask about their lactation support. How soon after delivery will you be visited by a lactation consultant? Do they offer other mother-supporting and baby-supporting measures, such as skin-to-skin contact and rooming in? Will they hold off on formula introduction to help facilitate breastfeeding?
• Reach out to your insurance company to see if your insurance plan covers lactation support and breast pump supplies. In some plans, even supplies like freezer bags for storing breast milk may be covered.
• Ask if your workplace offers paid parental leave, remote or flexible work opportunities or a dedicated space for lactation.
• At any stage in your journey, connect virtually or in-person with a certified lactation counselor and/or breastfeeding support group that you can reach out to for additional support when needed.

A note from Motherly

It’s important to recognize that any amount of breastfeeding for any duration can offer you and your infant significant benefits, but know that if the mental, physical or emotional toll of breastfeeding ever becomes too much, it’s always OK to stop. AAP continues to stress that breastfeeding should always be mutually beneficial for both mother and baby. If it’s not working for one of you, it’s not working for either of you.

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