My friend visited this weekend and expressed surprise that I am still breastfeeding my 9mo. I was surprised because she has 16 nieces and nephews and is an IM intern, so I'd think she'd realize that breastfeeding a 9mo is completely normal. Anyway, we got to talking and she expressed distaste about a woman who breastfed a 2.5yo. I have no problem with breastfeeding a 2.5yo, though I don't think I'd want to do it. But then another friend pointed us to this youtube video about a woman who breastfed one child until 5, and is still breastfeeding the other at 7: http://www.youtube.com/watch?v=H6rFsxpqNBE. I tried really hard not to judge while watching, but I just couldn't help myself - it seemed extremely weird, if not wrong.

I don't want to start anything inflammatory. I think we can all agree that breastfeeding is a wonderful thing (which is not to say that women who don't breastfeed are not equally wonderful mothers). But I'm interested in people's opinions - is there an age limit? When is your child too old to breastfeed?

Pregnant, but not a mom yet, but I have plans to breastfeed until at least six months, but preferably a year. Although, I will be in rotations then, and it will likely be through pumping that that breastmilk gets to my baby - so really - not actual breastfeeding anymore then.

The Academy recommends doing it as long as it is mutually desired between the mom and child, which seems open-ended; however, my grandmother's best friend's daughter still breastfeeds her kids, who are around 7 and 9, and my grandmother's BF thinks it is creepy. To the point that my grandmother was telling me about it after a visit to her where it came up in conversation. I'm sure everyone has an opinion, though. That's just mine (I agree with my grandmother).

I think more than about 2 starts to cross the line into creepy territory. 7 is just weird. Can you imagine if this kid's school peers heard this? It's one thing if you live in a village in AFrica and this is the only food available, but in the US breastmilk is just not a main nutrient past toddlerhood. In my totally off -the-cuff unresearched opinion.

Teeth + nipples = HELL NO!!!!!!

Southern, you might be surprised. Some women find that when they are weaning they can still nurse once or twice a day and not have to pump at work, at least for the last month or two. I found this to be true with my daughter--we were weaning, but I was still able to nurse her at night that last month during my surgery rotation. However it's not true across the board; some women dry up pretty quick.

Not to get off tangent or anything....

I don't know how old is "too old," but my daughter agrees with the woman's daughter: breastmilk is the most delicious thing in the whole world. She remembers that and talks about it occasionally, even though it has been many years since she has had any.

My children nursed after they started sprouting teeth and it was never an issue. They all self-weaned at around 10 months.

Mine got teeth at 3 months so it would have been early weaning. They did bite a couple of times. That ended the feeding, no matter how hungry they were. They didn't do it again.

I guess it depends on what you mean when you say possible to breastfeed too long. From the mother's perspective? From the child's? From personal experience, my mom breastfed me until I was 3 years old. I'm pretty sure I don't have any long-lasting psychological damage from this(!) although I do have vague, early-childhood memories of breastfeeding. These memories don't weird me out though, in the same way that memories of me running around naked in the neighborhood as a 3 year old don't weird me out. Maybe it would be different if I were much older. It doesn't bother me at all, actually, that I was breastfed for so long. But, I would probably not want to do this with my kids (maybe breastfeed for a year?)

On the up-side, I have 2 siblings who both stopped breastfeeding before they were 1 year olds because they both discovered and preferred bottles. Of the three of us, I am the only one who does not have any allergies (both of them have pretty bad hayfever.) Who knows if this is related, but I've heard that long breastfeeding can decrease the incidence of allergies later on in children.

Also, breastfeeding definitely decreases the mother's risk of breast cancer later in life (according to my professor), and the longer the breastfeeding the lower risk of breast cancer later on.

I guess at the end of the day it's up to the mom and the kid!

I just watched the above youtube video. I agree that this is a little strange. I think toddlers and young kids are one thing, but school-aged children are different. Personally, I think my cut-off for weird breast feeding is around age 4-5!

My kids were all breastfed until the 8-10 month range, when it just simply became too much with work/school/etc. I will be breastfeeding this one as well, hopefully closer to the 10 month mark.

I have to say, my kids got teeth later (6 mos), and that was another reason we stopped in the 8-10 month range. Ouch!

My seven year old came home upset because a classmate told him that the place he had chosen for his birthday party was for babies. This is not the first time I have heard of some of the cruelness that is already going on in 1st grade- I can't imagine the things children would say to a classmate who was breastfed at the age of seven.

At the end of the day, it is up to the mother and child. I would definitely wean by 12-18 months, but that is my personal choice.

Of course it's up to mom and baby (or child, as the case may be). Also, teeth aren't really a factor for a lot of people - just because they have teeth doesn't mean they bite. I know the AAP recommends at least one year, and further as long as both mom and baby desire, but I just wonder if at some point there are social/developmental/psychological consequences. Freud would certainly have a field day with this one.

I don't have kids, but a funny story about this one!

I have a good friend with four children, and all were breastfed until it was comfortable to wean them, or they weaned themselves (usually between 1-2 years). She knew the fourth was her last, however, and was having trouble weaning him. I knew this, but when I stayed a weekend at her house so she could get away with her husband she assured me that he was weaned now. She told me he typically woke up halfway through the night, at which point she'd bring him into bed with her and he'd go right back to sleep. He was three.

"Now" maybe meant for a day, because when he woke up in the middle of the night and I carried him into the room he immediately wanted to nurse. I told him no repeatedly. A three-year-old, however, has a decent amount of strength and dexterity... yeah, he got plopped over on the other side of my husband so his sneaky little hands would stop pulling at my shirt. I don't think in his half-awake stupor he even realized that I wasn't the right person... or maybe he thought all women had milk.

In hindsight it's funny... I don't know what I'll do as a mother. As a non-mother it's a little strange when a kid walks up to his mom and asks her if he can nurse, but maybe mine will do that, so I try not to judge.

My mother breastfed me until I self-weaned at 3 1/2. She weaned my brother at 4 1/2. I don't think I've been psychologically damaged by the experience... :P In fact, I think it's had little bearing on my relationship with her. We aren't very close (for reasons pertaining to events in my teens) and I've always been an exceptionally independent person. I do remember breastfeeding and remember her stroking my face as I fell asleep. I still love having my face stroked gently as a calming technique.

I intend to breastfeed for at least a year, longer if it works out that way.

My personal opinion... 3 or 4 seems reasonable. Obviously, I'm in the minority. I'm not sure there are significant benefits (health or emotional) to breastfeeding a 7y/o. At that age, verbal communication and bonding seems more developmentally appropriate. I doubt it's harmful, though.

The more I think about all of this, the more I realize that the bias against breastfeeding older children is completely cultural. Sure, prehistorically women may not have breastfed so long because it was time to move onto the next child (I'm basing this on absolutely nothing, to be completely honest!). But surely no physical harm can come from prolonged breastfeeding. So the only problem becomes one of cultural and societal expectations. Just like many people in our society are (sadly) turned off of breastfeeding in general because of the sexualization of breasts, most of us think breastfeeding older children is weird or even wrong.

Of course, just because something is cultural doesn't make it unimportant. After all, we all have to survive in the context of our society. So social ramifications are important, and I think that's really my only concern. Bottom line - it's up to mom and baby!

I'm still wrapping my head around all of this, but it's proving to be a very interesting discussion

Just came across this link in another forum, posted by mohm (thanks mohm!). Thoughts?

http://www.kathydettwyler.org/detwean.html

Interesting!

It is very interesting, but looking around her site more has disappointed me. I grabbed this quote from one of her commentaries:

" I can imagine a day when all cans of infant formula carry a series of rotating warning labels from the Surgeon General that clearly state: "Use of infant formula may be hazardous to your infant's health. Infant formula is known to be a contributing factor in many cases of infant illness and death, including cancer and Sudden Infant Death Syndrome. The use of infant formula is known to reduce children's IQ as much as lead poisoning does, and hinders the development of strong affective bonds between mother and child." I can imagine a day when parents would have to sign a release when they buy infant formula, relieving the formula company of responsibility for causing higher rates of infant morbidity and mortality. I can imagine a day when heavy taxes are levied on the sale of every can of infant formula, both to discourage its use and to help offset the enormous medical costs incurred by those who use it. I can imagine a day when insurance companies charge higher life-long premiums for health care coverage of bottle-fed children. I can imagine a day when all pregnant women are fully informed of the costs of bottle-feeding, in terms of both their own health, and their children's health."

She also explicitly compares "artificial feeding", as she calls it, to smoking!

Why is it that we can't be super supportive of breastfeeding without looking down on people who, for whatever reason, bottle-feed? It's so frustrating to me. Can't we all just get along? :P

NBP - I agree with you a thousand percent. My sister developed staph infections due to a predisposition to clogged ducts that had to be drained once already from a surgeon in her breasts. She wasn't able to breastfeed, and she cried her eyes out about this. In fact, she was even saying she could just periodically get her breasts drained by a surgeon and try to keep going with breastfeeding. I almost lost it on her. She was beating herself up so bad, and it took me a long time to get her to realize she wasn't hurting her baby. I also have a friend whose milk never came in, and for whatever reason - any artificial means to get it to come in via drugs weren't an option for her condition. Not sure of the details, but she was upset also. She also had to come to terms with not being able to breastfeed due to "judgement" from people. I think people who assume women and their breasts are going to function perfectly are unrealistic. We are not perfect and neither are all of our parts. No one should judge another woman for this. Not only that, some mothers may simply be unable to breastfeed due to jobs they hold or whatever.

And I don't really care what her data says - I still think 5-6 years of age is too much. My opinion though. I also don't agree with her immunology statement either based on what I learned in school, but that's another tirade for another day. LOL.

I completely agree. However, I also worry about some women getting the message that breastfeeding either works, or it doesn't, when it really isn't so cut and dry. For example: my brother's fiancee told me about a friend of hers who had a lot of pain in the beginning, bleeding etc., so she "just couldn't" breastfeed. Now I clearly don't know the whole story, and I don't judge this woman for stopping, but I do think that there are a lot of cases like this where, with the right support, a woman who would otherwise give up could actually go on to breastfeed successfully (and happily). But women really do need the support, from L/D, lactation consultants, pediatricians, family, etc.

Again, not saying that I disapprove of someone making the decision to stop, just that sometimes people think they can't when, if the support they needed was readily available, they could!

In my experience, most children wean themselves between one and two years of age. While I have no problem with prolonged BF, I do think that 7 is too old. I'm not sure where I would put the cutoff, but in my mind it is somewhere around 3.

I think that a lot of western society has become over-sexualized. I agree with the woman in the video that society has no problem with a woman baring her breasts in public. I see them on the street all the time. It seems as though as long as the nipples are covered, it is fine. So many things which should be kept private are today being aired out in the open, which cheapens them.

Growing up, my mother taught me that there are parts of our bodies which are meant to be private. When something is kept private, it is special. My body is special, and something to be proud of, not embarrassed of. The crown Jewels are special, so they are kept under lock and key and only displayed on occasion. So, too, with out bodies.

There are limits as to when we bare our body parts. Just as I would not get fully undressed in front of my 8 year old, why would I let her breastfeed? It is just not appropriate after a certain age. However, my breasts are meant to feed my babies. Therefore, it is appropriate to bare them at that point. What exactly the cutoff age is will be different for each mother/child, but as I mentioned above I think that 7 or 8 is way too old. Let them cuddle up a different way.

I used to think weaning around 1 was appropriate, but my first child wouldn't wean, even when I went away to meetings and didn't nurse for 5 days, and so we maintained a bedtime nursing strategy until she was about 2 1/2 when I developed a rapidly-growing lump that turned out to be fibroadenoma, but I think she sensed my fear and weaned herself in about 2 days. My next child weaned herself at 14 months, and I found myself wishing she had wanted it longer. It's like a lot of coping strategies, some kids outgrow them sooner than others, but I would think by preschool a child should be developing independence away from breastfeeding unless mom somehow encouraged the continuance in which case she needs to let go.

I agree with you! I have been bfing my son for exactly two years (now twice a day) and it has been the best thing I could have done for him. He benefits nutritionally and psychologicaly. When he is done he is so content and at peace with the world. He never gets sick and the few colds he has had have disappeared in a day or two. I even put a few drops of bm in his eyes when had the occasional congiunctivitis. It works!
I am trying to introduce more whole, raw milk (to avoid constipation) so that we can gradually stop. I have loved it but I just am ready to stop.
Do what is right for you and your baby. Usually they go through a little stress when you stop bf and that will show with altered appetite or sleep or bowel movements, etc.

Sorry! Forgot to add that the WHO recommends bfing at least until the age of 2 and even until 7 depending on culture and child's needs.

I had a similar experience. My milk never fully came in, and my baby lost so much weight he had to be put on supplemental formula. I worked with lactation consultant to promote milk production with pumping and feeding every 2-4 hours around the clock and taking supplements. I continued to not make enough milk where we needed to feed him formula. Eventually, I was told by the lactation consultants that I was one of the few people with a true supply problem. Their recommendation was to stop breastfeeding and pumping and just comfort nurse after a bottle. I could swear they gave up a bit easier when they learned that I was not a stay at home mom.

I came home and cried. I fed him formula and 'comfort' nursed him, and I felt like I was giving up something I couldn't replace. So I said forget lactation consultants. I continued to feed both formula and breast milk. My breast continued to make more and more milk, and by the time my son started to eat solids and decreasing his milk intake, I was able to feed him exclusively with breastmilk at least when I was home with him at nights, post call, and on weekends.

I can't believe even the lactation consultants had this all or nothing thinking. My baby is 10 months now, and we are still happily breastfeeding along.

To answer the original question, I'm with the Academy. One year if possible, as long as both mom and baby are comfortable. Personally, weaning is not a priority, but pumping stops 366th day of my baby's birth.

I have an amazing mom in my practice. She is one of those "rare" women with an inability to produce any real amount of milk. After trying everything with her first, she started using an SNS. She now uses that with each of her kids (she just had #4). For each feeding she fills the SNS, tapes it to her breast and "breastfeeds".

I have told her several times how much I admire her. It would be so much simpler to use a bottle instead, as the babies are really formula fed. However, she feels that this way they get some of the benefits of breastfeeding as well.

As a mom of 4 previously breastfed children and a pediatrician, I wholeheartedly support any mom and child dyad to breastfeed as long as mutually agreeable.

Actually I don't think this scenario is at all rare. Moms often will decide on their own to switch to bottle when they don't feel the baby is getting enough so the true incidence of breast feeding insufficiency is unknown.

With my first son, because of early engorgement my supply was inhibited and never fully came in. This is what happens when non-breast-feeding mothers dry up their milk. This early decline in milk production, unlike a temporary decline later when there has already been a full milk supply, is very difficult to reverse. I tried the SNS but had an allergic reaction to the tape (ouch). Combined bottle and nursing/pumping to six months. The second time, I pumped like crazy early on and was successful in bringing in a good supply. Nursed him exclusively to six months then continued nursing until he was almost two! By then he was just as happy to have his father put him down for nap sans nursing.

I agree though that mothers should not feel they have to choose between nursing and bottle. No reason you can't do both and combine them in what ever way works for you and your family. Except for in the case of allergies or poor weight gain, it should be the mother's choice. I think people are combining the two more now than ten years ago, I see lots of mothers who do this naturally.

I would add that at least here in the US,many women have to go back to work long before they would naturally wean their babies, and this has a huge impact on breastfeeding. My own history is a case in point-my first two self weaned at 10 months, but even with a lot of pumping, I had to supplement with formula for each around 7 months or so. I was working basically full time and very stressed, that reeks havoc with supply. My third, I breastfed exclusively until she was 11 1/2 months and she self weaned to milk at that point-she had barely any formula. I was part time and sleeping more and spent a lot more time with her. If I hadn't been working, i think I could have BF all three of them for a longer time, just b/c we would have been together more often. I am not one of those women blessed with an abundance of milk, I really have to work for it. I actually have a very supportive work environment for pumping-my patients who are waitresses or work in fast food, for example, usually cannot pump. But I notice a marked supply drop as soon as I go back to work. And my period came back each time about a month after starting work.

Until our society supports longer maternity leaves, with 60-70% of women in the workforce, breastfeeding is likely to continue to be difficult for many.

Docmomof3 - I completely agree. I would have never given a bottle so much if I wasn't in school and felt like I had to. I would have much preferred to keep just breastfeeding from the breast (despite my earlier posts of pain- you were all right - it turned out just fine, and I loved breastfeeding!!!).

Now, my son won't breastfeed at all, and I am pumping around the clock now, and I hate it. I'm going to do it, but I hate it. Part of me wonders how my supply is going to handle clerkships. Guess we'll see.

Sometimes I am sad I am not just a stay at home mom that could just breastfeed on demand. But then I also know I would be a miserable stay at home mom, because that isn't me at all, so I guess this works fine.

I hear you on pumping Southern. Been doing it exclusively for 7 months and a few weeks, and it sucks. I will keep it up, because it is best for my little Peanut, but I hate my pump, and do not look forward to being attached to it at all. Being able to breastfeed is so much better.

When I was working and BF, pumping was an issue, b/c in my position, I often had back-to-back-to-back meetings. By the time I would get to pump, I would get easily 12-14 ounces. Work would *say* they were supportive, but if I needed to delay a meeting by 10 minutes to pump, it was obvious they were not supportive.

I have started a countdown- 4 months and some odd weeks to go. I am determined to make it to the one year mark. Because it is good for her (only one URI to date- yeah!), but also b/c I remember how discouraging everyone was re: pumping to get a supply started, maintaining the supply, etc.

I also think there is a small part of me that has a delusion that once Peanut has her cleft repaired, that she will BF. Ha! I know, it will never happen- she screams and has no interest at all. But maybe that deluded dream is what is keeping me pumping.

Oh yeah, this is why I have an issue with the AAP's recommendation for exclusive breast feeding to six months. This is truly not attainable for most working mothers (ie. most mothers). I think the AAP breastfeeding subcommittee's heads are in the cloud on this one!. Although maybe it is important to espouse what is in the best interest of the infant in the hopes of changing society down the line...who knows what their motivation was on that one. But as a working mother myself, I honestly felt that it was a lot to expect.

If it is in the best interest of the infant, why shouldn't they recommend it? I think the recommendation may persuade some women to stick it out, and some employers to provide time and space for pumping. Sure, there are situations where it will not be possible, but why not encourage breastfeeding for those cases where it is?

I agree. I think the AAP's recommendations hold a lot of sway and have been used as evidence to guide employers' and policymakers' decisions (thank goodness).

I do think that women especially use it to judge other women--it's a recommendation, not an expectation!

ASunshine-I definitely agree about the judgement. I often felt it when my little ones had a bottle in public, like I had to point out-hey, it is expressed breastmilk they are drinking in that bottle!!!

I totally hear all of you about the pumping. I loathe pumping. I always say I love breastfeeding b/c I get to bond with the baby, and it satisfies the most basic nurturing urges in me in terms of feeding my family (OK, I am Italian and Puerto Rican-two cultures that show the love through food!!)BUT, I do not breastfeed to have a relationship with my double electric breast pump!!!

Puerto Rican and Italian? I bet eating at your house is YUMMY!

I think the AAP recommendation causes more guilt for working mothers than change in employers' and policy makers' decisions!

Southern-yeah, we have some interesting holiday dinners when the whole family is together

I can say I have felt the guilt for supplementing before six months. But it is funny- being in the medical setting 'officially' this time around, I have felt more guilt than with my other three kids- so is the guilt more so specifically because I am surrounding with evidence-based practices and people who have those guidelines fresh in their minds? I have to say with my former coworkers, no one ever gave an opinion or made me feel as if they were trying to educate me on the finer points of breast vs. bottle.

That being said, I think it is important for the recommendations to be out there, as if that was not a recommendation, employers would simply not make the effort at all. (Some do, some don't) I really don't think that our building would have a 'special' lounge in it for staff/students if those recommendations were not out there.

The other thing is--and maybe this is just my region/experience--most of the pediatricians I've worked with are very quick to suggest formula. The baby loses a couple ounces, the mom expresses frustration, high bilirubin, mom is on a medication-->formula seems to be the first answer rather than the last answer. My kids' pediatrician (at least he's honest) said, "Don't ask me, I don't do that stuff" when I had breastfeeding troubles. (But he did send me to the lactation consultants.) I even heard one pediatrician say he wouldn't allow his WIC patients to get pumps because he knew they'd just sell them. >:(

Honestly, if the guidelines weren't there, I'm afraid that medical advice for women (outside of academics and a few other pockets) would become "formula formula formula."

I sure hope this isn't the case everywhere....

I have to say, I've had the opposite response. I've reviewed a good bit of the primary literature myself and I am seriously underwhelmed by the evidence that apparently supports the AAP's recommendation.

As an example: I can find exactly one randomized study of breastfeeding (Promotion of Breastfeeding Invention Trial, JAMA 2001). 17K mother-child dyads were (cluster) randomized to an intervention designed to increase breastfeeding. The study achieved remarkable separation between the groups (4% breastfed in the control group vs almost 50% in the intervention group) and the children were followed for more than six years. There was no difference between the breastfed children and the formula fed children when it came to IQ, childhood obesity, allergy/asthma, respiratory infections. Two outcomes showed a statistically significant difference between the groups: GI illness and atopic dermatitis. In the case of GI illness, there was a 4% absolute difference between groups for rates of one or more episodes of GI illness. To put that in more concrete terms, that means you'd have to perform the breastfeeding promotion intervention on 25 children to prevent a single episode of GI illness. Assuming rates of gastroenteritis were similar among all non-breastfed children, 12 babies need to be breastfed to prevent a single case of gastroenteritis.

AAP, kiss my pump.

Honestly, I have practiced Pediatrics now for 13 years and there does not seem to be a difference between breast and formula fed infants. I see ear infections and gastroenteritis in both groups at the same rate (it seems). And formula fed infants do just as well in school as breast fed infants! So, yes, I have occasionally recommended formula for an infant with jaundice severe enough to be admitted or an infant with ten percent or more weight loss from birth weight. In these situations, the benefits of formula far outweigh any imagined risks.

The pediatric intensivist that taught me in Renal said his mother fed him powdered cow's milk as a baby. So...that said - I still have this compulsion to at least try to keep pumping. Although I know that my baby would be fine either way.

Obviously you should do what's right for you and your baby.

All I'm saying is, the AAP isn't doing women any favors by pretending that there's this incontrovertible mountain of evidence supporting BREAST IS BEST. Because there isn't. What there actually is, is a steaming mound of poorly designed and contradictory observational studies, some of which show a small effect and many of which do not. And women deserve to know that before they choose to make real sacrifices (like pumping for months on end when you despise pumping!).

Emily, I wholeheartedly agree with you. This is why I will not put a guilt trip on a mother who has decided to give formula. Moms have enough guilt without this too...

Are there really physicians out there that would do that? I agree that saying anything like that to a mom after the fact would be incredibly insensitive.


Of course it's easier to give formula, and I know that to some providers, the benefit is trivial, but for the sake of the mom who's making this a priority (and the baby, who also stands to benefit), why wouldn't more physicians at least try to be more supportive of breastfeeding women? Or at the very least learn how to manage common breastfeeding problems before first suggesting formula?

I think so much of this lies in the fact that it is nearly impossible for female physicians and physicians-in-training to follow the AAP guidelines, which makes female physicians so much more sensitive to "not guilt-tripping" other moms--I think this sentiment goes a little too far and hurts women who are desperate for support in their efforts to breastfeed. Often there is not much support at home or at work, and when the lack of support continues at the doctor's office....many women are surprised and disappointed. And then they just give up.

(Not directed at you, kpzr, I'm more thinking of the pediatricians I worked with and their stories...and the stories of their patients.)

SW and southern, you both deserve a crown and minions to do your bidding for exclusively pumping all this time. I could never have made it as far as you. Pumping--let alone breastfeeding--is a thankless, exhausting task. Good for you!

I am very knowledgeable about breast feeding problems and supportive of breastfeeding moms. I do not suggest formula instead of "managing common breastfeeding problems"; as I already said, I use it only when medically indicated. Until you have been in practice and seen dehydrated or sick newborns, it is hard to see beyond the "normal" breastfeeding experience to understand that there is a medically-indicated use for formula. This is in no way the same as "taking the easy way out" and recommending formula.

I know of several physicians who do guilt-trip moms who have decided to give formula.

kpzr, I definitely didn't mean to insinuate that you wouldn't support breastfeeding! From all accounts, it sounds like you're an excellent pediatrician, and I value your opinions on things. I just wish more physicians like you practiced in my neck of the woods.

And yes, of course I understand and respect that there are medical circumstances when a breastfed baby needs formula supplementation. It happened to my own baby. I didn't mean to imply that I didn't know that, so sorry for the confusion! Honestly, my kids would have been transitioned to formula, too, if I hadn't been able to take as much time away from clinical duties as I did.

How can AAP recommend breastfeeding without evidence? I remember being taught in medical school that breastfeeding benefits the baby like less allergies, less illness (during breastfeeding) due to antibodies in the milk, less constipation of other digestive problems, etc. So these are all hogwash? Really? How can they make such recommendations that profoundly affect women without support? I am giving AAP the benefit of the doubt here because to think otherwise would be too maddening.

That being said, I would not trade the emotional bond I feel with my son while I breastfeed for anything. Pumping for a whole year was worth it. And I despised pumping. I wanted to burn the pump at the one year mark but refrained myself in case I have another one. And I still need to pump when I am on call although I pretty much wait until my breasts are about to explode before I will do it. Now it is more about bonding and less about supply of milk.

As a mom of an almost 3 year old I will say this.... please do not judge me as this is my OPINION only....

I HAD to go to work when my kiddo was 6 weeks old. I was able to nurse or pump until 1 year old, at which time I felt that my son was ok without the breast milk, and I was ok without the bonding time. Honestly, I think nursing beyond 1 year is about what the parents feel is necessary. Breast milk is extremely beneficial for infants/toddlers, but I feel that after 1 they are able to get the same nutrients off of formula or natural foods. Nursing is about how mom feels about the relationship with baby. After I had to go back to work, I was able to pump a few times a day and provide sufficiant ammounts of milk for my babe (as was my sister who was a 3L in law school when she had her son). DRINK TONS OF WATER EVERYDAY IF THIS IS WHAT YOU CHOOSE!!!! I am ALL FOR breast milk, but I personally do not feel that you have to nurse to get those nutrients to your baby.
Hope this helps.

You know what..... Be a GOOD mom and do what YOU feel is good for your kiddo! If you are asking these questions, there is no doubt that you have your kids best interest at heart, and once (s)he comes, I know that YOU will know what to do. It's second nature! Be comfortable with your decision and back yourself up. YOU know what's best for YOUR kiddo. Congrats on the baby It's seriously the most amazing thing that you will ever experience

I TOTALLY agree. Being a good mom is first, and it's hard to be a good mom when dealing with guilt from every angle. Get as much sleep as possible, do what's best for eating outcomes, and change your baby's diaper when necessary. These are the important things, no matter how you choose to solve them. BOND with your baby!!! Don't worry about doing everything the "right way", but instead be there for him (her), because before you know it they will be applying for medical school too!!!!

You can't be serious. *Most* clinical recommendations issued by medical societies are without significant evidence to underpin them. As an unrelated but particularly illustrative example, check out this fascinating citation:

Khan AR, Khan S, Zimmerman V, Baddour LM, Tleyjeh IM. Quality and strength of evidence of the Infectious Diseases Society of America clinical practice guidelines. Clin Infect Dis. 2010 Nov 15;51(10):1147-56.

It's a systematic review of all IDSA guidelines from March 1994 to July 2009, published in a flagship IDSA journal. The entire article is an amazing and worthwhile read, but I'll quote the article's conclusion: The IDSA guideline recommendations are primarily based on low-quality evidence derived from nonrandomized studies or expert opinion.



More or less, yes. I've cited the abosolute best and only randomized evidence above.



It is maddening. The more I am in medicine, the more I am fascinated by how clinical recommendations are forumlated and the more I am convinced that a) we as clinicians *must* review primary literature ourselves and b) for my career, I am very keen to participate in the formulation of these recommendations for my own subspecialty.



I understand this and to some extent I feel the same way. I plan to breastfeed my second child, at least initially. However, because I'm a hopeless pot-stirer, here's one more citation. There is exactly one (prospective, non randomized) study that looked at brestfeeding and attachment.

Here's the citation:

Britton JR, Britton HL, Gronwaldt V. Breastfeeding, sensitivity, and attachment. Pediatrics. 2006 Nov;118(5):e1436-43.

The clinical bottom line: there is no association between breastfeeding and mother-infant attachment. Interestingly there was a weak association between the intention to breastfeed and attachment, which speaks to the central problem with the breastfeeding literature: overwhelming and unavoidable confounding.

Emily - because curiosity is just getting the better of me...

Is your "You can't stop the pancakes" from this:

http://www.youtube.com/watch?v=R5RapBjos3I

If so - I just saw this the other day and thought it was hilarious!

Sorry - so completely off topic!

OMG too funny southern!!!

southern, no, I hadn't seen that before. Pretty funny, though.

I had a co-intern last year who used to say, "You can't stop the pancakes." His point was, no matter how hellacious the call night, no matter the absurb catastrophes that swirled around us ... the morning would come and NO MATTER WHAT we were going to walk out of the hospital the next day ... and go home ... and sleep or shower or drink beer or eat pancakes.

And now I always make pancakes with my son on my days off.

Love it!

Ha-ha! When I was a new intern, a senior on with me remembered HIS version, that "no one can stop the clock from ticking" and then crying as realized he was on call Saturday night of October-daylight-savings- reset.

Emily - that is possibly the best thing I've read in a long time. Thanks for sharing the back story!

loved it... plus a beer on a post call morning often is the best thing ever...or pancakes...just not coffee!

Anytime I had questions on breastfeeding or medications that I was taking while breastfeeding I called the Infant Risk Center or looked on their website. I swear it saved me a few times.