The Canadian Pediatric Society on Breastfeeding

So a funny thing happened – after my post on Sunday, I got a very nice email from the Canadian Paediatric Society pointing me towards more of their resources on breastfeeding.

The CPS’ position on breastfeeding, also linked in Sunday’s post, can be found here:

The Canadian Paediatric Society recommends exclusive breastfeeding for the first six months of life for healthy, term infants. Breast milk is the optimal food for infants, and breastfeeding may continue for up to two years and beyond.

(emphasis mine).

What is exclusive breastfeeding?  Exclusive breastfeeding is defined by the WHO:

The WHO defines exclusive breastfeeding as the practice of feeding only breast milk (including expressed breast milk) and allows the baby to receive vitamins, minerals or medicine. Water, breast milk substitutes, other liquids and solid foods are excluded. (5)

Where the confusion sets in is when you read the current joint statement on breastfeeding from the CPS, Health Canada and the Dieticians of Canada:

Healthy term infants should be exclusively breastfed to six months of age and then continue to be breastfed with appropriate complementary feeding to two years of age and beyond.

As we can see this statement is much more strongly worded.  While the CPS, in its own recommendation, simply states that you can breastfeed to two and beyond, the joint statement, by virtue of using the word, “should” does more than imply that extended breastfeeding has benefits or might be a nice way to connect with your child or simply pass the time.  If it’s something we “should” do, I would say that’s a pretty strong recommendation and a statement on when mothers should wean.

There is a big difference between can and should.

However, the CPS pointed out to me that the joint statement (Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months)  is currently under revision.  The new statement (draft only) sort of resolves this conflict:

Breastfeeding – exclusively for about the first six months, and sustained for up to two years or longer, with appropriate complementary feeding — is important for the nutrition, immunologic protection, growth, and development of infants and toddlers.

It’s hard to know what to make of this sweeping statement.  While there are certainly measurable benefits to exclusive breastfeeding for the first six months, it seems less evident to me that, in the absence of research studies, those benefits can be extrapolated to older infants and toddlers.  Again, no evidence or rationale, no discussion of current expert opinion, is offered to support breastfeeding “sustained for up to two years or longer.”  What I really want to do, is read the upcoming joint statement on nutrition from six months to two years but I will have to wait until 2013/2014 when it is slated for publication.

Is breastfeeding important for the immunologic protection of toddlers or is that overstating the science a bit?  Is a kid that is weaned to whole milk a one year somewhat disadvantaged with respect to development compared to a kid that is breastfed until two?  Is that whole milk two-year old nutritionally deficient compared to the breastfed kid?  Is there even biologic plausibility for health benefits in older infants and toddlers that are also eating a wide variety of complimentary foods and drinking fluids other than breast milk…ie older babies that are only occasionally nursing?  What is the minimal effective dose for breastmilk in order to reap the nutritional, immunologic, growth and development benefits?

Undoubtedly there are “soft” benefits to extended nursing…I wish I could participate in them and I wish that my son would cooperate!  It would be nice to have nursing as a way of calming him down, sneaking cuddles and quiet time, and connecting after a busy day.  I think those things have incredible value in and of themselves and I would welcome changes in our society so that women don’t feel that they have to “hide” the fact that they are nursing their older infant or toddler.  And maybe that is the point.  Maybe, by overstating their case, fundamental changes will eventually occur in how we view extended breastfeeding.  Maybe it will no longer be dubbed “extended.”  And maybe that is worth something.

But, and this is a big but, in the absence of scientific evidence, that “something” should not come at the expense women who, for whatever reason, wean earlier.  Unfortunately breastfeeding has developed into a polarizing, contentious topic.  It shouldn’t be, but here we are.

Or maybe I should view this the same way I view Canada’s Food Guide.  I mean, who really gets 8 servings of fruits and vegetables a day, every day?  Unless blueberry muffins count, I certainly don’t.

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7 comments

  1. Box of Salt · · Reply

    Breastfeeding for 2 years? Really? Don’t 1-year-olds eat real food? They have molars! And shouldn’t the real food be the more important source of nutrition at this point? Or am I off base on that?

    According today’s recommendations, I’ve done everything wrong! I weaned my children after the first year, I switched them to forward facing car seats after they reached 20 lbs (for both kids it was after they turned 1-yo), and I had a crib with a drop-down side (btw I’m short). Oh, and both kids are happily enjoying grade school.

    I ended up weaning my first around 13 mos because my supply couldn’t handle my plan of backing off slowly. I too felt a little offended when the kiddo popped off, sat up, and was done forever. But I also felt a little bit relieved.

    Weaning my second was very much driven by me. I pretty much just quit as soon as he demonstrated he could drink milk. He too was around 13 mos at the time and had refused bottles (don’t ask how much pumped milk I’ve thrown away). I needed my own life back, and I also needed to go back to work after being off for over a year—in the US (i.e. not paid!).

    Oh, and the first one didn’t tolerate milk until she was 3, which meant as long as I was nursing her, I couldn’t have any either (and that included yogurt and cheese, based on baby’s gassiness and discomfort). That kind of thing only works short term for the mom. Let me eat my yogurt and cottage cheese and feed the kid the enriched alternative milks, green vegetables, and supplements.

    Adequate Mom, thank you for being up front about this. And enjoy the future: there’s lots of ways of getting snuggles. I still read with my younger one (already 5) on my lap.

    1. Box of Salt · · Reply

      Mmm… OK, I thought I was commenting on the Pumping be gone post!

  2. Should is strong language, not as strong as must, but strong none the less. I’m skeptical – I can see clear advantages until 4 months of age but between 4-6 months many infants are ready to incorporate other foods into their diets, and iirc there was some recent research that showed that waiting for 6 months might not be ideal….

    But I guess once you et that nuance it no longer fits into a one sentence “statement” suitable for general consumption.

    1. For the record, the resources sent to me by the Candian Paediatric Society are:

      1. The CPS recommends exclusive breastfeeding for the first 6 months of life, and notes that breastfeeding may continue for up to 2 years and beyond: http://www.cps.ca/english/statements/N/BreastfeedingMar05.htm We do not have an explicit recommendation on when mothers should wean.

      2. Our statement on weaning (http://www.cps.ca/english/statements/CP/cp04-01.htm) recognizes the many different circumstances under which weaning occurs, and that the timing is unique to each mother and baby.

      3. The joint statement by Health Canada, Dietitians of Canada, and the CPS that you cite is currently under revision. Here is an advance look at the draft: http://hc-sc.gc.ca/fn-an/consult/infant-nourrisson2/recommendations/index-eng.php#s1

      4. Our information directed at parents (http://www.caringforkids.cps.ca/handouts/breastfeeding and http://www.caringforkids.cps.ca/handouts/weaning_breastfeeding) aims to support all women who choose to breastfeed, whether for a relatively short period of time or longer.

  3. miriam · · Reply

    Because the evidence for breast milk in infants is SO GOOD (not), that we can CLEARLY extrapolate it to toddlers. Longer must be better, right?

  4. […] The Canadian Pediatric Society on Breastfeeding (theadequatemother.wordpress.com) […]

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