When the American Academy of Pediatrics urged in December 1997 that all babies be breast-fed for at least the first year of life, a 29-year-old mother in Champaign, Ill., cheered: The woman's son, then 2 1/2, was still nursing at least once a day, and seemed a rosy-cheeked testimonial to the health benefits of breast milk. He recovered quickly from stomach flus and colds, and seemed bright, happy and well-adjusted. The little boy was hitting developmental milestones and climbing the growth chart right on track.
But in July, the applause suddenly stopped. The woman's son, by then 5 years old, was removed from her home after caseworkers responded to a baby-sitter's complaint. Judge Ann Einhorn approved the separation, declaring that the woman's continued breast-feeding had created a situation with "enormous potential harm to this child." To protect the boy, the judge has ordered the woman's name withheld and has barred her from speaking to the media.
The incidence of breast-feeding in the United States is on the rise and, with a welter of new studies, the medical case for breast-feeding infants is growing stronger. But against this backdrop, the Champaign case has sparked a debate among parents, child welfare officers and health professionals: How much breast milk is enough? And can you get--or give--too much of a good thing?
In a country where fewer than 16% of babies are still being breast-fed on their first birthday, the question applies to a small group of children. And answering it is more than a case of consulting the medical literature on prolonged breast-feeding, which is, in any event, scant. For the subject of breast-feeding--and particularly the breast-feeding of older children--stirs up a complicated stew of politics, psychology and cultural belief.
Is breast-feeding beyond babyhood about sex--a charge that propelled the Champaign case into the courtroom in the first case? Does it foster a child's independence or smother it? Is there any nutritional or health benefit to nursing beyond infancy, or is the child who continues to feed at his mother's breast--usually no more than once a day--merely satisfying an impulse for comfort or sucking? And what exactly are the motives of the rare woman who bucks the American norm of early weaning?
Like almost all matters of child rearing--from a shared family bed to toilet training to spanking--such questions touch raw nerves and spark fervent debate at dinner parties and professional conferences. And like these practices, breast-feeding has gone in and out of vogue--responsive more to cultural and sometimes economic shifts than to clear scientific evidence. In the last century, the development and mass marketing of baby formula in the 1920s, the ebb and tide of mothers into the workplace, and even the counter-culture "earth mother" movement of the 1970s were key factors in driving nursing rates up and down.
After reaching a low point in 1971, the incidence of nursing among the mothers of newborns has reached roughly 64%, with less than three in 10 continuing to nurse at the six-month mark, and just 16% still nursing or planning to nurse at one year.
In the recent history of breast-feeding in America, that represents a spike. And in this case, the shift has had strong medical impetus. It has come at a time when two key organizations--the 55,000-member American Academy of Pediatrics and the United Nations' World Health Organization--have adopted sweeping new guidelines intended to promote longer-term breast-feeding. In 1991, the WHO urged that all children be breast-fed until they are 2. And in 1997, the AAP, in its first-ever statement on breast-feeding, recommended that almost all babies be breast-fed "for at least 12 months, and thereafter for as long as mutually desired."
After several decades of research, health specialists now can cite strong research evidence of breast-feeding's positive effects in the first year. But for a host of reasons, breast-feeding beyond that milestone is territory virtually uncharted by the scientific establishment.
If Some Is Good, Is More Better?
In a small number of well-regarded studies, some researchers see growing evidence of a "dose effect" for breast-feeding. Essentially, the studies suggest that if some breast milk is good for baby's health, then more breast milk--or breast milk given over a longer period of time--is even better.
How much continued breast-feeding will improve a child's health, and for how long, are not precisely understood, researchers acknowledge. But one thing is clear: The more-is-better school of thought is putting the lie to the widely held belief that breast-feeding works all of its magic in the first six months of life.