In the Champaign case, Judge Einhorn ultimately rejected charges that long-term breast-feeding amounted to sexual abuse, and has, seven months after his initial removal, allowed the child's return to his mother. But in her rulings, Einhorn appeared to accept the suggestion that the mother had problems granting her child's growing need for independence. She has ordered parenting courses and counseling as a condition of the child's return.
For the woman who allows her child to wean at his own pace, such messages can be a source of particular conflict. American society prizes the individual's self-reliance, and babies are not immune to the rigors that early independence demands. Unlike most of the world, for instance, most Americans choose to put even the youngest infants to sleep in a separate bed. In that cultural context, a mother who continues to breast-feed an older child raises suspicions that she finds it difficult to break the bond of babyhood.
But Nadja Flanagan, a South Pasadena mother of four (with a fifth about to be born), sees the decision as empowering. She nursed each of her first four children, including three through a subsequent pregnancy, until they were at least 3. Flanagan clearly believes that long-term nursing has health benefits. Her oldest, now 12, had her first ear infection at age 4, and Flanagan thinks it's the only one the family has had.
Flanagan also believes that she has boosted her children's confidence and self-control by letting them have some control over where, when and how they seek comfort and nourishment.
"They are comfortable in their own skin, comfortable with themselves. I wanted to feed them that security because I see it as a need that won't go away even if it's not fed," says Flanagan.
"They're not independent because they have to be but because they're empowered to be, ready to be," she says. "Forced independence may work in the short term, but in the long run it's not lasting."
La Leche League, the venerable organization that champions breast-feeding, sees signs of change in Americans' discomfort with the practice. In 1999, Congress passed a law protecting the rights of mothers to nurse publicly on federal property--the first in a welter of pending legislation that would promote breast-feeding. And pressed by the AAP, physicians who long hesitated to push the issue are more actively encouraging the practice.
As a breast-feeding researcher and pediatrician at the Venice Family Clinic, UCLA professor Wendelin Slusser straddles the two worlds of science and clinical practice. While she finds evidence of breast milk's dose effect compelling, she says there are plenty of other good reasons to promote longer-term breast-feeding. In a baby's second year of life, for instance, breast milk can provide as much as 25% of a child's caloric intake and 90% of her daily need for vitamin C, in addition to an ongoing dose of immunological protection. "Breast milk is still good food. And it's a real safety net" for babies and their families, she says.
While her clinical experience doesn't count as research, Slusser says she perceives "a bright little twinkle" in the children she treats who are breast-fed for long periods. And she almost never, she adds with a laugh, sees them because they're sick.
And if it provides comfort and support to an older child exploring his world? "What's wrong with that?" Slusser asks. "That's one of the roles of a parent."
But finding the endpoint of a good thing is one of medical research's most difficult challenges, says Goldman of the University of Texas. And in industrialized societies, nursing beyond the first year of life has become enough of a rarity that, even if scientists like Goldman could command the research funds to conduct them, they fear they would have problems gathering sufficient populations and designing reliable studies to explore its effects.
Which is not to say that long-term breast-feeders do not exist in the United States. In a bid to study the practice of long-term breast-feeding, anthropologist Dettwyler set out to find American women who have nursed beyond their child's third birthday. On a first pass, she found 1,280 potential research subjects, and she continues to hear from women who step forward when they learn of her work.
"I call them my closet breast-feeders," says Dr. Slusser.
In the final analysis, many say that while useful, much of the medical research on breast-feeding currently underway approaches the question from the wrong direction. Given that primates and humans living in nonindustrial circumstances all nurse for several years, says Dr. Gartner, researchers should be asking, what are the ill effects of early weaning as it is practiced in the United States?
"The question is, are you doing any harm?" asks Gartner. Until you answer it, he says, "there truly is no basis for any upper limit," says Gartner.