Breastfeeding/Chestfeeding Older Infants: Nutrition and Weaning

Parents often ask how long they should continue to breastfeed/chestfeed their children. The American Academy of Pediatrics (AAP) recommends human milk exclusively for the first six months. At this time, the baby could then start complementary foods and continue to breastfeed/chestfeed until at least 12 months of age, and continue for as long as desired by both the parent and baby. In many countries, it is common to breastfeed/chestfeed for two years or longer.

Nutritionally speaking, human milk provides everything that a healthy, term baby needs for the first six months of life, except for Vitamin D which requires supplementation. This is necessary since Vitamin D deficiency is prevalent in the general population and human milk does not generally provide the amount needed to prevent a deficiency. Additionally, there are countless other non-nutritional benefits to providing human milk, including providing protection against infections and supporting the baby’s immune system.

Six months of age is a good time to introduce complementary foods, assuming the baby is developmentally ready. Signs that the baby is ready include being able to sit upright in a highchair with minimal support. The baby may also show interest in watching other people eat, and may even mimic chewing motions or reach for a parent’s food. Whether you chose to offer pureed foods or follow a baby-led-weaning approach (skipping purees and offering soft finger foods while allowing the infant to self-feed), it is important to realize that the first foods offered to a baby are not necessarily for nutritional sake, but rather for oral skill development. Human milk should continue to be the baby’s primary source of nutrition as new, single-ingredient foods are offered to the baby. By offering only one new food every three to five days, the parent can then monitor for signs of intolerance or allergy to that food item.

By starting and increasing the intake of complementary foods, a gradual and natural weaning process from human milk begins. As solid food intake increases over the next several months, so does the nutritional value of these foods, leading to decreased human milk intake. The baby may breastfeed/chestfeed less often during the day, but usually feedings surrounding sleep (before naps and at night) is retained. By age one, the baby should tolerate a large enough variety of balanced food choices to not need as much human milk. This may be why so many parents in the United States choose to wean at one year of age. However, it is important to remember that there are ongoing immune benefits to extended breastfeeding. The decision to wean is exclusive to the parent and baby, and the parent should feel supported and celebrated for providing human milk for any length of time.