Letter for Court Cases
(in support of extended breastfeeding)
by Katherine A. Dettwyler, Ph.D.
Department of Anthropology,
Texas A&M University and
Department of Anthropology,
University of Delaware, Newark, DE
Prepared by Kathy Dettwyler, in the process of being updated -- December 2007. Can be downloaded and sent to lawyers, judges, social workers, ex-spouses, pediatricians, family physicians, etc. If you would like a signed paper copy, please send a legal-sized SASE (Self-Addressed Stamped Envelope) to K.A. Dettwyler, 1 Orchard Ave., Newark, DE 19711-5523. Contributions for photocopying costs are encouraged/welcomed. Please do not call me to tell me your story -- I have, unfortunately, heard it all way too many times before. Please visit http://www.kellymom.com/bf/normal/bf-law.html#Family for links to issues concerning breastfeeding and divorce/custody/visitation/family law/etc.
DATE: March 2005
TO: Whom It May Concern
FROM: Katherine A. Dettwyler, Ph.D., Adjunct Associate Professor of Anthropology Texas A&M University, Adjunct Associate Professor of Anthropology, University of Delaware, Newark, DE, Kadettwyler@hotmail.com
RE: "Extended" Breastfeeding
I am a biocultural anthropologist who has conducted research, since 1981, on cross-cultural beliefs and practices concerning infant/child feeding, growth and health, as well as the evolutionary underpinnings of human feeding practices. I am the acknowledged world expert on extended breastfeeding and weaning from both evolutionary and cross-cultural perspectives.
My research concludes that the normal and natural duration of breastfeeding for modern humans falls between 2.5 years and 7 years. Some children nurse less than 2.5 years, and some nurse longer than 7 years. It is quite common for children in many cultures around the world to be breastfed for 3-4-5-6-7 years, including quite a few in the U.S. (see below). My research on the age ranges for natural weaning has been published in a peer-reviewed scholarly book, and in the medical journal Clinical Obstetrics and Gynecology (2004), and I have presented my research at many scientific meetings and conferences to audiences of anthropologists, doctors, nurses, lactation consultants, and other health care professionals.
In addition, my research has been used to counter charges of child abuse and "inappropriate parenting behaviors" in many court cases, especially involving divorce and custody disputes, where fathers may accuse the mother of "inappropriate parenting by virtue of extended breastfeeding" as a strategy to gain custody of children, or may simply claim that 'continued breastfeeding' is not relevant to shared custody arrangements.
At this point (2005), all of the research that has been conducted on the health and cognitive consequences of different lengths of breastfeeding shows steadily increasing benefits the longer a child is breastfed up to the age of 2 years, and no negative consequences. No research has been conducted on the physical, emotional, or psychological health of children breastfed longer than 2 years. Thus, while there is no research-based proof that breastfeeding a child for 3 years provides statistically significant health or cognitive benefits compared to breastfeeding a child for only two years, there is no research to show that breastfeeding a child for 3 years (or 4-5-6-7-8-9 years) causes any sort of physical, psychological or emotional harm to the child. This has recently been confirmed in the 2005 American Academy of Pediatrics "Recommendations for breastfeeding the healthy term infant" (see below).
Breastfeeding a child beyond the age of three years is not common in the United States , but it is not unknown. It is more common than most people realize because families that practice extended breastfeeding often do not tell others, who they fear will be judgmental. A breastfeeding child of 3 or 4 years or older will typically only be nursing a few times a day - usually first thing in the morning, before nap and bedtime at night, perhaps more often if they are sick, injured, frightened, emotionally distressed or developmentally delayed. It is quite easy for even close friends of the family to be unaware of a continuing breastfeeding relationship. A pediatrician who is vocal in his non-support of breastfeeding may not even be told if a mother in his practice continues to breastfeed. Thus, "extended" breastfeeding - beyond three years - seems more rare and unusual in the United States than it really is.
It is quite feasible for divorced parents to work out shared custody or visitation arrangements that allow the father to have ample time with his child while not sacrificing the breastfeeding relationship the child has with its mother. There is no reason why the child cannot have close relationships with both parents, including spending substantial amounts of time with both, without weaning having to take place before the child is ready.
Breastfeeding and co-sleeping with children are perfectly normal and healthy behaviors, practiced by many people in cultures all around the world, and in the US .
In conclusion, there is no research to support a claim that breastfeeding a child at any age is in any way harmful to a child . On the contrary, my research suggests that the best outcomes, in terms of health, cognitive, and emotional development, are the result of children being allowed to breastfeed as long as they need/want to. Around the world, most children self-wean between the ages of 3 and 5 years, but given that the underlying physiological norm is to breastfeed up to 6-7 years, it is quite normal for children to continue to breastfeed to this age as well, and the occasional "normally" developing child will nurse even longer. Children who nurse for more than a year or two tend to regard their mother's breasts as sources of love and nurturance and comfort, and are more or less immune to the broader society's attempts to culturally define breasts as sex objects.
I will be happy to provide more information and input on this subject if needed. You can contact me at (302) 738-5631 or (302) 388-7836/cell or by email to: email@example.com. More information can be found on my web site at: http://www.kathydettwyler.org
In any specific court case, there will be many factors to which outside observers are not privy, and many different perspectives that must be brought to bear in deciding what is in a child's best interests. As a general rule, the child who is allowed to breastfeed as long as they need is the lucky child, one who has a mother who deeply cares for and respects her child. In the absence of neglectful or abusive circumstances, a child and mother should never be punished or criticized for breastfeeding longer than the cultural norms, and a child should not have to lose the breastfeeding relationship with its mother just so the father can have the child for overnight or weekend visits.
Expert Recommendations on Duration of Breastfeeding
What do pediatric nutrition experts at the national (United States) and international levels recommend concerning how long children should be breastfed?
World Health Organization: "two years of age or beyond"
Promoting appropriate feeding for infants and young children
10. Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond . Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production.
American Academy of Pediatrics, Policy Statement, Breastfeeding and the Use of Human Milk, PEDIATRICS Vol. 115 No. 2 February 2005, pp. 496-506, http://pediatrics.aappublications.org/cgi/content/full/115/2/496 :
Recommendations on Breastfeeding for Healthy Term Infants (#1-9 and 11-15 removed)
10. Pediatricians and parents should be aware that exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months of life and provides continuing protection against diarrhea and respiratory tract infection. 30 , 34 , 128 , 178 - 184 Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child . 185
Complementary foods rich in iron should be introduced gradually beginning around 6 months of age. 186 - 187 Preterm and low birth weight infants and infants with hematologic disorders or infants who had inadequate iron stores at birth generally require iron supplementation before 6 months of age. 148 , 188 - 192 Iron may be administered while continuing exclusive breastfeeding.
Unique needs or feeding behaviors of individual infants may indicate a need for introduction of complementary foods as early as 4 months of age, whereas other infants may not be ready to accept other foods until approximately 8 months of age. 193
Introduction of complementary feedings before 6 months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk. 194
During the first 6 months of age, even in hot climates, water and juice are unnecessary for breastfed infants and may introduce contaminants or allergens. 195
Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother, especially in delaying return of fertility (thereby promoting optimal intervals between births). 196
There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer. 197
Infants weaned before 12 months of age should not receive cow's milk but should receive iron-fortified infant formula. 198
American Academy of Family Physicians: " Breastfeeding beyond the first year offers considerable benefits to both mother and child, and should continue as long as mutually desired. . . If the child is younger than two years of age, the child is at increased risk of illness if weaned."
AAFP Policy Statement on Breastfeeding
Breastfeeding is the physiological norm for both mothers and their children. The AAFP recommends that all babies, with rare exceptions, be breastfed and/or receive expressed human milk exclusively for about the first six months of life. Breastfeeding should continue with the addition of complementary foods throughout the second half of the first year. Breastfeeding beyond the first year offers considerable benefits to both mother and child, and should continue as long as mutually desired. Family physicians should have the knowledge to promote, protect, and support breastfeeding. (1989) (2001)
AAFP, Specific section on nursing the older child:
Nursing Beyond Infancy
Breastfeeding should ideally continue beyond infancy, but this is currently not the cultural norm and requires ongoing support and encouragement.85 Breastfeeding during a subsequent pregnancy is not unusual. If the pregnancy is normal and the mother is healthy, breastfeeding during pregnancy is the woman's personal decision. If the child is younger than two years of age, the child is at increased risk of illness if weaned. Breastfeeding the nursing child after delivery of the next child (tandem nursing) may help to provide a smooth transition psychologically for the older child.61
61. Lawrence RA, Lawrence RM. Breastfeeding: a guide for the medical professional. 5th ed. St. Louis : Mosby, 1999.
85. Powers NG, Slusser W. Breastfeeding update 2: clinical lactation management. Pediatr Rev 1997;18(5):147-161.
"Extended Breastfeeding Survey" --
A survey of "extended breastfeeding" - beyond three years - was conducted by Katherine A. Dettwyler, Ph.D., Adjunct Associate Professor of Anthropology, Texas A&M University, College Station, TX 77843-4352. The data summarized below come from the United States , and most were collected between December of 1996 and March of 1998. Most of the respondents were middle- and upper-class, well-educated, and of European ancestry. These data have been published in "When to Wean: Biological Versus Cultural Perspectives," in the medical journal Clinical Obstetrics and Gynecology , Volume 47, Number 3, pp. 712-723. In addition, I have reported on them at a number of professional conferences.
In brief, during the late 1990s, I surveyed 1,280 children in the US who breastfed for a minimum of three years. The mean age of weaning for these children was 4.24. years, with a median of 4.00 years, a mode of 3.5 years, a standard deviation of 1.08 years, and a range of 3.00 to 9.17 years . The half-yearly break down of ages at weaning was:
3-3.49 years 297 children
3.5-3.99 yrs 286 children
4.00-4.49 yrs 213 children
4.50-4.99 yrs 162 children
5.00-5.49 yrs 154 children
5.50-5.99 yrs 58 children
6.00-6.49 yrs 50 children
6.50-6.99 yrs 17 children
7.00-7.49 yrs 22 children
7.50-7.99 yrs 7 children
8.00-8.49 yrs 7 children
8.50-8.99 yrs 2 children
9.00-9.49 yrs 5 children
To quote from the Clinical Obstetrics and Gynecology article: "The demographic characteristics of the sample indicate that in the United States, extended breastfeeding is most often found among middle-class and upper-class women, women who work outside the home, and women who are highly educated. . . Areas of the country with relatively large groups of mothers and children nursing beyond 3 years of age included Seattle , Washington ; Salt Lake City , Utah ; College Station , Texas ; and Wilmington , Delaware ."
Dettwyler, K.A. 2004 When to Wean: Biological Versus Cultural Perspectives, Clinical Obstetrics and Gynecology , 47(3):712-723.
Dettwyler, K.A. 2001 Weaning. Breastfeeding Annual 2001 . Washington DC : Platypus Media.
Dettwyler, K.A. 2001 Believing in Breastfeeding. ORGYN , XII(2):42-45.
Dettwyler, K.A. 1999 Evolutionary Medicine and Breastfeeding: Implications for Research and Pediatric Advice. The 1998-99 David Skomp Distinguished Lecture in Anthropology , Department of Anthropology, Indiana University, Bloomington, IN, 47405.
Dettwyler, K.A. 1995 A Time to Wean: The Hominid Blueprint for the Natural Age of Weaning In Modern Human Populations. In Breastfeeding: Biocultural Perspectives , edited by Patricia Stuart-Macadam and Katherine A. Dettwyler, pp. 39-73. New York : Aldine de Gruyter.
Dettwyler, K.A. 1995 Beauty and the Breast: The Cultural Context of Breastfeeding in the United States . In Breastfeeding: Biocultural Perspectives , edited by Patricia Stuart-Macadam and Katherine A. Dettwyler, pp. 167-215. New York : Aldine de Gruyter.
Last updated March 22, 2004, by kad. Contents copyright 1999-2004 Sue Ann Kendall
and Kathy Dettwyler. Thanks to Prairienet, the Free-Net of east-central Illinois
, for hosting this site from 1999 through 2004.
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