Big babies

Breastfeeding a 6-year-old: harmless, helpful, or downright crazy?

If you scrolled through Twitter last week, you may very well have come across photographs of Maha Al Musa, an Australian mother and self-proclaimed “wisdom birth visionary.” The latest issue of Woman’s Day Australia features a photo shoot with Al Musa and her six-year-old daughter Aminah, hanging out in the park. It would be a perfectly ordinary scene, were it not for one slight deviation: in each photo, Aminah is latched onto Al Musa’s breast like an enormous baby.

The feature coincided with Al Musa’s appearance on a Discovery TV special called Extreme Breastfeeding, which, incidentally, also features a woman who breastfed a Rottweiler puppy. Inter-species nursing strikes me as far more inflammatory than breastfeeding a human six-year-old, but as the Woman’s Day photos of Al Musa made rounds on the Internet, the vitriol started pouring in. Take, for example, this selection of comments sourced from a Huffington Post article about the feature: “That is just creepy and disgusting.” “Sad that this woman [sic] ego is more important than her child’s well being.” “Breast feeding is beautiful and normal but not when the child can hold a knife and fork. Come on.”

For her part, Al Musa said that she believes so strongly in the salutary powers of breast milk that she has not had Aminah immunized. Al Musa also wrote on her Facebook page that “4-8 is NORMAL age [sic] for self weaning” and implored her audience to “let child and mother choose whats [sic] best for … their circumstance and family.”

There is, without doubt, something disarming about the image of a gangly six-year-old going to town on her mother’s bosom, and I would like to posit that this is in no small part due to the fact that the kid is making eye contact with the camera. I must admit that my initial reaction to the photos of Al Musa and her daughter was not favorable: I dismissed the health benefits touted by Al Musa as hippie delusions. I doubted that a child could lead a normal social life once her friends spotted her nursing in a public park. I soundly concluded that Al Musa’s adherence to so-called “extended breastfeeding” was fueled by a selfish desire to keep her little girl close.

But the more I pondered these convictions, the more I saw incongruity in them. For babies who are too young to toddle, we tout breast milk as a sublime sort of ambrosia, able to protect against everything from colds to cancer. While it goes without saying that breast milk can’t take the place of vaccines, should it not stand to reason that breastfeeding would confer at least some benefits to older children as well?

To find out, I called Dr. Dyan Hes of Gramercy Pediatrics in New York, who said that the problem with extended breastfeeding is not a medical one. “Listen, there is always going to be a benefit to breast milk,” she told me. “But for many other reasons, that child doesn’t need to breast feed anymore. What we usually say is that if a child is breast-feeding at six years, it is not that the child needs it, but the mother [who] needs it.”

According to Dr. Hes, the American Academy of Pediatrics recommends breastfeeding babies for at least six months, because by that age, they can supplement their diet with other foods. She also explained that it’s unclear as to whether or not children continue to receive immunizing benefits if they are breastfed past infancy. Since extended breastfeeding is so unusual within the context of Western culture, there simply aren’t enough children to provide a viable sample size for studies.

“The thing is that society is not accepting of a woman who is going to breastfeed her six-year-old,” Dr. Hes said. “And honestly, the patients that I have had, just anecdotally speaking, … [who] breastfeed past two years … have had other mental illnesses. I’m not even lying. It’s just the truth.”

It’s a harsh assessment and not, as it turns out, one that is universally accepted. A few days after my conversation with Dr. Hes, I spoke to Dr. Denise Duval Tsioles, a child psychotherapist based in Chicago. She disagreed that nursing a growing child primarily serves to satisfy a mother’s needs, and asserted that breastfeeding is a complex relationship that does not need to conform to specific timeframe.

“[Breastfeeding] takes its toll on [the mother’s] body, it takes a toll emotionally,” Dr. Duval Tsioles said. “But for some kids, they transition to other means of soothing a lot easier, and for some, that’s still kind of their primary source of comfort.

And if a child is unable to self-soothe by the age of six or seven?

“It’s a little more unusual,” Dr. Duval Tsioles said. “But that would make me [ask], ‘OK, well, is it working for the family? Is everything else going OK for the child? Are they having any other issues and concerns? Could this be part of it, or does this have nothing to do with it?’”

“But you wouldn’t want to be breastfeeding a 16-year-old,” I said.

Duval Tsioles laughed. “I’ve never heard of that. I think most kids themselves are done by seven, just given where they are developmentally.”

Breastfeeding a first-grader does not, in other words, necessarily indicate developmental delays, nor does it cause them. Provided that the child is progressing normally in school and in relationships with peers, breastfeeding is at the very least a harmless method of comfort. At best, Dr. Duval Tsioles asserted, it is a practice that can bolster confidence, independence, and emotional wellbeing.

“The more [the] parents helps to soothe children, and comfort children, and help them manage emotion, the more children are going to be able to internalize that themselves,” she explained. “Nursing is part of that as well … And that helps develop a child’s self-esteem. They feel good about themselves: ‘I matter, I’m important, someone thinks enough of me to help me.’ Then when it comes time for them to try things and to do things, they feel confident in that because they’ve had their needs met.”

If extended breastfeeding is not medically unsound or developmentally abnormal, why does it strike us as so weird? Katherine Dettwyler, an anthropologist who specializes in breastfeeding research, says it is a matter of social constructs. Dettwyler has done extensive studies on the nursing practices of mothers in Mali, West Africa. There, she observed that children often wean at the age of six or seven if their mothers are not pregnant with another baby.

“Children are typically nursed for two years and then weaned so the mother can get pregnant again,” she wrote in an e-mail. “But many adult women mentioned that the last child is often nursed longer—including as long as 5,6,7 years—[if] there is no younger child coming along to displace them.”

According to Dettwyler, there is an evolutionary precedent for this behavior. Studies indicate that the weaning process among non-human primates is informed by a variety of factors, such as the period of gestation, the age at which babies reach one-third of their adult weight, and the age at which they sprout their first permanent molars. Based on these different factors, Dettwyler has calculated that human babies can reasonably nurse for at least two and a half years, and for as long as seven years.

“The nonhuman primates are our best predictor for what weaning would look like in humans if not modified by cultural beliefs about how long is too long or how short is too short,” Dettwyler explained. “These … predictors suggest 2.5 years to 7.0 years for modern humans as a natural age at weaning … This is common around the world, and also common even in Western cultures, where some people who don’t understand anything about biology get their knickers in a twist when anyone breastfeeds longer than they think people should.”

There has certainly been a fair amount of knee-jerk outrage when it comes to the extended breastfeeding debate, which did not start with the Woman’s Day story on Maha Al-Musa. In 2012, Time magazine ran a feature about “attachment parenting,” a cultish philosophy that counsels, among other things, a child-led weaning process. The cover of the magazine featured a photograph of blogger Jamie Lynne Grumet striking a defiant pose as she breastfed her son Aram, who was three years old at the time and able to reach his mother’s breast by standing on a stool.

The feature spawned reams of think pieces, many of them unfavorable. Grumet was accused of all sorts of ill-intentioned nastiness including—but not limited to—pedophilia. Aram self-weaned soon after the Time piece ran, and three years later, Grumet is still a little bitter about the reception of her parenting style.

“It’s not about the breastfeeding, but [about] supporting families to do what they feel or know is right for each individual child,” she told me. “You know what’s right for you. We’re all just trying to get by. That’s what I can’t stand. [Critics] kind of bastardized the whole attachment parenting thing, and [parents] were being stigmatized for feeling what they were doing was the best way to parent their children.”

It is true that debates about parenting tend to reek of sanctimony, which usually doesn’t sit well with the guilt that most parents feel on a regular basis, for some reason or other. Just this week, a group of bottle-feeding mothers protested against “bressure,” or breastfeeding pressure, brought about by the onslaught of breastfeeding selfies on social media. The so-called “brelfie” movement (every breast-related movement, it seems, needs a portmanteau) was itself a response to backlash against mothers who breastfeed in public. These might seem like hyper-sensitive reactions, but mothering is a hyper-sensitive subject. No woman wants to be made to feel as though she isn’t giving her child everything he needs.

At the end of the day, though, the kids will be OK. Children who are bottle-fed will be fine. Children who are breastfed for six months will be fine. Children who are breastfed for six years will be fine too. They have mothers who are doing their best to love them, and that, really, is what matters most.

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