great expectations

AAP Now Recommends Breastfeeding For Two Years

“Families deserve nonjudgmental support," says the organization.

A mother breastfeeding a toddler. The AAP now recommends breastfeeding for two years or more.
Victor Dyomin/Moment/Getty Images

The American Academy of Pediatrics (AAP) seems to view parenting an infant in the U.S. through a pair of rose-colored glasses. In the only high-income country in the world without paid parental leave, they are increasing their recommendation for breastfeeding from one to two years. This brings their recommendations in line with those of the World Health Organization — but it may leave many nursing parents with another thing to worry they aren’t doing right in a country where they already greatly lack support.

The AAP highlights health benefits for children (lower rates of respiratory infections, ear infections, severe diarrhea and obesity) as well as the nursing parent (lower risk of type 2 diabetes, several cancers, and high blood pressure.)

The recommendation that babies be fed human milk exclusively for the first six months of life, with complimentary foods added thereafter, remains unchanged.

What also remains unchanged is the total lack of support for breastfeeding parents in this country. There is no guaranteed parental paid leave, and maternity leave policies vary greatly from one company to another. We do have the Family Medical Leave Act, which grants 12 weeks of unpaid leave to employees of companies of a certain size, but only half of workers are eligible. The reality is that few families can consider going so long without a paycheck.

Nursing a three-month-old baby is a full-time job, often incompatible with working another full-time job for pay. In addition to the lack of guaranteed time to pump and a quiet, hygienic place to do so, many parents find it hard to keep up with their baby’s needs by pumping when they are physically apart. Pumping is time-consuming, has its own challenges, and is often less effective than feeding an actual baby. A breast pump can be a poor substitute for an infant when it comes to efficiently emptying your breasts. It also comes with significant expenses.

Breastfeeding at night can help keep your supply up, but if you’re working you need sleep in order to function cognitively the next day.

Is is any wonder that while the majority of birthing people (83.9%) initiate breastfeeding with their newborns, only 25.8% make it to six months exclusively breastfeeding? There’s no lack of desire to breastfeed, only a lack of support for the people doing it.

In their policy statement, the AAP does recognize that American parents need help, and additionally calls for: paid family leave, insurance coverage of breast pumps and lactation support, break time and space for pumping at work, and support for nursing in public and at locations such as schools and daycares. They note racial disparities in rates of breastfeeding. Black babies are less likely to be breastfed than white, Asian and Hispanic babies. The statement also encourages the use of the word “chestfeeding” to be “more inclusive” with gender-diverse families, and mentions that it is possible for surrogate and adoptive parents to induce lactation.

“Families deserve nonjudgmental support, information and help to guide them in feeding their infant,” said the report’s lead author, Joan Younger Meek, MD.

Still, the new guidelines seem like a counter-intuitive way to offer aid. In reality, it just feels really overwhelming, even if there’s evidence that it’s better (in ideal circumstances). Oh, I see you’re struggling. Why don’t you try doing this for twice as long?

Thanks, AAP. Super helpful.