The American Academy of Pediatrics (AAP) updated their position statement with a recommendation to breastfeed for 2 years or more (Meek et al., 2022a). This brings the AAP statement in congruence with the World Health Organization's (WHO) recommendations (Meek et al., 2022a; WHO, 2022). Current breastfeeding rates are suboptimal, with the Centers for Disease Control and Prevention (CDC) reporting initiation rates of 83.2% with only 35.9% of women breastfeeding at 1 year (CDC, 2022). The CDC currently does not report breastfeeding at 2 years of age. Given the new AAP breastfeeding recommendations, perhaps this should be a consideration.

We recently published research that demonstrated families who had a tailored prenatal intervention had breastfeeding outcomes that surpassed national data (Froh & Spatz, 2022). Patients in our study had a breastfeeding initiation rate of 98.1% with 50.6% breastfeeding at 1 year and 34.4% breastfeeding beyond 1 year (Froh & Spatz, 2022). Therefore, this prenatal intervention may have important implications for helping families make informed feeding decisions with a family-centered approach that can improve breastfeeding in the hospital setting and beyond discharge. I have always believed that parents need to understand the science of human milk, exactly how human milk works to protect their infant from morbidity and mortality, and how human milk helps with optimal infant development.

Ensuring that families make an informed feeding choice is a health equity issue. The AAP position statement specifically addressed suboptimal breastfeeding in the non-Hispanic Black population that is associated with 1.7 times excess cases of acute otitis media, 3.3 times cases of necrotizing enterocolitis, and 2.2 times excess number of child deaths compared with a non-Hispanic White population (Meek, 2022a).

As nurses and other health care providers, we need to support families who breastfeed beyond a year. Many families report feeling alienated or ridiculed when they breastfeed long-term (Meek, 2022a). The AAP reports that families may not discuss their decision with pediatric primary care providers and 38% of women stated their provider was unsupportive of breastfeeding past the first year so they elected to change their pediatric primary care provider (Meek, 2022a).

We should use this updated position statement as a call to action. Three specific benefits of breastfeeding beyond 1 year are 1) antibodies, 2) brain development, and 3) comfort. When infants breastfeed, they receive immune support which changes with every day of breastfeeding. The antibodies that are produced are not the same on day one as they are on day 365; therefore, breastfeeding beyond a year is important for antibody protection for what is in their environment. This is particularly important in the United States where families must go back to work and often place their child in day care. Brain development of the infant who is breastfed is different than those who are formula fed. The exposure to human milk is dose-dependent and the longer and more exclusive human milk, the infant receives the more benefit. Parents should be encouraged to continue to breastfeed for optimal brain development and developmental outcomes. Breastfeeding can be an enjoyable experience for families. Many older children enjoy breastfeeding for comfort and the positive security of the breastfeeding relationship.

We must help families meet their personal breastfeeding goals and encourage and support breastfeeding for 2 years or more. Review the AAP position statement (Meek et al., 2022a) and the corresponding technical report (Meek et al., 2022b) for current supportive evidence on breastfeeding.

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