WASHINGTON -- The real issue with breast-feeding is this: Too few infants who could really benefit from it are getting mom's milk.
Sure, Time magazine's cover photo of a woman breast-feeding her 3-year-old is generating debate about how old is too old. But examples like that are pretty rare.
About 44 percent of U.S. moms do at least some breast-feeding for six months. But only 15 percent follow advice from the American Academy of Pediatrics that babies receive breast milk alone for that time span. And fewer still stick with breast-feeding for a year, also recommended by the academy.
About three-quarters of mothers say they breast-feed during their baby's first days and weeks of life. Then it drops off fast.
By their first birthday, fewer than a quarter of children are getting breast milk, according to the government's latest national report card on breast-feeding.
That's a public health issue, because breast-feeding brings so many benefits to babies.
By 2020, the nation's health goals call for more than a quarter of babies to be exclusively breast-fed through their first six months of life, and for more than a third to still be nursing when they turn 1 year old.
To help reach those goals, the surgeon general last year issued a call to ease the obstacles that make it harder for women to breast-feed – from the hassles of pumping milk at work to a general lack of understanding about how super-healthy it is during that critical first year.
"We have a lot more work to do," says Academy of Pediatrics' spokeswoman Dr. Tanya Altmann, a pediatrician near Los Angeles. "It would be much more beneficial to focus on breast-feeding infants and young toddlers," she said, than on the rare older examples like Time found for its cover.
Not every mother can or chooses to breast-feed. And the surgeon general's report said they shouldn't be made to feel guilty.
But the academy's latest update, published in March in the journal Pediatrics, lists the benefits of breast-feeding for at least several months and up to a year: Breast-fed infants have a lower risk of sudden infant death syndrome. They suffer fewer illnesses such as diarrhea, earaches and pneumonia, because breast milk contains antibodies that help fend off infections until their own immune systems become robust. They're also less likely to develop asthma, or even to become fat later in childhood.
Moms can benefit, too, decreasing their risk of developing breast or ovarian cancer.
How old is too old for the child? The pediatricians' guidelines say breast-feeding should continue along with solid foods to age 1 – "or as long as mutually desired by mother and infant."
The World Health Organization recommends continuing "along with appropriate complementary foods up to 2 years of age or beyond."
Toddlers sometimes make clear that they prefer a cup, but Altmann says if both mom and child are comfortable, there's no harm in going longer than average.
Still, the clear nutritional benefit wanes as youngsters start getting most of their nutrition from solid food, and Altmann says parents need to teach their tots to soothe themselves.
"At some point it's less about nutrition and more about comfort," says Altmann, who breast-fed her own two sons until they were 1.
Lauran Neergaard covers health and medical issues for The Associated Press in Washington.