Parental concerns about extended breastfeeding in a toddler.

CASE Matthew, a healthy 18-month-old toddler, is seen for a health-supervision visit. The dietary history reveals that Matthew is breastfeeding and eats a variety of fruits, vegetables, cheese, yogurt, and grains. He is able to feed himself with a spoon, although he prefers to use his fingers. His height, weight, and head circumference have followed the 50th percentile, and developmental milestones are appropriate for 18 months. Matthew’s mother is conflicted about continuing to breastfeed. Matthew often pulls at her shirt and puts his hand down her shirt when they are out in public. He seems to want to breastfeed when he is upset or in a new or unfamiliar situation. She is aware of some of the benefits of breastfeeding, and after checking with the American Academy of Pediatrics Web site, she discovered that extended breastfeeding is encouraged. Matthew’s mother asks her pediatrician for guidance.