Thinking About Weaning?

NOTE: This is the third and final article in a series about weaning.
Depending on where you live, “weaning” may mean either introducing other foods or stopping breastfeeding. In this article, we are talking about weaning from the breast.

You may want to read the previous articles first:
When is the Best Time to Start My Baby on Foods Other Than Breastmilk?
Good Foods for Babies

Kendra was confused. “Before I had Jason, everyone was after me to breastfeed. They said it would be good for the baby. So why do they now keep asking me when I am going to wean him? Even some of the articles I read say that there is no reason to keep nursing after the first few weeks. Is this true?”

Tanya had a similar question. ”When I was still pregnant with Davy,” said Tanya, “I thought I would only nurse him for a few weeks before switching to formula. But now I have come to realize how much we both love breastfeeding, and I feel sad when I think about stopping. Davy is 9 months old and eating all kinds of other foods as well as nursing. When am I supposed to wean him?”

There is good news for both of these mothers: human milk does not suddenly turn to water after a certain length of time! Mothers can nurse their babies for as long as both they and their children wish to continue. Children will wean all by themselves when they are developmentally ready to do so.

Your milk continues to provide both food and health benefits even after your baby has begun to eat other foods. In fact, it continues to be the most important part of your baby's diet until he is about a year old. Did you know that the American Academy of Pediatrics (AAP) recommends that babies continue to nurse until they are at least a year old and that the World Health Organization (WHO) recommends continuing to nurse for at least two years?1,2

Many mothers are surprised to learn that during their baby’s second year (12-23 months), 15 ounces of their milk provides:

  • 29% of energy requirements
  • 43% of protein requirements
  • 36% of calcium requirements
  • 75% of vitamin A requirements
  • 76% of folate requirements
  • 94% of vitamin B12 requirements
  • 60% of vitamin C requirements 3,4

Why do so many mothers worry about weaning?

I'll bet you have never heard a mother say, “I will make him walk by the time he is xxx,” or “I will make him talk by the time he is xxx.” We KNOW that you cannot make a baby walk or talk before they are ready to do so! All babies are different, and there is no reason to set an exact date. The same goes for weaning; children wean when they are ready.

What can I say to people who ask when I am going to wean?

It depends who is asking. For example, you could:

  • Explain that breastfeeding is the healthy option.
  • Make a joke like, “Until she goes to an out-of-state college!”
  • Tell them that your doctor recommends natural weaning.
  • Share that natural weaning is a family tradition.

And if all else fails, ask why they need to know!

Weaning is a process, not an event!

As he gets older, your baby will gradually eat more table foods. You will notice that he needs to nurse less frequently or for shorter periods of time. However, babies nurse for many reasons besides the need for food. Even when he becomes a toddler, your baby may still need to nurse when it's time to go to sleep, when he wakes up, or when he has a boo-boo.

There will also be days when he needs to nurse more than usual: perhaps when he is teething or coming down with a cold. Nursing can help him cope with these upsets. In fact, many mothers say they could not imagine getting through the toddler stage without nursing to smooth the way. All too soon, as he progresses in natural weaning, your little one will be too busy exploring the world to nurse as often.

But what if I want a night out with my partner or friends or to go to the gym?

  • You can pump or hand express some milk to leave for your baby while you are away.
  • Be sure to nurse immediately before leaving, so that you both will feel comfortable.

For more information on leaving breastmilk for your baby while you are apart, see our article: Breast vs. Bottle: How much should baby take?

What if I have to go back to school or work?

  • You do not have to wean completely from the breast!
  • You can nurse when you are home and pump when you are away, and your sitter can give your baby your pumped milk.
  • Even if you decide to use formula while you are away, you can still nurse when you are home. Even a little milk is important to your baby's health!

What if I get sick and need to take medicine?

Most medications are safe to use when breastfeeding. For those medicines that are not safe, there is almost always another, safer drug available. Your healthcare provider can look them up online at Lactmed, a free government service, before writing a prescription.
http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

The InfantRisk Center www.infantrisk.com provides answers to questions about the use of drugs during pregnancy and breastfeeding. Call (806)-352-2519 for information about the safety of using drugs, over-the-counter drugs, herbal products, chemicals, vaccines, and other substances.

Remember, you can always get a second opinion!

What if I want to have an alcoholic drink?

Here are some things you will want to know:

  • Only a very small proportion of the alcohol will go into your milk.
  • Nurse the baby before having your drink.
  • There is no need to pump and dump, because the alcohol will pass out of your milk in the same way it passes out of your blood.
  • It takes about two hours for complete metabolism of one standard drink (12 oz of 5% beer, or 5 oz of 11% wine, or 1.5 oz of 40% liquor (80 proof) 5
  • If you are fit to drive, then you are fit to nurse.
  • If you are planning on drinking a lot, express your breastmilk ahead of time so that your baby will have milk to drink until you are sober.
  • Be sure to have somebody else care for your baby until you are able to do so safely.
  • Do not sleep in the same bed as your baby if you have been drinking.

What if I get pregnant?

  • It is usually safe to nurse through a pregnancy.
  • According to Lesley Regan, PhD, MD, head of the Miscarriage Clinic at St. Mary’s Hospital in London, the largest referral unit in Europe, and the author of Miscarriage: What every woman should know:

    "Once a pregnancy is clinically detectable, breastfeeding should pose no added risk of pregnancy loss. There isn’t any data suggesting a link between breastfeeding and miscarriage, and I see no plausible reason for there to be a link." 6

  • Many women continue to nurse while pregnant. During early pregnancy, your milk production may go down as the milk changes back to colostrum. Your baby may not like the taste and wean on his own, but many babies continue to breastfeed throughout pregnancy. Some mothers develop sore nipples when they become pregnant. If you have this kind of soreness, you can think about offering shorter nursing sessions rather than weaning completely.
  • It will not hurt the new baby if the older child also nurses. A mother who is “tandem nursing” makes enough milk for both children, just as if they were twins.

But people tell me that weaning will make life easier!

  • As a general rule, babies who are weaning need MORE attention, holding, and comforting!
  • Breastfeeding is much more than food: it is comfort and medicine, too. Your baby will still need to be held and cuddled when feeding. A propped bottle is a choking hazard, and there is a serious risk of aspiration pneumonia.
  • Although some partners start off by doing the night feeds, most don't continue for long, and then it will be you getting out of bed every night to heat a bottle when your baby cries.
  • Your baby is more likely to get sick if he is not getting antibodies from your milk, so you may be spending more time at the doctor's office and need more time off work.

If you need to wean before your baby is ready...

Do what feels right for you and your family. Each mother's circumstances are different!

  • If your baby is under a year old, talk to your doctor about which formula to use and mention any allergies that run in the family.
  • If your baby is over a year old, ask your doctor about using other milks instead of formula. You may be able to go straight to a cup.

Go slowly!

  • Each time you are ready to drop another nursing, let your baby nurse briefly at that feeding before offering the bottle during the first couple of days. This process will help him get used to the bottle more gradually. It will also help to prevent you from becoming over-full and maybe developing mastitis. If you still feel uncomfortable, pump or hand-express JUST ENOUGH to relieve pressure.
  • Let another person be the one to feed him the bottle if you will be only partially weaning. You will want your baby to associate you with breastfeeding only. Be prepared to backtrack. There will be days when your baby is not feeling well and needs to nurse. It is NEVER wrong to listen to your baby! Two steps forward and one step backwards is quite normal.

Bottle feed as much like breastfeeding as possible.

  • Use a slow-flow soft bottle nipple that has a wide base and a shorter, round nipple (not the flatter, orthodontic kind.)
  • Start by resting the tip of the nipple on your baby's upper lip, and allow him to take it into his mouth himself, just as if he was nursing.
  • Keep the bottle only slightly tilted, with baby in a more upright position, so he has to work to get the milk out. If you hold the bottle straight down, the milk will come out too fast, and he may feel as if he is drowning.

Start by substituting a bottle for one nursing a day for about a week. Keep your baby's favorite nursing sessions for the last. Follow your baby's lead as much as possible. For example, if he is sick, you may want to nurse a little more often until he is feeling better again. Unless there is an urgent reason for immediate weaning, it is easier on both of you to go slowly.

Remember, you know your baby best, and you know what is best for your family. Trust your instincts, and you won't go far wrong.

Want to know more about weaning?

Here is a great book:
How Weaning Happens by Diane Bengson

Here are some articles you may find helpful:
“A Natural Age of Weaning” by Katherine Dettwyler, PhD
http://www.kathydettwyler.org/detwean.html
Breastfeeding Past Infancy: Fact Sheet
http://www.kellymom.com/bf/bfextended/ebf-benefits.html
Comfort measures for mom during weaning
http://www.kellymom.com/bf/weaning/weaning_mom.html

References:

1. The American Academy of Pediatrics (AAP)
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496
2. The World Health Organization (WHO)
http://www.who.int/mediacentre/news/statements/2011/breastfeeding_201101...
3. Mandel D, Lubetzky R, Dollberg S, Barak S, Mimouni FB. Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation. Pediatrics. 2005 Sept; 116(3):e432-e435.
4. Dewey KG. Nutrition, Growth, and Complementary Feeding of the Breastfed Infant. Pediatric Clinics of North American. February 2001;48(1).
5. Texas Tech University Health Services Center (InfantRisk Center) http://www.infantrisk.com/content/alcohol-and-breastfeeding
6. Flower, H., Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond, 2003.