Weaning your child from breastfeeding

DrNote.qxd 24/03/2004 10:38 AM Page 254 A NOTE FROM THE DOCTOR: ADVICE FOR PARENTS AND CAREGIVERS Weaning your child from breastfeeding Français en page 264 When you start to give your baby foods other than breast milk, it’s called weaning. Most parents consider weaning to mean completely stopping breastfeeding. Weaning is a natural stage in your baby’s development. Still, many mothers have mixed emotions. It’s normal to feel excited at the new independence you can both enjoy, as well as some sadness as your baby moves to another stage in her life. WHEN SHOULD I WEAN MY BABY? When it is time to wean, it’s better to do it gradually rather than all of a sudden. And while there is no right or wrong age to wean, it’s best to continue breastfeeding until your baby is at least six months old. Prolonged breastfeeding, whenever possible, is good for your baby. HOW DO I WEAN MY BABY? When you and your baby are ready to wean, there are few things to remember that will make the experience a more positive one for both of you: • If you can, it’s easiest for you and your baby if weaning is gradual – over several weeks, months or even longer. A sudden, abrupt wean should only be considered in extreme circumstances and is hard on both of you (see “Can’t I just stop breastfeeding?”). • The transition to weaning may be easier if you first introduce your baby to a cup instead of a bottle. Breastfed babies easily learn to drink from a cup as early as six months of age (try expressed breast milk). • Start off by substituting one feed, the least ‘favourite’ one of the day. Someone else may need to offer this feed for your baby to accept it. • When you’re ready to wean even more, substitute the next least favoured feed at the opposite time of the day. Continue this way, substituting one feed at a time. The pace of weaning is up to you 254 and your baby, but in general, the slower the better. Wait at least a few days in between each new feed before substituting another one. • You may want to try a ‘partial’ wean instead. This means you substitute one or more feedings with a cup or bottle and breastfeed at other times. This can work well if you are going back to work but still want to breastfeed. When you do this, make sure you check your baby’s weight gain regularly. • If your breasts are uncomfortable while you are weaning, try expressing enough milk so that you are comfortable. Over-the-counter medications like acetaminophen or ibuprofen can also help. Cold compresses or gel packs applied to your breasts can also be of some comfort. • You shouldn’t bind your breasts or drink less fluids while you’re weaning. Check your breasts regularly to make sure you aren’t developing a blocked duct, which will feel like a firm tender area of the breast. If you do, see your doctor or lactation consultant. These problems are more likely to occur during an abrupt wean. • Watch the cues you give to your baby. If you sit in the same chair you usually use when you’re nursing, he’ll likely want to breastfeed. He probably won’t be satisfied with a cup or a cuddle. • Some mothers choose what is called ‘infant-led weaning’. This means watching your baby’s cues and weaning at his pace (that is, never refusing the breast but also not offering the breast when he is not interested). With infant-led weaning, breastfeeding may continue for two to four years. This type of weaning is practiced by many non-western cultures. MY BABY IS REFUSING THE BREAST. DOES THAT MEAN HE’S READY TO WEAN? Sometimes your baby goes on a ‘nursing strike’ and suddenly refuses to breastfeed. This doesn’t mean Paediatr Child Health Vol 9 No 4 April 2004 DrNote.qxd 24/03/2004 10:38 AM Page 255 A Note from the Doctor your baby is ready to wean. It can be caused by many different factors, such as teething, an ear infection or other illness, the onset of your period, or a change in your diet, soap, or even deodorant. Try making feeding time quiet and spend more time cuddling your child. Don’t ‘starve’ him, but instead, try offering the breast when he is sleepy. If you can’t figure out the reason for the strike, see your doctor. Remember that a nursing strike does not mean your baby is rejecting you. If this happens, be sure to pump your milk so you don’t develop a blocked duct. CAN’T I JUST STOP BREASTFEEDING? If possible, avoid an abrupt wean, which can be uncomfortable for you and upsetting for your baby. Sometimes you may have no choice, such as if you are very sick, if you and your baby have to be separated for a long time, or if you have to take certain drugs, like chemotherapy. If that’s the case, try some of the previously mentioned suggestions. If your breasts get uncomfortable, express your milk to avoid blocked ducts, mastitis or a breast abscess. Babies who are sick should not be abruptly weaned. WHAT SUBSTITUTE FOODS SHOULD I USE? Appropriate substitute feedings depend on how old your baby is when you start to wean: • Under 12 months: iron-fortified infant formula. • 12 to 18 months: follow-up formula or whole milk (3.25%). • 18 to 24 months: whole milk. • Two years and over: whole or 2% milk. After 12 months of age, your baby should not take more than 24 ounces of milk products per day. Otherwise, she’ll fill up and won’t want to eat solid foods. Also, she may develop iron deficiency anemia. If your baby has a milk allergy, talk to your doctor about appropriate substitute feedings. WHAT ABOUT OTHER FOODS? Between four and six months, you’ll start to introduce solid foods into your baby’s diet. When this happens, your baby will begin to take less breast milk. Introduce solid foods one at a time and in small amounts at the beginning. Some babies get very constipated if they are given too much solid food early on. You can also offer your baby small amounts of water once or twice a day, usually after six months of age. You can give 100% fruit juice, usually diluted with water, but it has no real advantage over water and should not exceed a few ounces per day (two to four ounces). Too much juice can lead to dental cavities, obesity or even poor weight gain and diarrhea. Your weaning experience is ultimately up to you and your baby. Try to follow his cues whenever possible. If you’re feeling ‘blue’ or if the baby is not taking what you consider to be enough other foods or liquids, you should see your doctor. For more information You probably have many questions about breastfeeding and your baby’s nutrition. There are many sources of information, including your paediatrician, family doctor, community health nurse, breastfeeding clinic, lactation consultant and La Leche League. Source: Developed by the CPS Community Paediatrics Committee, and reviewed by the CPS Public Education Subcommittee. This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances. May be reproduced (...truncated)