Blog Post 5.3.15 Weaning from BF recenteredSo, I was going to delay this topic for an unknown length of time because I wanted to write about other things – like, the nutritional changes breastmilk goes through after your baby is 12 months old, the physiological changes that toddlers undergo to indicate readiness to start potty training, etc. because I planned on nursing Jia until she was 18 months old. 

But, since I’m getting a bit anxious to get my body back to myself I figured – hey – as long as I was reading up on it, may as well write about it!  (And besides, we clocked in an entire 14.5 months of 4 nursing sessions a day.)

First Things First – What’s Recommended?

So I’ll get started by saying this: the World Health Organization recommends to continue breastfeeding (along with solid foods) until 2 years old, and longer if possible, as long as it is mutually (mamma and baby) desired. No bottles, no formula, zilch. The absolute minimum recommendation is to exclusively (no formula at all) the first 6 months, with continued nursing through baby’s first year while supplementing with solid foods starting at 5/6 months of age.

Why? Because the first year of breastfeeding is the most important, where immune-building antibodies, perfect balance of macronutrients (protein, carbohydrate, and fats) and vitamins/minerals are at their peak levels in breast milk, and it’s when baby’s immune system is maturing (so when he needs it the most). Baby’s sensory and cognitive brain functions are further developed through the act of breastfeeding. Your own immunity against certain viruses (like the flu, pertussis, etc) is transferred through milk, too. 

Doctors should not tell you that you “should” stop breastfeeding at 12 months (or before). DO NOT listen to that nonsense! These doctors clearly aren’t practicing by the recommendations of the American Academy of Pediatrics – or in baby’s best interest  – and you should be skeptical about whatever else they tell you. There is NO reason why a babies “should” be actively weaned from breastfeeding at 12 months (or earlier)! (I would also bet that these quack doctors would also tell you that you need to forward-face your baby once they are 12 months old, which is COMPLETELY UNSAFE! – toddlers should rear-face at LEAST until 2 years and preferably up to 4 years old)

About the Term “Weaning”

So, weaning technically begins when you introduce your baby solid foods, because you are teaching your baby to take food other than what is provided solely by nursing. Weaning also occurs once mom is ready to stop nursing, when baby becomes more eager to eat solid foods than breastfeed, or because it is medically indicated by mom’s doctor (very few conditions necessitate weaning so make sure to get a second opinion on the matter, and discuss with a breastfeeding expert.

Some (very few) medications cannot be taken if nursing. For help on these topics, it is best to talk to a La Leche League leader and your obstetrician/pediatrician. Many doctors will play it safe and advise against nursing when you take a certain class of medication before researching more on the topic, but in reality the drug is likely safe. Please talk to a breastfeeding expert who can assuredly answer your question. As a nurse, I am well aware that General Practitioners (internal medicine) – even ICU doctors – know a whole hell of a lot about adult and general medicine, but they often lack a great deal of knowledge when it comes to specifics of breastfeeding. When I had questions about traveling to Philly when Jia was 1 year and 1 week old, I contacted my local LLLI rep and she was so graciously helpful and would text me to follow up. 

Keep in Mind: Time Away From Baby ≠ Weaning!

If you are planning to be separated from your baby for a determined amount of time (a trip, hospitalization, etc), it is important to stockpile some breast milk (easiest done between feedings or at night when baby is not nursing) and pump at regular nursing times, while you are away from baby. This is to maintain your milk supply to continue nursing when life goes back to normal. Again – You should still continue to breastfeed and keep your body in the mode of producing milk, by pumping regularly while away from baby. If you don’t do this, your body will start to produce less and it will take some patience and a little time before your supply returns to normal. If you stop pumping for an extended period of time; however, your supply can drop off entirely. 

Remember, it is highly recommended that you continue to nurse if you are sick (unless infected with HIV or other rare instances), even with a fever. For more tips on these topics, see “Boobienomics: Nature’s Supply & Demand” and “Breastfeeding While Sick.” 

How is Weaning From Breastfeeding Actually Done? 

Weaning from nursing is sometimes initiated naturally by baby, once he has become more interested in solid foods than breastfeeding (baby-led weaning, “BLW”), usually around the 6-8 month mark. More on BLW here. Weaning can also be initiated by mom (mother-led weaning), who wants to stop breastfeeding for whatever reason (planning the next pregnancy, wanting to inhale protein powder and start bodybuilding, whatever the case).

In this post, we are addressing Mother-Led Weaning, a topic I didn’t think I would be addressing at all… until now. 

There is a lot of – I don’t want to say “controversy”, so I’ll say “differing opinion” – on what is best for baby. The consensus among breastfeeding experts is that your baby will signal when he is ready to wean, and to prevent any emotional anxiety on baby’s part it’s best to wait until he decides.

It’s a really personal decision, as is basically everything related to breastfeeding. Nutritionally, you shouldn’t actively wean your baby from breastmilk or breastfeeding before 1 year. They need the iron, high concentration of species-specific fats, the bonding, the immunity.

Why Wean?

Some moms plan on weaning once their baby celebrates their 1-year birthday. It’s a huge and wonderful accomplishment to breastfeed until your baby is 1 year old! In the US, less than 30% of moms are actually still breastfeeding by 1 year. If you’re one of those moms who made it to 1 year, congratulations!!!!! It’s something you should be super proud of yourself for doing for you and baby!

Other moms have stopped because they wanted to get pregnant again and didn’t want to risk miscarrying by continuing to breastfeed (I’m sure we’ll get to this topic on the blog eventually, a lot of professionals say there is very little risk, but I know it does and has happened to even a couple of my friends). And to you moms (I know a few of you are reading) who are STILL breastfeeding well past 16-, 18- and 24- months, you friggin rock and I admire your dedication! 

Some, like me, wanted to continue longer but have decided it’s time to start the process and do it in the most supportive and gradual way possible; a way that would minimize baby’s resistance or induce separation anxiety from losing that close and intimate time with mom.

A Little About our Weaning Journey

Jia naturally phased out of her late-afternoon 4 PM feeding (cutting down from 4 to 3 feedings: 8 AM, 11 AM, 7:15 PM) a few weeks ago, too. So I figured maybe this is her telling me we can do this. Then I decided to do the “Don’t offer, Don’t refuse” method for her pre-nap 11 AM feeding to see how that went. So far, so good. We are now on 2 feedings (morning and bedtime) for 4 days now (May 2).

I am just so happy that I was able to successfully breastfeed her for that entire year without a drop of formula. I know a lot of great moms who have struggled with establishing breastfeeding, so I don’t say that with grim smugness. When I was pregnant, I told Jeff that as long as I was able to breastfeed for at least 1 whole year (with the hopes of two), I would be more than happy. I would’ve been able to say that I did the best thing I could’ve possibly done for Jia.

But, we have quite a few weddings coming up, and a couple of them I’ll be out of town and away from Jia. I also want to diet and I know lots of moms are able to diet and breastfeed – but Jia’s a little skinny thing, my milk is already not super fatty, so I don’t want to give her weaker milk while dieting. Plus, I want some time to have my body be completely mine before we have another baby, so this is where my journey starts.

So here we are. 

(disclaimer: I purposefully did not include evidence-based research into this post because much of the research out there on MLW or BLW is about mothers’ experiences, ages at which it was done, feasibility of BLW with infant feeding, impact on mom’s ability to produce milk after weaning, maternal control during the weaning period, etc. I just wanted to post what appears to be legit expert opinion on the actual weaning process.)

What The Experts Recommend on Mother-Led Weaning

  • Weaning is a developmental milestone that is different for each child. Not every child is ready by 12- 18- or however many months. 
  • Weaning is a huge change for your child, in and of itself. It is highly discouraged to initiate or maintain the weaning process when your child is sick. Allow them to nurse on demand while sick and resume when he is healthy again. KellyMom said it best: “continued, unrestricted nursing will probably speed the healing process and to be honest, there’s really no better way to comfort an ill toddler than nursing.”  So, please spare your toddler any additional discomfort and allow them the comfort of nursing while they are sick. 
  • Decide how you will wean (you may want to try a couple to see what works best for you and baby)
    1. Cut down time (like weaning from night feedings) each day for that feeding until it is dropped, then gradually start with the next feeding; or
    2. Note during which feeding(s) she seems easily distracted (the family pet, noises, the TV, etc) to assess for readiness and skip that particular feeding. Offer a comfort toy or snack. Observe for cues of irritation, hunger, attachment when skipped. If she seems OK, then try again the next day. Continue skipping that one feeding for however long you are comfortable with how she is handling it, then choose the next feeding to skip. 
    3. “Don’t Offer, Don’t Refuse” This means that for your 12 month + child, pick a feeding you won’t offer and go about your day as normal. But, if she seems hungry, is tugging at your shirt, snuggling your breasts, don’t refuse the feeding. You can repeat this until it gradually becomes a consistently unrequested feeding. Instead, offer a snack, earlier meal, or change of scenery. 
    4. I love this one – doubt it’ll work for us – Instead of feeding a morning feeding, have dad take her to the kitchen for a “daddy-style” breakfast in place of the nursing session. La Leche League International says that this may become a special shared moment between the two, allowing you more sleep. Like I said – I would love this to work but I doubt it will, ha. If you’re reading this Jeff, the link to that proof is here, fourth paragraph. 
    5. More of a tip than a method – I recommend pumping in place of nursing your child, just so you can A) have that extra sip cup of expressed milk ready to go for snack or meal time; and B) in case you have to return to that feeding because your child wasn’t ready to give up that feeding. Remember, supply and demand! (if your body doesn’t respond to a pump or hand expression, don’t fret)

Weaning is a developmental milestone that is different for each child. Not every child is ready by a certain age and there is no magic number that is telling of when yours will be ready. 

  • Additional Milk Needs
    • None! (read below)
    • If your baby is older than 9-10 months  (less than 1 year) and your infant is nursing at least 3 times per day, you don’t need to feed your baby any formula in place of a weaned feeding. KellyMom suggests meeting their nutritional needs with expressed breast milk or additional solid foods with water or juice (no more than 3-4 ounces per day). 
    • However, if she is older than 9-10 months and nursing less than 3 feedings per day, you’ll need to replace the missing feeding(s) with iron-fortified infant formula. Cow’s milk shouldn’t be introduced until 12 months, anyway, due to its highly concentrated formulation that can lead to constipation. 
    • If your child is 12 months and older and does not want to drink cow’s milk, you can fulfill her vitamin D, fat, protein, calcium, etc. in other forms (yogurt, cheese, milk in scrambled eggs, etc). They don’t actually have to drink milk, at all! And you definitely don’t need to give toddler formula! Click here to visit KellyMom’s webpage on nondairy sources of calcium from an International Board-Certified Lactation Consultant. 
    • Introducing WHOLE (not skim, 1% or 2%) cow’s milk while weaning (a 12+ month old): 
      • Ounce-by-Ounce, Week-by-Week: Substitute 1 ounce of breastmilk for 1 ounce of cow’s milk and gradually increase. Example:
        • Jia drinks about 4 ounces of breast milk at each day time feeding, so for each feeding I’m weaning:
        • Week 1: 1 ounce of cow’s milk + 3 ounces of breast milk (total 4 oz).
        • Week 2: 2 ounces of cow’s milk + 2 ounces breast milk (total 4 oz)
        • (and so forth.)
        • It’s important to do this slowly!
        • You can give this “blend” of breastmilk and cow’s milk in the latter part of each meal, at snack time, play time, however you prefer.
      • Introducing cow’s milk too quickly can lead to real constipation issues! After 1 year+ of changing poopy diapers, I’m sure you’d like less poop, but we’re talking days without pooping. Imagine if you didn’t poop for 3-5 days! You’ll wish you went slower, if you go too fast.
      • Too much cow’s milk (in excess of 24 ounces per day) can lead to iron absorption issues, leading to iron deficiency anemia. Read more in my post about Iron Deficiency Anemia in Toddlers.
  • “breastfed toddlers are healthier toddlers overall” According to breastfeedingbasics.com, as long as you are breastfeeding, your child will still benefit from the immunological advantages over a toddler who is not receiving breast milk. So I guess this point is to say that, definitely don’t feel rushed. You’re not necessarily doing your child a favor by weaning once they’re a toddler. I don’t feel like I’m doing a disservice to Jia by starting to wean her at 14 months either, so take what you will.  

To maintain your baby’s optimal comfort and security during weaning:

  • Make your approach gradual, do not rush the weaning process (rushing can lead to signs of premature weaning: increased separation anxiety, whining, crying, tantrums, night wakening, aggression, biting, thumb sucking, refusal to eat, vomiting, constipation, stomachache, and withdrawal from activities or general “aloofness” and inattention)
  • Rushing it can hurt you, too. According to La Leche League International, if you stop breastfeeding “cold turkey,” you can wind up with painful mastitis from breast engorgement, from shocking your breasts into retaining milk that is usually emptied during nursing. Clogged milk ducts leading to swelling, infection, and fevers along with a course of antibiotics doesn’t seem fun for you and your toddler might not be having fun, either. 
  • Be observant to your child’s cues of premature weaning and don’t attribute them to wonder weeks, growth spurts, teething, etc. You likely need to hold off and try weaning another time (week, month). 
  • Make sure your baby seems ready. Premature weaning can lead your child to feel unfulfilled and trust violated, because it is “pushing [them] into independence before he is completely ready. (Dr. Sears)” No joke. Not even trying to be overdramatic here. Breastfeeding is a HUGE sense of security for your little one, so understand that this may be tough on her. 
  • Drop your baby’s least favorite feeding first. Do you stop your child’s playing at 4 PM to nurse? Do you find yourself losing track of time around the 4 o’clock feeding and not realizing you’re “late”? (this happened to me often because Jia was having too much fun exploring, playing, etc) Do you have to wrangle your child into a feeding position because she keeps wriggling and wants to go back to playing? These are a few signs of readiness to drop this particular feeding session. 
  • Be flexible and understanding of your child’s needs. If your toddler wants to nurse, do not refuse. Refusing a feeding may backfire, leading them to focus on nursing even more than before. So, if your child is reaching for your shirt and you try to distract her but she continues to reach for you, understand that she may need this feeding for a bit longer. Wait it out, this may not be the right time to wean this feeding. 
  • Offer lots of extra cuddling and close mommy time, your child needs this emotional reassurance and physical connection (and you probably will too). With decreased feedings, there is decreased physical contact, so make up for it! 
  • During this extra close mommy/baby time: 
    • DON’T watch TV, look at your phone, during this time; remember, this is HIS time to feel close to you
    • DO look and talk to him
    • DO hold, rock, or lie down with him
    • DO play with those fingers, toes, feet, legs, and arms. Point out her nose, bellybutton, tummy, etc.
    • DO tickle her and other things that make her laugh
    • DON’T hold back on hugs and snuggles
  • Offer an extra snack and comfort toy/lovey in place of the weaned feeding(s)
  • Morning and bedtime feedings are usually the ones that toddlers are most attached to and will have more difficulty weaning. You may decide to wean from other daytime feedings while still choosing to feed in the morning and before bed. LLLI.org says the bedtime feeding is (almost always) the last to go, so focus more on bedtime stories or the rest of the bedtime ritual as you wean slowly from this one. 
  • Make a bottle or sip cup of breast milk in place of the feeding that is weaned, and offer during playtime or snack time. 
  • If your child is sick, they will usually want to nurse more often and longer. The act of nursing brings them comfort, safety, and calms them (and it also helps keep them hydrated, as breastfeeding is often the only nourishment they don’t refuse when sick). 

Keep in mind that weaning can take days, weeks, or months. Be patient and always be understanding and responsive to your baby’s needs throughout this process – it’s a big one.

I personally am not even there yet where I am no longer breastfeeding, so I don’t know how to expect to feel with regards to my identity as a non-nursing mom. But, I can expect that I’ll want a LOT of extra close snuggle time with my little firecracker. I can only hope that she will want it from me, too.

Sources:

http://www.breastfeedingbasics.com/articles/weaning-your-baby

http://www.breastfeedingbasics.com/articles/why-breastfeed

http://kellymom.com/ages/weaning/wean-how/weaning_faqs/

http://www.lalecheleague.org/faq/weanhowto.html

http://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/weaning/art-20048440?pg=2