Ancient Hebrews completed weaning at about three years. Most children in traditional societies are completely weaned between two and four years of age. Anthropological theories have recommended final weaning at the following points: when the infant acquires four times his birth weight; when the infant’s age is six times the length of gestation (ie, 4.5 years); or when the first molar erupts. Ultimately, it becomes a decision of choice or even forced necessity.
According to the NIH (National Library of Medicine), “For infants, not being breastfed is associated with an increased incidence of infectious morbidity, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome. For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, myocardial infarction, and the metabolic syndrome.” To make matters worse, there is now a national shortage of formula caused by recalls related to infant deaths and pandemic-related reasons for non-reall related shortages.
Sadly, for many babies and mothers in the United States, the decision as to when their baby will be at least partially weaned will be made by their mother’s employer. Many employers do not provide adequate maternity leave and/or do not offer work breaks for pumping. But remember, weaning does not have to be all-or-nothing. Some women choose to wean during the day and breastfeed at night, depending on their work situation and their schedules.
Natural weaning occurs as the infant begins to accept increasing amounts and types of complementary feedings while still breastfeeding on demand. When natural weaning is practiced, complete weaning usually takes place between two and four years of age. In western cultures, there remains a relative intolerance to this type of weaning often because Western society wants to appease the guilt of working mothers who often have employers who are unwilling to provide additional maternity leave and/or breaks for pumping breastmilk. Instead, it is easier for the Western culture to shame the few mothers are actually able to do what is best for their babies. For this reason mothers who breastfeed older infants and children often become ‘closet nursers who secretly continue to breastfeed.
Planned weaning occurs when the mother decides to wean without receiving cues from the infant that he or she is ready to stop breastfeeding. Some reasons commonly given for planned weaning include the following:
• Returning to work.
• A drop in supply because the mother chose to reduce the amount of feedings.
• The infant is unwilling to eat any tablefoods (at a time when it has become developmentally appropriate to eat meals).
• Painful feedings due to an incorrect latch.
• Mastitis due to going to long between feedings or incomplete feedings that do not empty the breast.
• A new pregnancy.
• Wanting or needing another care-giver to be able to administer feedings.
• The baby’s teeth are beginning to erupt and mom chooses to use this as a reason to discontinue breastfeeding.
These situations may result in premature complete weaning even despite the mother’s original goal to continue breastfeed to a certain age. A physician should inform and support the mother, regardless of whether or not she wishes to continue to breastfeed. If a physician is unsure as to how to provide this type of support, then a referral to a breastfeeding expert should be considered.
Natural weaning should not be confused with a ‘nursing strike’. A sudden refusal to nurse can occur at any time and may be followed through by complete weaning if the mother interprets this as a personal rejection. Nursing strikes are temporary and may be the result of any of a number of different causes such as onset of mother’s menses, a change in the mother’s diet, soap, or deodorant, or teething or illness in the infant. Simple steps that can be taken to manage a nursing strike include the following:
• Make feeding time special and quiet; minimize distractions.
• Increase the amount of cuddling and soothing of the baby.
• Offer the breast when the infant is very sleepy or when just waking up.
• Do not attempt to ‘starve’ the infant into submission.
• Offer the breast frequently using different nursing positions, alternating sides. Try nursing in different rooms.
If the above steps do not result in reinstitution of breast-feeding, then the infant should be evaluated to rule out possible illness.
Abrubt or emergency weaning
Occasionally, there is a need for abrupt or emergency weaning, such as in the case of a prolonged unplanned separation of the mother and infant, or severe maternal illness. Many mothers are inappropriately advised to wean when they are placed on medication. There are very few medications that are contraindicated during breastfeeding. These include antimetabolites, therapeutic doses of radiopharmaceuticals, and most drugs of abuse. Other drugs must be considered individually. The benefits of continued breastfeeding need to be weighed against the risks of exposure of the infant to the drug as it appears in the breast milk.
A sudden illness of the child need not be a reason for weaning, and in fact, breastfeeding or pumping and storing the milk until the infant is able to take it should be supported and facilitated by the physician.
When an infant is weaned abruptly, he may refuse the bottle. In these cases, a cup can be offered. The infant may also initially refuse any other type of food from the mother, in which case, a patient caregiver may need to feed the infant. The mother should continue to spend time in close physical contact with the infant, if possible, so that the weaning process is less psychologically traumatic for both mother and infant.
An abrupt weaning will likely cause the mother some discomfort, especially if this occurs during the early postpartum period when her milk production is high. She should be advised to take analgesics and to express just enough milk so that her breasts feel comfortable. Cold gel packs, cold cabbage leaves, or breast massage may help to relieve the engorgement. She must be watchful for signs of a plugged duct, which may lead to mastitis. She should wear a comfortable, supportive bra. Binding the breasts is not recommended because this will lead to more discomfort and may also result in blocked ducts. There is no need for fluid restriction. Bromocriptine, a prolactin suppressant, is no longer sanctioned as a ‘dry-up’ medication due to reports of serious adverse drug reactions such as seizures, strokes, and death.
Once the time has come to start final weaning, it should be a gradual process. Abrupt weaning is traumatic for the infant, uncomfortable for the mother, and may result in blocked ducts, mastitis, or breast abscesses. Abrupt weaning is to be avoided if at all possible.
When is the right time to wean?
When to wean is a personal decision. A mom might be influenced by a return to work, her health or in extremely rare cases the baby. Mothers start breastfeeding with the best intentions. Often obstacles are met and premature weaning may result. It is important for the physician to explore a mother’s reasons for weaning and to provide her with information so that she can make an educated decision about the process and timing of weaning. Once informed, a mother should not be pressured to breastfeed for longer than she feels is appropriate. Nor should she be criticized for continuing to breastfeed for longer than is the norm in her culture.
A mother may experience mixed emotions when she starts to wean her baby. She may enjoy some of her newly found freedom, but may also mourn the passing of a very intimate phase in her relationship with her child. It is common for a mother to report a sense of loss or sadness, even with gradual weaning. She can be reminded that her infant is achieving a new social milestone, that of eating solids and drinking from a cup. As long as she approaches the process with flexibility and sensitivity, the experience should be positive.
Whenever you decide to wean, your child may have another time in mind. Some children wean themselves earlier than the mother intended and others resist weaning when the mother is ready. Those wean later in life tend to be more resistant. For example, a 2-year-old toddler may be more attached and less flexible about giving up breastfeeding than a 12-month-old baby. At times like these, it’s important to take it slow and be sensitive to each other’s needs.
Approaches to weaning
To let both mom and baby adjust physically and emotionally to the change, weaning should be done over time. One approach is to drop one feeding session a week until your child takes all the feeds from a bottle or cup. If you want to give your child pumped breast milk, you’ll need to pump to keep up your milk supply. If you are weaning your child off breast milk, slowly dropping feeds can help avoid engorgement.
Here are some more ways to make this change easier:
• Engage your child in a fun play activity or an outing during times when you would usually nurse.
• Avoid sitting in your usual nursing spots or wearing your usual nursing clothes.
• Delay weaning if your child is trying to adapt to some other change. Trying to wean when your little one is just beginning childcare or during teething might not be a good idea.
• If your baby is younger than one year, try to introduce a bottle or cup when you would typically be nursing. For an older child, try a healthy snack, offering a cup, or maybe a cuddle.
• Try changing your daily routine so that you’re otherwise engaged during breastfeeding times.
• Enlist your partner’s help to provide a distraction at a typical nursing time.
• If your child picks up a comforting habit (such as thumbsucking) or becomes attached to a security blanket, don’t discourage it. Your child might be trying to adjust to the emotional changes of weaning.
For more information visit www.ncbi.nlm.nih.gov/pmc/articles/PMC2720507.