Breastfeeding and weaning

How to wean
Ideally, your baby will nurse until he outgrows the need. This is called natural, or baby-led weaning. Just as you would not set an arbitrary limit on other areas of your baby's development, such as deciding exactly when he will sit up, roll over, move into a bed instead of a crib, etc. (instead, you watch for signs that he is ready to move on to the next developmental stage), it just makes sense not to set an arbitrary time limit on how long you will nurse your baby.

You actually begin weaning your baby the very first time you offer him any food other than your milk. Weaning should be a process, rather than an event. Depending on how you go about it, weaning can be abrupt or gradual, and may take days, weeks or months.

Abrupt weaning should always be avoided, if at all possible, for the sake of both you and your baby. If you suddenly stop nursing, your breasts will respond by becoming engorged, and you may develop a breast infection or breast abscess. Your hormone levels drop abruptly, and depression can result. Mothers with a history of depression should especially consider this when making decisions about weaning.

Abruptly withdrawing the breast can cause emotional trauma in the baby. Since nursing is not only a source of food for a baby, but a source of security and emotional comfort as well, taking it away abruptly can be very disturbing. Weaning gradually lets you slowly substitute others kinds of attention to help compensate for the loss of the closeness of nursing.

If you are told to wean your baby abruptly for medical reasons, you need to make sure that there are no other options. It is well worth getting a second opinion from someone who is knowledgeable about breastfeeding. Most of the time, you'll find that there are alternatives. (See article on Drugs and Breastfeeding for more information.) For example, if you are prescribed a medication that is incompatible with breastfeeding, ask your doctor to see if another, safer drug can be substituted.

Even if you do have to take a drug that isn't safe while nursing, you have the option of just weaning temporarily and picking up breastfeeding where you left off. This involves expressing your milk during the interim, so that you will ready to resume nursing, and also to avoid engorgement. A hospital-grade electric pump is better for this purpose than a manual or small electric pump.

Benefits of extended breastfeeding
There are many, many benefits to extended breastfeeding, and very few benefits to weaning early. That is not to say that even one feeding at the breast doesn't have value, because it does. Whether you nurse for days, weeks or years, breastfeeding provides both you and your baby with many important benefits -- but breastfeeding for a year or longer offers the most advantages. Extended breastfeeding is definitely not the norm in this country -- in the US, fewer than 20 percent of babies are still nursing when they are six months old. While you may find it hard to imagine a mother in India nursing a three year old, that same mother would probably be baffled at the idea of taking a baby off the breast when he was just a few weeks old.

If you decide to go with natural weaning, be prepared for lots of unsolicited advice. You will be told that you're doing it for you, not the baby (this is ridiculous, because it is a proven fact that you absolutely cannot make a baby nurse if he doesn't want to). You will be told that your child will become a sexual deviant (yep, I bet if you took a survey you'd find that prisons are just chock full of men who were breastfed till they were ready to wean...sure...). You will be told that your child will become hopelessly dependent on you, and you'll be following him to Kindergarten to nurse at rest time (interestingly enough, experience and research have shown that babies who are nursed until they are ready to wean are actually less dependent because their security needs have been met as infants). It really boils down to following your instincts as a mother -- nobody knows this little individual better than you, and you will know when he is ready to wean.

There are many benefits of extended breastfeeding. The American Academy of Pediatrics recommends nursing for at least the first year of your baby's life.

• Your baby continues to get the immunological advantages of human milk, during a time when he is increasingly exposed to infection. Breastfed toddlers are healthier overall.
• When he is upset, hurt, frightened or sick, you have a built in way to comfort him. Often a sick child will accept breastmilk when he refuses other foods.
• Many of the medical benefits of breastfeeding (lower cancer risk in mother and baby, for example) are dose related -- in other words, the longer you breastfeed, the greater the protective effects.
• Human milk offers protection for the child who is allergic.
• Mothering a toddler is challenging enough -- nursing makes the job of caring for and comforting him easier. There is no better way to ease a temper tantrum, or put a cranky child to sleep than by nursing.
• Nursing provides closeness, security and stability during a period of rapid growth and development.
• Letting your baby set the pace for weaning spares you the unpleasant task of weaning him before he is ready.

It should be obvious that I have a bias toward baby led weaning. It just makes sense to me on so many levels. If someone tells you that babies shouldn't be nursed past six months, or one year, try asking them "Why?" They will be hard put to come up with a reason that makes sense, much less one that they can back up with any empirical evidence.

This is not to say that I think long- term nursing is right for everyone. When to wean is a very individual decision, and sometimes early weaning is the right decision. If a baby is not happy and thriving, and a mother is so stressed that she can't enjoy her baby, then it may be time to wean. Most babies do quite well on formula, and breastfeeding at all costs is not the most important consideration. You also need to be aware than nursing for days or weeks (or even one feeding at the breast) still offers important benefits to your baby. Nursing should never be an endurance contest.

Guidelines for early weaning
If you do decide that early weaning is right for you and your baby, here are some guidelines to follow:

• Try to do it as gradually as possible. Eliminate one feeding each day for several days to allow your milk supply to decrease slowly. After a couple of weeks, he should be down to nursing just a couple of times a day. Usually the last feedings to go are the first one in the morning, and the last one at night. If you're not in a huge rush, you may want to continue these couple of feeding for another week or two.
• Talk to your baby's doctor to find out what formula he recommends. Since babies are not ready for cow's milk until they are a year old, it is important to find the appropriate formula.
• Since young babies have a strong need to suck, offer a substitute (bottle or pacifier). Some babies will find their thumbs during this period, and there's not much you can do about that one way or the other. There are advantages to having a thumb-sucker -- those babies tend to be self-soothers, and often are better sleepers and travelers than babies who depend on pacifiers.
• Offer lots of physical closeness during this time. There is a tendency to avoid cuddling, because the baby associates the nursing position with breastfeeding, but it is important to snuggle your baby and get lots of skin-to-skin contact, even if you avoid the cradle hold.

If the decision is left up to them, most babies will wean themselves gradually, beginning by cutting back on nursing around the time they start solids. Physically, most toddlers are "ready" to wean. Nursing a child who is no longer an infant is done more out of concern for his psychological and emotional needs than for his nutritional ones. However, there are some older babies who make the transition from infancy to toddler-hood without the slightness indication of readiness to wean.

Weaning the older child
Weaning an older child who isn't ready can be a real challenge. You should not feel guilty if you decide to wean your toddler, because only you know when the time is right for you and your family. For example, you may be pregnant again, and while that in and of itself is not a reason to wean, your nipples may be so sore that you are gritting your teeth and not enjoying nursing your toddler AT ALL. He may begin to pick up on your feelings of resentment, and it may be time to wean.

Weaning an older baby doesn't have to be traumatic, although it may not be easy. Here are some tips:

• If possible, allow several weeks of concentrated time and attention to the process of weaning. Any baby who has nursed for a year or more is obviously really into it, and isn't likely to give it up easily.
• Don't offer, but don't refuse. Nurse him only when he is really adamant about it, but don't offer to nurse at other times.
• Make sure that you offer regular meals, snacks and drinks to minimize hunger and thirst. Remember also that babies nurse for reasons besides hunger, including comfort, boredom and to fall asleep.
• Try to change your daily routine to minimize situations where he wants to nurse. Does he want to nurse when he is bored? Try distracting him with a snack or a walk outside. Do you usually lie down with him at naptime? Try reading him a book or rocking him instead.
• If Dad is around, encourage him to take an active role in weaning. Have Dad try to put him back to sleep if he wakes during the night. If he nurses first thing in the morning, try letting Dad get him up instead of you and feed him breakfast.
• Watch his preferences and respect them. If he is having a really hard time giving up the first thing in the morning nursing, you may want to continue that one for a while rather than force the issue.
• With older toddlers (two years plus) you can begin by setting limits on nursing. For example, you can say "We'll nurse when we get home, but not at the mall." Substitute nursing on demand for nursing at your convenience.
• Shorten the duration of any given feeding. Say "That's enough, now." and gently remove the breast from his mouth.

In summary: weaning is a process that begins as soon as you introduce other foods into your baby's diet. (This comes in handy when someone asks you if you have started weaning him yet -- you can truthfully answer "yes"). Babies wean at different ages, just as they get teeth at different ages. When you wean your baby is a decision for you to make, ideally based on signs of developmental readiness. Breastfeeding provides benefits for both you and your baby no matter how long you nurse. Gradual weaning is always better than abrupt weaning, although there are times when this just isn't possible.

If you and your child both enjoy nursing, and your only reason for weaning is that you are under pressure from other people who think you should, then you need to look further for outside support of your decision to continue nursing. If you no longer enjoy nursing, or if there are legitimate pressing reasons for you to wean, you should do it and feel good about the time you did nurse, without feeling guilty about what might have been.

On a personal note: I have nursed six children. The first three weaned themselves before they were a year old. I was a La Leche League leader at the time, and all my friends were nursing their toddlers. I couldn't believe my babies were doing that to me -- I was willing to nurse them till they went to college, but there was absolutely no way to convince them to keep nursing. Even withholding food didn't work. My experience with my next three babies reminded me of the old adage "Be careful what you wish for," because they all wanted to nurse between 2 1/2 and 4 1/2 years. I practically had to pry them off with a crowbar. It was interesting to me that the early weaners were all thumb-suckers and blanket holders, while the late weaners were never self-soothers, but used the breast for comfort as well as nutrition. All were breastfed on demand from day one, so I can only assume that individual differences accounted for the different weaning experiences.

I am happy to report that all six have turned out normal and well adjusted, so their radically different weaning schedules apparently didn't have a long term effect on their development. I'm so glad -- with six children, I have plenty of other things to feel guilty about.