When is weaning a problem?
Breast or bottle feeding can be considered prolonged after
about 18 months of age. The older toddler who only
occasionally nurses or drinks from a bottle may not need to
be pressured into giving up the bottle or breast. Delayed
weaning should be considered a problem only if it is causing
one or more of the following types of harm:
refusal to eat any solids after the age of 6 months
anemia confirmed by a routine screening test at the age
of 1 year
tooth decay or baby-bottle cavities
obesity from overeating
withdrawal from other children and lack of interest in
play because the child is always carrying a bottle around
frequent awakening at night for refills of a bottle
inability to stay with a baby sitter because the child is
exclusively breast-fed and refuses a bottle or cup.
If your baby has any of these problems, read the next
section. Otherwise, continue to breast or bottle feed your
baby when she wants to (but no more than three times a day)
and don't worry about complete weaning.
How do I eliminate excessive breast or bottle feedings?
To decrease breast or bottle feedings to a level that won't
cause any of the problems described above, take the
following steps:
Reduce the number of milk feedings your child receives to 3 or 4 a day.
When your child comes to you for additional feedings,
give him extra holding and attention instead. Get your
child on a schedule of three main meals a day plus two or
three nutritious snacks.
Introduce feeding from a cup if this was not done at 6 months of age.
Cup feedings are needed as substitutes for breast or
bottle feedings regardless of the age at which weaning
occurs. The longer the infant goes without using a cup,
the less willing he will be to try it. Starting daily
cup feedings by 5 or 6 months of age is a natural way to
keep breast or bottle feedings from becoming overly
important.
Immediately stop letting your child carry a bottle around during the day.
The companion bottle can interfere with normal
development that requires speech or two-handed play. It
can also contribute to problems with tooth decay. You
can explain to your child, "It's not good for you to
carry a bottle around" or "You're too old for that."
Immediately stop letting your child take a bottle to bed.
In addition to causing sleep problems, taking a bottle of
formula or milk to bed may cause severe tooth decay. You
can offer the explanations suggested above.
Once you have made these changes, you do not need to do
anything more unless you want to stop breast or bottle
feedings completely. Attempt total weaning only if your
family is not under stress (such as might be caused by
moving or some other major change) and your child is not in
crisis (such as being sick or learning to use the toilet).
Weaning from the breast or bottle to the cup should always
be done gradually and with love. The "cold turkey" or
abrupt withdrawal approach will only make your child angry,
clingy, and miserable. While there is no consensus about
the best time to wean, there is agreement about the
appropriate technique.
How do I eliminate breast-feeding completely?
Offer formula in a cup before each breast-feeding.
If your child refuses formula in a cup, offer expressed
breast milk in a cup. If that fails, add some flavoring
he likes to the formula. If your child is older than 12
months, you can use whole milk. Some infants won't
accept a cup until after they have nursed for several
minutes.
Gradually eliminate breast feedings.
First, eliminate the feeding that is least important to
your child (usually the midday one). Replace it with a
cup feeding. About once a week drop out one more breast
feeding. The bedtime nursing is usually the last to be
given up. There's no reason why you can't continue
bedtime nursing for months if that's what you and your
child want.
Some mothers prefer to wean by decreasing the length of
feedings. Shorten all feedings by 2 minutes each week
until they are 5 minutes long. Then eliminate them one
at a time.
Relieve breast engorgement.
Because the breast operates on the principle of supply
and demand, the reduced amount of sucking time eventually
reduces the amount of milk your breasts produce. In the
meantime, express just enough milk to relieve breast pain
resulting from engorgement. (This is better than putting
your baby to the breast for a minute, because she
probably won't want to stop nursing.) Remember that
complete emptying of the breast increases milk
production.
An acetaminophen product also may help relieve
discomfort.
If your child asks to nurse after you have finished weaning, respond by holding her instead.
Explain to your child that the milk is all gone from your
breasts. If your child has a strong desire to suck, a
pacifier may help.
How do I eliminate bottle-feeding completely?
Offer formula in a cup before each bottle feeding.
Use whole milk if your child is 1 year of age or older.
Make the weaning process gradual.
Eliminate one bottle feeding every 3 to 4 days, depending
on your child's reaction. Replace each bottle feeding
with a cup feeding and extra holding.
Eliminate bottle feedings in the following order: midday, late afternoon, morning, and finally bedtime.
The last feeding of the day is usually the most important
one to the child. When it is time to give up this
feeding, gradually reduce the amount of milk in the
bottle each day for a week.
After you have completed the weaning process, respond to requests for a bottle by holding your child.
You can explain that bottles are for little babies. You
may even want to have your child help you carry the
bottles to a neighbor's house. If your child has a
strong need to suck, offer a pacifier.
When should I call my child's health care provider?
Call during office hours if:
Your child is over 6 months of age and won't eat any food
except milk and won't drink from a cup.
Your child has tooth decay.
You think your child has anemia.
This approach to weaning has not been successful after
you have tried it for 1 month.
Your child is over 3 years old.
You have other questions or concerns.
