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Nursing Your Older Baby and Weaning

Mother-led weaning

Nursing Your Older Baby and Weaning

For many women, weaning their breastfed infant represents the first among a host of developmental transitions that characterize childhood. The long journey involved in transforming a totally dependent newborn into a fully responsible, contributing adult is charted by a progressive series of transitional milestones, including weaning, becoming toilet-trained, starting kindergarten, entering puberty, or going off to college. It is our job as parents to serve as guides to see our child safely through the course, helping her at each junction to let go of old, familiar patterns and embrace new opportunities. In some instances, when circumstances mag-nify the sense of loss about what is being given up, negotiating life transitions can be uncomfortable, even painful, for both parents and children. On the other hand, when parents and children successfully move from one milestone to another with a sense of accomplishment and expectation, they emerge better equipped to navigate the next transition in a satisfying manner. For more than half of all infants in the United States, the process of weaning from the breast is one of their first significant transitions, making the topic worthy of an in-depth discussion.

What Is Weaning?
Few terms convey such broad connotations as the diverse meanings that can be expressed by the word "weaning." A single word hardly seems adequate to describe all of the following: breastfeeding that could stop at either three weeks or three years; the prolonged, gradual discontinuation of nursing and the abrupt termination of breastfeeding; a process that is initiated by the mother's desires and one that is guided by the baby's needs. Obviously, weaning can refer to diverse situations.

In the broadest sense, weaning begins as soon as an infant starts consuming any foods in addition to breast milk. Thus, the two-week-old baby who is given a daily bottle of formula has already begun the weaning process. An exclusively breastfed infant may not start to wean until solids are introduced at six months of age. Babies who enjoy the full natural course of breastfeeding, extend-ing into the second or even third year, eventually spend more time weaning than breastfeeding exclusively.

Although weaning was meant to be a gradual process, sometimes abrupt termination of breastfeeding becomes necessary. This is especially difficult on mother and baby when an exclusively breastfed infant must be weaned suddenly.

Mother-Led Weaning
In our society, weaning is commonly structured around the mother's plans and desires. For example, many American women wean their babies prior to returning to work because they doubt they can combine breastfeeding and employment. Women may commit to breastfeeding for an arbitrary length of time, such as six months, and then stop nursing when they reach their predetermined goal. Unfortunately, countless women who originally intended to nurse longer resign themselves to weaning early due to unresolved lactation difficulties that place a damper on their breastfeeding experience. Some women say they feel tied down by breastfeeding, especially when their babies refuse to accept nutrition by any other means. They may decide to wean in order to share responsibility for feedings with their partners. Other common mother-led reasons for weaning include to go on a strict weight-reduction diet, to resume alcohol consumption, to participate in certain athletic activities, or to go on a vacation with their partner. Probably the most frivolous explanation I've ever heard for early weaning was to be able to wear a particular gown to a formal affair!

Sometimes mother-led weaning occurs for more valid reasons. For example, I have known some older women who, having started their families late, decided to wean in order to increase their chances of conceiving another child. I also have encountered a number of women whose breastfed babies displayed severe allergic reactions to numerous foods in the mothers' diets. These dedicated women had restricted their own diets while breastfeeding, sometimes to a drastic degree. Once their babies were old enough to drink cow's milk, some of these women were anxious to wean in order to be able to eat a more varied diet.

A few women must wean their babies due to compelling health issues that leave them no choice. For example, a young mother with cystic fibrosis chose to wean her three-month-old infant because her lung function had deteriorated so rapidly while breastfeeding and she had lost excessive weight. In another heart-wrenching case, a woman was diagnosed with extensive breast cancer while exclusively breastfeeding her six-month-old baby. With her very survival at stake, the mother was forced to wean abruptly, much to her own and her baby's distress. Within a matter of days, she underwent a mastectomy and began a course of chemotherapy. I can't imagine the turmoil of emotions with which she must have wrestled as she reluctantly weaned her confused infant in the battle for her own health. Happily, this exceptional woman is alive and well, free of cancer, more than fifteen years later.

While most babies handle weaning without permanent trauma, sometimes a mother's decision to wean conflicts with a baby's health or emotional needs. I recall an infant with severe, chronic liver disease whose mother had managed to breastfeed her through multiple hospitalizations. After many months of nursing and providing specialized care for an extremely ill infant, the weary mother expressed her desire to wean. While I applauded this woman's remarkable efforts to that point and empathized with her wish for more control over her life, my compassion for her critically ill little girl was even greater. Breastfeeding clearly served as the principal source of consolation and pacification for this unfortunate, and often miserable, baby. Her tired mother wistfully imagined that weaning would bring respite from the near-constant care required by her chronically ill infant. In actuality, it was more probable that the sudden withdrawal of this child's emotional anchor would create more problems than it would solve. After a candid discussion, we attempted to balance the needs of both parties by validating the mother's weariness, providing her with regular breaks and sufficient opportunity to attend to her own needs, while allowing her sick infant to continue to nurse. Whether the decision is based on a trivial want or a pressing need, the fact is that mothers often determine when breastfeeding stops. As a family advocate, I view my principal role in this matter as providing accurate information to enable parents to make the best possible decision given their unique circumstances. Then I commit to supporting parents, especially mothers, in the achievement of their goals. I know many well-meaning breastfeeding advocates whose mission is to prolong the duration of breastfeeding at any cost. However, coercing mothers to nurse or inflicting guilt when they decline to breastfeed does not serve families well. Many of the reasons for weaning that I cited above might be considered invalid by you or me. But I believe we must honor, and not judge, another woman's decision based on her circumstances and values. Whenever weaning occurs and whatever the reason, I believe emphasis should be given to validating the breastfeeding that was accomplished, rather than focusing on the breastfeeding that might have been.

Baby-led weaning; late nursingBaby-Led Weaning
In cultures where unrestricted breastfeeding is the norm, weaning is a slow, baby-led process, geared to the baby's developmental needs. Among dozens of societies and cultures studied, breastfeeding extends into the third year, with the average age of weaning being around two and a half. The Bible contains references to weaning at age three, while the Koran calls for nursing until two years. In many cultures, breastfeeding continues to four years of age.

The gradual nature of the weaning process is captured by the expression "You never know when the last nursing has occurred." Toward the end of the transition, days or even weeks may elapse between nursings. Obviously, by this stage, the volume of milk is usually inconsequential. A nursing may last only a moment, as a youngster reassures himself of his mother's presence and love. What starts out as principally a method of feeding a newborn gradually evolves into principally a method of comforting and reassuring an increasingly independent toddler or preschooler. Baby-led weaning guarantees that the process is paced according to the child's unique dependency needs rather than society's expectations or the mother's preference. The chief advocate of child-led weaning in the United States is La Leche League. Bolstered by the support and example of like-minded peers, League members often nurse into their baby's third year or longer.

Late Nursing in the United States
Certainly, contemporary American patterns of breastfeeding are extremely abbreviated by worldwide standards. In the United States, only about 25 percent of babies are still being breastfed at six months of age and about 15 percent at one year. The result is pervasive unfamiliarity with the image of the older breastfed baby and inadequate social supports for achieving the full, normal course of breastfeeding. All too often, what is uncommon translates into what is unacceptable. Instead of commending those few American women who manage to breastfeed the full course, we are quick to pass judgment. "Are you still nursing?" "Don't you think she's too old for that?"

A number of years ago, a new intern at a teaching hospital was performing a two-year checkup on a little boy when the anxious toddler became upset, lifted his mother's blouse, and petitioned, "Nursy, nursy." The stunned intern had not even considered the possibility of breastfeeding at this age, and it never would have occurred to him to even ask about it. Now he wondered whether the child was developmentally appropriate. He made an excuse to slip out of the exam room so he could ask the attending physician in the clinic whether breastfeeding at this late age was normal and what he should do about it.

This encounter prompted the faculty member to schedule a teaching conference to discuss late nursing, and I was invited to serve as a consultant at the seminar. After hearing the brief case presentation, I decided to pose a few more questions before making my comments. "How often does the youngster nurse?" I inquired. After a brief pause, the puzzled intern hesitantly replied, "I suppose with his meals."

This story serves as a reminder of how ill-informed and unfamiliar our society is about late nursing. Few Americans have any appreciation for the full natural course of breastfeeding and the way a baby moves from depending on the breast as the sole source of food to relying on the breast for comfort and reassurance. The same intern who doubted the normalcy of a two-year-old requesting to nurse would have been unaffected if a three-year-old asked for his pacifier or began sucking his thumb.

It's little wonder that many American women resort to "closet nursing" their older babies to avoid incurring the hostile comments of an uninformed public. Some have their toddlers use code words for nursing to avoid exposing their secret, such as the woman who taught her twenty-month-old to announce, "I want a snack," when she wished to nurse. Intuitive toddlers soon learn not to ask for "milky" in certain settings, but to save their request until they arrive home. Not only is late nursing uncommon, but when it does occur, it is largely hidden from public view.

Unfortunately, the tendency for late nursing to be masked in the United States only serves to perpetuate the problem of lack of familiarity with breastfeeding older babies. Rather than succumbing to societal pressure to disguise the practice, the relatively few women who manage to achieve the full natural course of breastfeeding should be encouraged to talk about their experience with confidence. Publicizing the normalcy of late nursing is the only way to make Americans more comfortable with the image of the older nursing baby. Rather than hiding it, we need to implement de-sensitization strategies to increase Americans' exposure to late nursing.

Several years ago, I observed one such desensitization opportunity when I had the privilege of being a guest on the Leeza Show. The entire hour was devoted to various aspects of breastfeeding. Early in the show, a woman guest who was breastfeeding her newborn admitted that she had nursed her first son, Philip, until he was four years old. Philip, now seven, was seated in the audience next to his grandmother. He was a darling child-engaging, confident, and apparently quite normal. Leeza approached the youngster, mike in hand, and asked him if he remembered breastfeeding and what it was like. The boy, speaking softly and articulately, explained with great precision that breastfeeding was "warm . . . and sweet . . . and nice for babies." In this brief moment, Philip became an effective spokesperson for late nursing by demystifying and normalizing it.

How to decide; structured weaningDeciding When to Wean
My best advice about deciding when to wean is not to decide in advance. Instead, keep your options open. After all, how can you know before giving birth what the breastfeeding relationship will mean to you or your baby or just how intertwined feeding, comforting, and mothering can become? Just take one day at a time. And don't insist, "I could never nurse past a year." I don't know many new mothers who specifically plan to still be nursing two years later. These things just happen as successful breastfeeding takes its natural course. So stop worrying about when to wean and savor your breastfeeding experience. It's such a short and precious time out of your life. The American Academy of Pediatrics recommends that breastfeeding continue for at least twelve months, and thereafter for as long as mutually desired.

Ambivalence About Weaning
I find that most women acknowledge some ambivalence about discontinuing breastfeeding. Ambivalence is a good word to describe weaning because it evokes simultaneous feelings of attraction and repulsion. Along with the increased freedom that can accompany weaning comes the termination of one of the most unique, intimate, reciprocal relationships found in nature. One minute a nursing mother may complain of being tied down and wonder when her body will be her own again. A short while later, she may be tempted to awaken her child and offer her breast, finding nothing so dear as the comfort of a nursling. This natural ambivalence contributes to the indecisiveness that often surrounds weaning. Not only is some ambivalence perfectly normal, but it might be a clue to a woman's innermost feelings. Strong ambivalence suggests that you should examine more carefully whether this really is the right time to wean.

On the other hand, I must caution that a few women have such difficulty relinquishing the intimate breastfeeding relationship that they unwittingly allow their own need to continue the nursing relationship supersede their babies' need to wean. While it is highly appropriate to awaken a newborn baby to nurse if too much time has elapsed between feedings, toddlers should signal their need to nurse rather than having the breast offered to them. A helpful guideline suggested by La Leche League is "don't offer; don't refuse." If you find yourself regularly offering your breast to keep your older child nursing, chances are that your own ambivalence is getting in the way of letting your baby move on developmentally. In that case, you would be wise to acknowledge your pain and ambivalence, and then honor your baby's developmental timetable.

Recently, I dreamed that I gave birth to another baby, and was basking in the magnificent glow of new motherhood, with a warm, naked infant nestled contentedly at my breast. I awoke to the realization that all my children are grown, and I will never again relish the experience of breastfeeding. If I still miss breastfeeding twenty years after weaning my last child, is it any wonder that women express mixed emotions as they face this transition?

Suggestions for Structured Weaning
Despite the merits of baby-led weaning, many parents seek some structure in facilitating the weaning process. They may request help for introducing bottle-feedings to a baby whose mother is returning to work. Or, they may wish to implement guided weaning for their three-year-old.

Children vary widely in how they tolerate the weaning process. Some seem to adjust smoothly to decreasing breastfeeding, while others protest vehemently. What works for one baby may not for another. Babies over seven months of age may be able to wean directly to cup feedings, while younger infants usually will substitute a bottle for missed breastfeedings.

The most important principles of weaning are to have great empathy for your baby, to keep her needs foremost, and to proceed gradually, positively, and with love. Focus on substituting other forms of intimacy for the close nursing relationship that your baby is being asked to relinquish.

Consider the timing of weaning. Try to structure weaning when your baby is losing interest in breastfeeding anyway. Some babies are easily distracted from nursing by nine months of age. If you haven't weaned by twelve to fifteen months, be aware that toddlers can become very attached to the breast as a security object, making weaning harder than it would have been earlier. Avoid weaning during times of family stress or turmoil in a baby's life, such as a divorce, move, hospitalization, or starting day care.

Weaning tips

Whenever possible, plan to wean gradually rather than abruptly. Gradual weaning is easier on both mother and baby. Requiring an infant to abruptly relinquish both his method of feeding and his principal source of comfort and security can be emotionally distressing. Furthermore, you won't want to stop nursing completely and drastically decrease your milk production until you are confident that your baby tolerates formula well. For younger infants, plan to eliminate one nursing at first, substituting formula for the skipped breastfeeding. Several days to a week later (depending on how rapidly you want to wean), you can replace a second nursing with a feeding of formula. Gradually tapering your breastfeeding also helps prevent your breasts from becoming uncomfortably engorged.

Eliminate first those nursings that hold the least interest for your child. Certain nursings have special significance for a baby, who is sure to protest if you stop these breastfeeding sessions before she is ready. Perhaps you've been bringing your baby into your bed first thing in the morning and the two of you start the day with a leisurely nursing. Consider how special those times are for your little one. Or maybe you always nurse your baby to sleep for naps or at bedtime. Think about what you can substitute for the comfort, security, and intimacy of nursing.

It might help to keep a diary for a few days to note when, why, and how long your baby nurses. Try first to eliminate one of the midday nursings, or one when your baby typically stays at the breast for only a few minutes. Or, you might choose to omit an evening nursing, especially if your milk supply is noticeably lower in the evenings or if a substitute caretaker is available to take over.

Substitute other intimate activities. Breastfeeding is such a highly effective method of soothing and quieting an upset child that it's easy to rely solely on nursing when other comforting measures might be equally effective. Consider whether there are times when you offer your breast to your child simply because it seems easier at the moment to restore calm. Or there may be times when your child nurses simply out of boredom. Children may resist weaning if nursing is the principal form of one-on-one attention they receive. Be creative as you taper nursing, and make sure you offer your child ample opportunities for comforting and interesting stimulation. When several children in the family compete for Mom's attention, the youngest may use nursing as a surefire way to get Mom all to himself. No wonder the last child often breastfeeds the longest! Try substituting rocking, cuddling, stroking, singing, reading a story, making a puzzle, or playing a game.

Wear inaccessible clothing. A nursing toddler soon learns to pull at her mother's blouse buttons and lift her mother's shirt to nurse. Seeing the exposed breasts-for example, as you change clothes or emerge from the shower-will trigger the desire to nurse. When you are structuring weaning, try wearing clothing that is inaccessible for nursing, such as a one-piece dress that pulls over your head or zips up the back. Explain in a matter-of-fact tone that you simply aren't able to nurse right now because of what you are wearing. Although toddlers and preschoolers have a limited capacity to reason, your explanation may postpone their desire to nurse for a while, especially if you can distract your child with an interesting activity or offer some cuddling and extra hugs.

Change your routine and avoid situations where you normally would nurse. If you had a favorite rocker where you often nursed, move it into the garage for a while. If you normally nursed while on the phone, keep calls short and remain standing while you talk. If you often nursed in front of the TV, don't watch any programming while your child is awake. If you want to eliminate the early-morning or bedtime nursing, ask Daddy to help out by being the one to get your child up or tuck her in at night.

Use a timer to limit the duration of nursings. In addition to eliminating the number of breastfeedings, you can also structure the weaning process by limiting the length of nursings. If you try to end a nursing before your youngster is ready, it can feel like rejection to her. Instead, use a timer to monitor the length of some nursings. Explain to your child that when the sand is gone or the timer buzzes, you will have to stop nursing. Whereas a parent's limits might easily evoke an emotional response in a child, a neutral instrument like a timer can serve as an objective way to limit nursing.

Focus on your child's increasing independence. Emphasize what a big girl she is becoming and the new privileges she enjoys, like going to preschool, becoming potty-trained, and staying overnight at Grandma's house. You can acknowledge how special nursing is for little babies and reminisce about her babyhood.

Enlist the help of other caretakers. Encourage Daddy, grandparents, and baby-sitters to lavish extra love and affection on your child during the time she is tapering her nursing. They can help distract and entertain her and keep her preoccupied, especially at former nursing times. Their close involvement will remind your child that other loving adults can be effective sources of comfort and love.

Let your child know you have needs too. One woman put Band-aids over her nipples and explained to her three-year-old that she had "owies" on her breasts and wouldn't be able to nurse anymore. Her cooperative and considerate child agreed to wean. Another mother told her child that her breasts were getting tired of making milk and wanted to rest now. When your child requests to nurse while you are doing something else, ask her to wait a few minutes until you are done.

Keep your sense of humor. On those days when you wonder whether your breasts will ever belong to you again, remember that a sense of humor can help you maintain your perspective and a positive outlook. Every child does wean eventually, and late nursers are sure to leave their moms with some funny anecdotes. For example, I recall a woman whose recently weaned four-year-old gazed at her breasts in the bathtub and remarked, "Those used to be mine, but they're no use to me now." Another preschooler reluctantly weaned after announcing that his mother's breasts were "broken," since her milk flow had slowed to a trickle.

Don't put noxious substances on your nipples. Although countless stories are told of women who have put foul-tasting substances on their nipples to dissuade a baby from nursing, I have never recommended this method. I must emphasize that nothing ever should be applied to the nipples that could prove to be toxic to a baby. Cases have been documented where babies were harmed by ingesting a potentially dangerous substance that was topically applied to the mother's nipples. Besides, don't you want your child to end your nursing relationship with positive memories and complete trust in you?

Physical changes; untimely weaningDrying Up
If the weaning process is kept gradual, your milk will taper slowly, and you shouldn't experience uncomfortable breast engorgement. The younger your baby is when you wean and the more abruptly you do it, the more likely it is that your breasts will become painfully full when your baby stops nursing. Abrupt weaning is uncomfortable, and it could predispose you to a breast infection. If you must stop nursing suddenly for some reason, you should use a breast pump to taper your milk production gradually. Wearing a good support bra, applying cold compresses to your breasts, and taking ibuprofen as directed also will help relieve breast discomfort due to rapid weaning.

When the milk supply drops markedly, the sodium content increases and milk tastes more salty. This phenomenon actually helps babies give up nursing when the supply becomes very low. A small amount of milk may continue to be produced for many months after weaning. It is not uncommon for a woman who has breastfed to be able to express a few drops of milk even a year or more later. Frequent attempts to check if milk is still present and lovemaking involving nipple stimulation may contribute to its continued production. Consult your doctor if you leak milk spontaneously or produce more than a few drops six months after weaning.

Your breasts should return to your prepregnancy size several months after weaning. Any droopiness or sagging that might be present is more related to having been pregnant and the skin elasticity you inherited than the fact that you breastfed.

Untimely Weaning
Untimely weaning refers to the discontinuation of breast-feeding before a mother had wanted to stop nursing. It is difficult for someone who has not breastfed her own baby to appreciate fully the enormous sense of disappointment that can accompany a woman's loss of her anticipated breastfeeding experience. Well-meaning physicians and others often underestimate what breastfeeding means to women and may exclaim with all sincerity, "I don't understand why you're so upset. Your baby will do just fine on formula. You nursed three whole months. That's plenty."

But weaning before you had wanted to is not a trivial matter. It is a real and legitimate loss for many women who, rightfully, feel cheated out of an expected and longed-for experience. Such women deserve to hear someone say, "I'm sorry. That must really hurt. It's not fair." I work with many breastfeeding counselors and lactation consultants whose own untimely weaning experiences have made them even more compassionate and effective in their role. Some of these specialists have found that helping other women achieve the success they desire is one way to heal from their own breastfeeding loss. Not surprisingly, it is often those who have felt the disappointment of abbreviated breastfeeding who have the most empathy and compassion for other women.

I also know what it means to have to give up breastfeeding too soon, having experienced untimely weaning with my first four children. While I enjoyed several glorious months of successful breastfeeding with each of these babies, the separations we experienced due to my being in college, medical school, and internship eventually undermined my milk supply. Weaning was gradual, but essentially completed by six months each time, although I desperately had wanted to experience for myself and provide for my babies the full, natural course of breastfeeding.

In my case, untimely weaning resulted from some tough choices I made that precluded full breastfeeding. I learned the hard way that by choosing certain alternatives, I had excluded other options. I found that when I was away caring for other people's babies, I couldn't fully breastfeed my own babies. In those days, fancy electric pumps and lactation breaks were unknown. Too often I was somewhere else when my babies needed to be nursed. Too often, my breasts went unemptied when my milk needed to be expressed. Too often I did what I thought I had to do instead of what I longed to do.

At the same time that I acknowledge a deep loss over breastfeeding terminated early, I also am grateful for the privilege of breastfeeding as long as I did during the bottle-feeding era and under my particular circumstances. The pain of untimely weaning is offset by the sweet memory and the celebration of the breastfeeding that I was able to enjoy.

And like all adversity in life, my untimely weaning experiences have provided an opportunity for greater personal growth. Only by getting in touch with what I had lost was I finally prompted to make the major lifestyle changes necessary to put my own baby's needs and my own desires first. With my last child, Mark, I refused to compromise, and I finally achieved the full, natural course of breastfeeding. That experience changed my life and changed the very direction of my career! I wish for you the same joy and fulfillment that I found in successful breastfeeding.