Definition

• You want to stop breastfeeding.
• Your child is older than 12 months.
• Your child may not want to stop breastfeeding, especially as they get older. After 18 months of age, some children protest with crying.
• The AAP recommends mothers breastfeed until 12 months. After 12 months, they recommend continued nursing "as long as you and your baby desire it". The AAP does not recommend an upper age limit for weaning from breastfeeding.
• If you want to continue breastfeeding, be sure to avoid the pitfalls that can lead to weaning resistance.

Health Information

Causes of Breastfed Weaning Resistance

• Frequent breastfeeding in older infants is the main reason. Examples are feedings more often than 4 times per day after 6 months.
• Excessive breastfeeding often comes from nursing for reasons other than hunger. Examples are nursing for crying, normal fussing or putting the child to sleep.

Potential Problems from Excessive Breastfeeding

• Sleep problems are the most common unintended consequence. The ability to sleep through the night is delayed. Night wakings to be nursed continue far beyond 6 months. Reason: Nursing is used to put your baby to sleep. Result: Child does not learn how to self-initiate sleep. Harm to the mother: Sleep-deprivation.
• Refusal of bottle feeds and mother needs to return to work or school. Not able to leave baby with a sitter.
• Refusal to eat any solid foods and over 6 months old. Reason: Missed the window of opportunity. Hard to start baby foods after 9 months old.
• Frequent interruptions of the mother's day by responding to crying for short (1 minute) comfort feeds.
• Anemia confirmed by a routine blood test at the age of 1 year. Reason: Breastmilk can only meet iron needs until 8 months.
• Older children may strongly resist weaning. Habits become harder to change with each passing month.
• If your child has any of these problems, please don't feel guilty. Excessive breastfeeding is given out ot love. Follow the tips on how to help your child become a more healthy breast-feeder. You can do this without having to wean your child.

Prevention of Sleep Problems and Feeding Problems

The following 2 recommendations are made to prevent potential feeding associated problems:

• Nursing a baby to sleep is discouraged. It interferes with learning self-soothing behavior. It will cause persistent sleep problems. Exception: first 2 months.
• Comfort nursing is discouraged. Comfort nursing is very brief nursing to calm a fussy child or one who seems unhappy, but not hungry. It will make later weaning more difficult.
• If your doctor or lactation advisor disagree, the choice is yours.

Care Advice

How to Remove Problems and Prepare a Child for Later Weaning

1. Excessive Breastfeeding - Remove Any Bad Habits:
   • Your child is over 1 year and is more demanding around nursing than you would like.
   • Breastfeeding sometimes causes unnecessary problems. Sleep problems are those that are most common. Potential problems are listed in Health Information section.
   • Breastfeeding can be continued for as long as you like.
   • Weaning will become easier if any problems are recognized and addressed now. Removing them now will make future weaning go smoothly.
   • Here are some tips to help.
2. Reduce the Number of Breast Feedings to 4 per Day:
   • For children over 1 year, get your child on a schedule of 3 main meals a day, including nursing.
   • Also, offer 2 nutritious snacks that do not include feeding at the breast.
   • Provide your fourth breastfeeding at the start of the bedtime ritual.
3. Start Some Feedings from a Sippy Cup (if this was not done at 6 months):
   • Cup feedings are needed as substitutes for nursing. This is needed regardless of the age at which weaning occurs.
   • The longer your child doesn't use a cup, the less willing they'll be to try it.
   • Ideally, start daily cup feedings soon after 6 months of age. This is an easy way to help your child become more flexible with feedings.
4. Stop Using Nursing to Fall Asleep Now:
   • Stop this immediately.
   • All babies can handle a 7 hour fast by 6 months of age. That means they can easily sleep through the night.
   • But if they are nursed until asleep, they will not learn to self-soothe to sleep. After normal night wakings, they will want the breast to get back to sleep.
5. Phase Out Any Night Time Breast Feedings:
   • Ideally, this is done before 6 months.
   • If your child is still feeding at night after 1 year, ask for help or information on how to gradually phase out night time feedings.
6. Start Complete Weaning When the Time is Right for You:
   • Once you have made these healthy changes, you don't need to do anything more. When to wean your child is your personal choice.
   • Facts to Consider: After 12 months of age, nursing interactions tend to become more important to your child. After 18 months, for some children, weaning becomes harder with each passing month.
   • Caution: Do not start weaning if your family is under stress (such as moving). Also wait if your child is under stress (such as entering a new child care.)

Weaning: How to Stop Breastfeeding Completely

1. Weaning from the Breast:
   • You want to stop breast feeding. If done gradually, most children acccept the change.
   • Some older children do not want to give up the joys of breastfeeding. They protest with crying or other demands to be nursed.
   • The weaning advice is the same for them as others. It just needs to be done with even more patience.
   • Don't postpone starting to prepare your child. Any resistance will become harder to change with each passing month.
2. Offer Pumped Breast Milk or Formula in a Cup Before Each Breastfeeding:
   • At first, offer the cup after your child has nursed some from the breast. This might be the only way your child will accept the cup.
   • After your child accepts the cup, offer pumped milk from a cup before nursing. You can also use formula for introducing the cup. You can also mix pumped milk with formula. If your child is older than 12 months, you can use whole milk.
3. Gradually Stop Breast Feedings During the Day:
   • Weaning to the cup should always be done slowly and with love. The "cold turkey" abrupt withdrawal approach will make your child very upset.
   • First, stop the feeding that is least important to your child. This is usually the midday one.
   • About once a week drop out one more feeding. Replace each feeding with a cup feeding and extra holding.
   • The bedtime ritual nursing is usually the last to be given up. You can continue bedtime ritual nursing for months if that's what you prefer.
   • Caution: To prevent sleep problems, make it the first step in the bedtime ritual. And always place your child in the crib drowsy but awake.
   • Some mothers prefer to start weaning by decreasing the length of feedings. Shorten all feedings by 2 minutes each week until they are 5 minutes long. Then phase them out one at a time.
4. Replace Nursing with Holding Your Child:
   • Do not offer the breast after you have completed the weaning process.
   • Wear a top that completely hides your breasts.
   • Respond to ongoing requests to nurse by holding your child and comforting her.
   • Explain to your child that the milk is all gone from your breasts.
5. Relieve Breast Pain:
   • Weaning slowly will result in less pain from engorgement. Your breasts will gradually make less milk over time from less demand. Drop the number of breast feedings gradually.
   • In the meantime, express just enough milk to relieve breast discomfort. Remember that complete emptying of the breast increases milk produced. Use a pump or manually express the milk for a minute or so.
   • Don't put your baby to the breast to relieve discomfort. Reason: They won't want to stop nursing.
   • A pain medicine such as ibuprofen can help.
   • You can also use an ice pack for 20 minutes.

Call Your Doctor If

• This approach to weaning has not been successful after you have tried it for 1 month
• Your child is over 3 years old
• You think your child needs to be seen
• You have other questions or concerns

Pediatric Care Advice

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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