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Patient education: Weaning from breastfeeding (Beyond the Basics)

Author
Lisa Enger, RN, BSN, IBCLC
Section Editor
Teresa K Duryea, MD
Deputy Editor
Mary M Torchia, MD
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INTRODUCTION

Breastfeeding without any supplementation (infant formula, juice, water, solid foods) is recommended for the first six months after birth. Partial breastfeeding is recommended until the infant is at least 12 months old, and thereafter for as long as a woman and her child choose to continue [1].

Partial breastfeeding is defined as breastfeeding while also providing other sources of nutrition, usually beginning at approximately six months of age. At this time, soft puréed meats, infant cereal, and then puréed fruits and vegetables may be introduced slowly. Cow's milk is not recommended until a child is at least 12 months old and fruit juice is not recommended until a child is at least six months old. (See "Patient education: Starting solid foods during infancy (Beyond the Basics)".)

More information about breastfeeding is available separately. (See "Patient education: Breastfeeding guide (Beyond the Basics)" and "Patient education: Common breastfeeding problems (Beyond the Basics)" and "Patient education: Pumping breast milk (Beyond the Basics)" and "Patient education: Maternal health and nutrition during breastfeeding (Beyond the Basics)".)

THE WEANING PROCESS

Weaning is defined as the gradual replacement of breast milk with other sources of nutrition.

When should I wean? — Weaning may be initiated by the child, the mother, or it may be a shared decision by mother and child. Most children who self-wean do so between two and four years of age; it is uncommon for an infant younger than 12 months to self-wean. The duration of the weaning process varies from child to child. Some children will wean quickly while others will take months to completely wean.

Do I have to wean? — There are many possible reasons for wanting to wean, although it is rarely necessary to wean. There is no particular age by which weaning should be complete and continued breastfeeding is not harmful to a child's development. Women who are told that they must wean should consult with someone who is knowledgeable about breastfeeding to help them explore their options. (See 'Finding a lactation consultant' below.)

The World Health Organization advises women to continue partial breastfeeding for up to two years and beyond [2]. The benefits of breastfeeding persist for as long as it is continued. Some of the benefits persist even after breastfeeding is discontinued. The benefits of breastfeeding are discussed separately. (See "Patient education: Deciding to breastfeed (Beyond the Basics)".)

Pregnancy and breastfeeding — Breastfeeding is not a reliable method of birth control. Most women are able to become pregnant, even while breastfeeding, within the first three months after giving birth.

Women who become pregnant are usually able to continue breastfeeding if they wish. However, the woman will need to consume extra calories (approximately 200 per day) to satisfy her own needs and those of her fetus and breastfeeding child. This is especially true if breastfeeding is exclusive (the infant is not eating or drinking other foods). (See "Patient education: Maternal health and nutrition during breastfeeding (Beyond the Basics)".)

Weaning and guilt — Weaning can be a very emotional time for the woman and child. It is not just a transition to another feeding method, but is the conclusion of a special relationship between mother and child. Even if both are ready for the weaning process, unexpected feelings of sadness may occur.

Some women who need to wean develop feelings of guilt. Although this is a normal reaction, you should feel proud of any breastfeeding you have done, knowing that you have provided a wonderful start to your child's health and well-being.

During the weaning process, your child may need more attention and cuddle time to take the place of nursing time. You may find that some days your child needs to nurse after having nearly weaned completely. Being flexible and understanding will go far in the weaning process and make it a comfortable time for everyone involved.

HOW DO I WEAN?

When the woman is ready to initiate weaning, one option is to gradually eliminate one breastfeeding session every two to five days. Other ways to wean include shortening nursing sessions slowly or lengthening the time between nursing sessions.

It may be possible to wean a child from nursing during the day and to continue breastfeeding at night; this may be a good option for women who are unable to pump breast milk while working. The midday feeding may be a good time to start as children tend to be most interested in nursing at the first and last feedings of the day, when their need for comfort is greater. Pre-bedtime or nighttime feedings are usually the last to go.

However weaning occurs, mothers should watch their breasts carefully for any sign of pain, redness, or tenderness. These can be signs of plugged ducts or mastitis (see "Patient education: Common breastfeeding problems (Beyond the Basics)").

Stopping breastfeeding "cold turkey" is not recommended because the breasts will become engorged, painful, and may develop an infection (mastitis). If breastfeeding must be stopped immediately for medical or other reasons, it may help to hand-express or pump milk a few times per day until the breasts feel comfortable (not empty) and the milk production slows, usually over a few days. Do not wait to express milk until the breasts are painful or very full. Wearing a well-fitting, supportive bra can be helpful. Hand expression is discussed in detail separately. (See "Patient education: Common breastfeeding problems (Beyond the Basics)".)

Bottle or cup? — An infant can be weaned to a bottle then a cup, or directly to a cup, depending upon the child's age. Children under 6 months of age may use a bottle while children older than 12 months can usually use a cup. Children between 6 and 12 months may use either a cup or a bottle. Weaning directly to a cup avoids the problems associated with bottle feeding. A trainer cup with two handles and a snap-on lid with a spout may be easiest to manage.

When introducing a bottle, it helps if the baby is not extremely hungry, so that he or she may be more patient. It also helps if another caregiver introduces the bottle; some babies initially refuse a bottle if the mother is near.

Initial feedings from a bottle/cup may be easier if the bottle/cup contains expressed breast milk. Breast milk is sweeter than formula. Infants may be more willing to accept the bottle or cup if the taste of the milk is familiar. If the child is older than 12 months, cow's milk may be given instead of formula. (See "Patient education: Starting solid foods during infancy (Beyond the Basics)".)

The child should not be left with a bottle of milk or formula while sleeping. Falling asleep while bottle feeding can lead to "baby bottle tooth decay" and is not recommended.

When partially breastfeeding, try to offer the breast before the baby is hungry and impatient. After bottle-feedings have started, some babies get frustrated with breastfeeding because milk flow is not as fast from the breast as from a bottle. This may be prevented by selecting a bottle nipple with slow flow. Another suggestion is to pace the infant with the bottle so that a feeding takes at least 10 to 15 minutes, similar to a nursing session.

LIFE AFTER WEANING

As weaning occurs, you may find that your breasts begin to feel less full and may begin to become smaller. Most women's breasts will remain slightly larger than pre-breastfeeding. Some women will have stretch marks similar to those on their abdomen from pregnancy. These will fade to pale, silvery colored areas over time.

Once breastfeeding has stopped entirely, your breasts will stop producing milk. Even after breastfeeding has stopped, there may be milk in the breasts for several months to years. You may notice drops of milk on occasion or may be able to express drops by hand. If your breasts become painful, hard, or reddened after weaning, you may have a plugged duct or breast infection; talk with a healthcare provider to determine if treatment is needed.

As you produce less breast milk, you will need to consume fewer calories to maintain your body weight. This may mean eating fewer snacks or reducing portion sizes. (See "Patient education: Maternal health and nutrition during breastfeeding (Beyond the Basics)".)

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Weaning from breastfeeding (The Basics)
Patient education: Breastfeeding (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Starting solid foods during infancy (Beyond the Basics)
Patient education: Breastfeeding guide (Beyond the Basics)
Patient education: Common breastfeeding problems (Beyond the Basics)
Patient education: Pumping breast milk (Beyond the Basics)
Patient education: Maternal health and nutrition during breastfeeding (Beyond the Basics)
Patient education: Deciding to breastfeed (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Common problems of breastfeeding and weaning
Dietary history and recommended dietary intake in children
Failure to thrive (undernutrition) in children younger than two years: Etiology and evaluation
Introducing formula to infants at risk for allergic disease
Introducing solid foods and vitamin and mineral supplementation during infancy
Failure to thrive (undernutrition) in children younger than two years: Management

The following organizations also provide reliable health information.

National Library of Medicine

(www.nlm.nih.gov/medlineplus/healthtopics.html)

The Center for Disease Control and Prevention

(www.cdc.gov/breastfeeding)

The United States Department of Health and Human Services

(www.womenshealth.gov/Breastfeeding/index.html)

American Academy of Pediatrics

(www.healthychildren.org/english/ages-stages/baby/breastfeeding/Pages/default.aspx)

Massachusetts Breastfeeding Coalition

(http://massbreastfeeding.org)

Breastfeeding On Line

(www.breastfeedingonline.com)

Working and Pumping

(www.workandpump.com)

Working without Weaning: A working mother's guide to breastfeeding,

Kirsten Berggren

Finding a lactation consultant — Certified lactation consultants, or LCs, are available at most hospitals as well as privately, and can be an invaluable resource for instructions about breastfeeding, pumping, milk storage, and bottle-feeding breast milk. The websites listed below have information about finding a lactation consultant or breastfeeding counselor.

La Leche League

(www.lalecheleague.org)

International Board of Lactation Consultant Examiners

(www.iblce.org)

phone: 703-560-7330

International Lactation Consultant Association

(www.ilca.org)

phone: 919-861-5577

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Literature review current through: Nov 2016. | This topic last updated: Thu Sep 29 00:00:00 GMT+00:00 2016.
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