Weaning

The Babble Staff

Breastfeeding is a symbolically charged topic. In the ideal world, the perfect earth mother breastfeeds regularly and with ease, mother and child basking in peace and glory as in a Renaissance painting. Breast milk has a host of beneficial qualities, from preventing infection to allegedly boosting IQ scores, and most would agree that it is not only normal, but good and preferable to breastfeed for at least a couple of months after your baby is born. The WHO recommends exclusive breastfeeding — no teats or pacifiers — for nine months, though this might be difficult to live up to for most mothers. Opinions diverge once your baby is one year old. Dr. Sears encourages you to think about breastfeeding "in terms of years, not months." BabyCenter® encourages breastfeeding beyond the year mark, yet terms it "extended breastfeeding" (which is admittedly less than normative-sounding). Most sources, even those in favor of breastfeeding toddlers, acknowledge that breastfeeding at age two might elicit stares and snide comments about the mother. Yet anthropologist Katherine Dettwyler asserts that if we were free of social conventions, we would follow the gorilla's example and wean our children at six years of age.

In societies where children are allowed to nurse "as long as they want," they usually self-wean, with no arguments or emotional trauma, between 3 and 4 years of age. My research has looked at the various "life-history" variables (such as length of gestation, birth weight, growth rate, age at sexual maturity, age at eruption of teeth, life span, etc.) in [our closest relatives in the animal kingdom, especially gorillas and chimpanzees] and at how these variables correlate with age at weaning. I came up with a number of predictions for when humans would "naturally" wean their children if they didn't have a lot of cultural rules about it. ... It is true that there are still many societies in the world where children are routinely breastfed until the age of four or five years or older, and even in the United States, some children are nursed for this long and longer.

Some of the results are as follows:

1. In a group of 21 species of non-human primates (monkeys and apes) studied by Holly Smith, she found that the offspring were weaned at the same time they were getting their first permanent molars. In humans, that would be: 5.5-6.0 years.

2. It has been common for pediatricians to claim that length of gestation is approximately equal to length of nursing in many species, suggesting a weaning age of 9 months for humans. However, this relationship turns out to be affected by how large the adult animals are — the larger the adults, the longer the length of breastfeeding relative to gestation. For chimpanzees and gorillas, the two primates closest in size to humans and also the most closely genetically related, the relationship is 6 to 1. That is to say, they nurse their offspring for SIX times the length of gestation (actually 6.1 for chimps and 6.4 for gorillas, with humans mid-way in size between these two). In humans, that would be: 4.5 years of nursing (six times the 9 months of gestation).

3. It has been common for pediatricians to claim that most mammals wean their offspring when they have tripled their birth weight, suggesting a weaning age of 1 year in humans. Again though, this is affected by body weight, with larger mammals nursing their offspring until they have quadrupled their birth weight. In humans, quadrupling of birth weight occurs between 2.5 and 3.5 years, usually.

4. One study of primates showed that the offspring were weaned when they had reached about 1/3 their adult weight. This happens in humans at about 5-7 years.

5. Studies have shown that a child's immune system doesn't completely mature until about 6 years of age, and it is well established that breast milk helps develop the immune system and augment it with maternal antibodies as long as breast milk is produced (up to two years, no studies have been done on breast milk composition after two years post partum).

And on and on. The minimum predicted age for a natural age of weaning in humans is 2.5 years, with a maximum of 7.0 years.

In terms of the benefits of extended breastfeeding, there have been a number of studies comparing breastfed and bottle-fed babies in terms of the frequency of various diseases, and also IQ achievement. In every case, the breastfed babies had lower risk of disease and higher IQs than the bottle-fed babies. In those studies that divided breastfed babies into categories based on length of breastfeeding, the babies breastfed the longest did better in terms of both lower disease and higher IQ. In other words, if the categories were 0-6 months of breastfeeding, 6-12 months, 12-18 months and 18-24+ months, then the 18-24+ month babies did the best, and the 12-18 month babies did the next best, and the 6-12 months babies did the next best, and the 0-6 months babies did the worst of the breastfed groups, but still much better than the bottle-feeding group. This has been shown for gastrointestinal illness, upper respiratory illness, multiple sclerosis, diabetes, heart disease, and on and on and on. Likewise, the babies nursed the longest scored the highest on the IQ tests. One important point to notice is that none of these studies looked at children who had nursed longer than 2 years. Anyone 18-24 month or longer was lumped into big category. Presumably, the benefits continue to accrue, as your body doesn't know that the baby has had a birthday and suddenly starts producing nutritionally and immunologically worthless milk.

Clearly, babies born in the U.S. don't have to contend with all the diseases and parasites and contaminated water that babies in Third World countries do. [...] We can get our children immunized, and get them antibiotics for infections when necessary. [...] Breastfed babies still have the "edge" over bottle-fed babies, even in a squeaky clean environment with wonderful medical care. They get sick less often, they are smarter, they are happier. Another important consideration for the older child is that they are able to maintain their emotional attachment to a person, rather than being forced to switch to an inanimate object such as a teddy bear or blanket. I think this sets the stage for a life of people-orientation, rather than materialism, and I think that is a good thing. I also can't imagine living through the toddler years without that close loving connection to a child going through enormous changes, some of which are very frustrating to the child.

Weaning is not a negative term, nor is it something that you do to a child. Weaning is a journey from one relationship to another. The Hebrew word for wean is gamal, meaning "to ripen." In ancient times, when children were breastfed until two or three years of age, it was a joyous occasion when a child weaned. It meant the child was filled with the basic tools of the earlier stages of development and secure and ready to enter the next stage of development. A child who is weaned before his time may show anger, aggression, habitual tantrum-like behavior, anxious attachment to caregivers, and an inability to form deep and intimate relationships. We call these traits diseases of premature weaning.

While we advocate extended breastfeeding that comes to a natural end when the child is ready, we realize this ideal is not always attainable in every family situation. Breastfeeding is meant to be a pleasurable experience. When one or both members of the mother-infant pair aren't enjoying it anymore, it's time to wean. After all, all good things must come to a timely end.

In many cultures, a baby is breastfed for two or three years. Our western culture is accustomed to viewing breastfeeding in terms of months. This is not the norm the world over. While weaning is a personal decision, nutritionists and physicians advise breastfeeding for at least one year because by that time most infants have outgrown most of their food allergies and will thrive on alternative nourishment. We urge mothers to think in terms of years, not months, when contemplating how long to nurse. Breastfeeding is a long-term investment in your child. You want to give your baby the best emotional, physical, and mental start. Extended breastfeeding is nature's way of filling your baby's need for intimacy and appropriate dependency on other people. If these needs are met early on, your child will grow up to be a sensitive and independent adult. We have noticed that children not weaned before their time are:

? More independent and self-confident

. Gravitate to people rather than things

? Are easier to discipline

? Experience less anger

. Radiate trust

Former Surgeon General, Dr. Antonia Novello, proclaimed: "It's the lucky baby, I feel, who continues to nurse until he's two." A baby's sucking need lessens sometime between nine months and three years. The age at which this need lessens is individual, yet very few babies are emotionally filled and ready to wean before a year. Have confidence in your intuition. While this beautiful breastfeeding relationship may seem like it will never end, you are laying a solid foundation for the person your child will later become. Cutting corners now will only create problems in the future.

The key to healthy weaning is doing it gradually. [...] The following are suggestions for gradually weaning your child:

? Start by skipping a least favorite feeding, such as in the middle of the day. Instead, engage in a fun activity together, such as reading a book or playing a game. Nap and night nursings are favorite feedings and will probably be the last to go.

? Minimize situations that induce breastfeeding, such as sitting in a rocking chair or cradling baby. If you put baby in a familiar breastfeeding setting, he will want to breastfeed.

? Use the "don't offer, don't refuse" method. Don't go out of your way to remind her to nurse. However, if your child persists, or her behavior deteriorates, this may indicate that breastfeeding is still a need rather than a want. Watch your child and trust your intuition.

? Become a moving target. Don't sit down in one place for any length of time. But, remember, weaning means releasing, not rejecting. Breastfeeding helps the child venture from the known to the unknown. If you don't let your child make brief pit stops, he may insist on lengthy feedings when he finally gets you to sit down. Checking into home base and refueling reassures him that it's okay to explore his environment, and gives him the emotional boost to venture out. Rejecting this need could developmentally cripple your child.

? Keep baby busy. Nothing triggers the desire to breastfeed like boredom. Sing songs, read books, or go on an outing together.

? Set limits. Putting limits on nursing, such as: "We only nurse when Mr. Sun goes down and when Mr. Sun comes up" does not make you a bad parent.

? Don't wean baby from you to an object, such as a stuffed animal or blanket. Ideally, you want to wean baby from your breast to an alternative source of emotional nourishment. This is when dad should begin to take on a more involved role in comforting. As dad's role in baby's life becomes bigger, nursing will be less important.

? Expect breastfeeding to increase during times of illness. These are times when your child needs comfort and an immune-system boost.

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Nursing beyond the first year (also known as extended breastfeeding) is normal, healthy, and common in many countries. However, some Western societies, with their emphasis on independence and self-sufficiency, take a dim view of the practice. So, depending on where you live, long-term breastfeeding may mean putting up with comments and disapproving stares from friends, family, and strangers.

There are significant emotional and physical benefits to long-term nursing, though, so don't let others pressure you to stop. We recommend that you weigh the pros and cons of extended breastfeeding and then do what feels right for you and your child.

Why nursing your toddler is a good idea

? Even though your child is now getting most of his nutrition from solid food, breast milk still provides calories, valuable immunities, vitamins, and enzymes. In fact, studies have shown that breastfeeding toddlers get sick less often than their peers.

? As your child becomes more independent, breastfeeding can be an important source of reassurance and emotional support. The strong connection your child feels with you while nursing will foster independence, not make him overly dependent or clingy as some may have you believe. Our culture tends to believe that pushing children away will help them develop a strong sense of self-worth and independence, says Kathleen Huggins, author of The Nursing Mother's Companion, when in fact, the opposite is true. Forcing a child to stop nursing before he's developmentally ready won't necessarily create a more confident child; rather, it could make him more clingy.

? If your child is sick, breast milk may be the only thing he can keep down. You'll feel better too, knowing that you're helping him fight off the illness.

? If you travel a lot, breastfeeding is a lot easier than carrying around milk or worrying about having to buy any at your destination. And when you're staying overnight in a strange place, the comfort of your breast may be the best way to ease your child's fears and make him feel more secure.

? You may be able to put off getting your period for a year or more, an advantage for anyone who dreads the thought of dealing with cramps and bloating again after a long hiatus. But keep in mind that nursing isn't an effective form of birth control, especially after your baby is 6 months old, when you've introduced solids and you might not be nursing as often. It's a good idea to use a backup birth control such as a condom every time you have sex if you're not ready to have another baby.

? Weaning when your child is ready is more natural and less abrupt than picking an arbitrary end point. Nursing a child beyond the first year was common around the world before the invention of formula and still is in some cultures.

Why nursing your toddler can be a challenge

? People who think nursing an older child is strange may offer rude comments and criticisms. You may have to be more cautious about breastfeeding in public if you want to avoid the remarks. This can be difficult if your toddler lifts up your shirt in the supermarket and asks for a quick snack.

? Some people say it's harder to wean a child after the first year. Many mothers are nervous about trying to wean a stubborn 2-year-old or allowing a toddler to wean on his own timetable, as this may be longer than they're willing to nurse. (You can wean your child any time, of course, but if you take the lead, you might have to work to distract your child with other food, drink, and activities when he wants to nurse. The process may not go smoothly or quickly, especially if your toddler has any setbacks such as an illness, teething, or a change in caregiver.)

? Your child may start to rely on the breast when he's really just bored or it's the only way to get your attention. You can learn to engage your child in other ways — toddlers are eager to explore the world and need stimulation to fuel their rapid development.

? Nursing a toddler when you have another baby on the way is certainly possible, but some women find the very idea too overwhelming.

Making extended breastfeeding work for you

? If you're bothered by unsolicited comments and stares, you might find it easier to nurse your child at home before heading out to the store or the park. Some moms find it more acceptable to nurse at set times during the day — like in the morning, before naps, or before bed — and teach their toddlers to drink from a cup during meals and snacks.

? If you don't care what people think or say, then have some snappy responses ready when someone asks you the inevitable question: "Is she still nursing?" Sometimes a simple "yes" is the best conversation stopper. Or, the next time you're nursing in public and someone asks, "Are you ever going to stop breastfeeding?" say, "Yes, in about ten minutes."

? You can teach your child a code word for your breasts, so that when he starts demanding "nummies" or "mama" in the middle of a restaurant, no one will pay any attention.

? If you're pregnant and want to keep nursing, be prepared for your milk supply to ebb as your hormone levels change. You might produce less milk as your body starts redirecting resources toward the developing fetus. But many women do succeed in nursing an infant and a toddler — it just takes extra time and patience. You'll need to be doubly sure you're eating the right foods and drinking enough fluids if you go that route.

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. A recent review of evidence has shown that, on a population basis, exclusive breastfeeding for six months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to two years of age or beyond.

To enable mothers to establish and sustain exclusive breastfeeding for six months, WHO and UNICEF recommend:

? Initiation of breastfeeding within the first hour of life

? Exclusive breastfeeding - that is the infant only receives breast milk without any additional food or drink, not even water

? Breastfeeding on demand - that is as often as the child wants, day and night

? No use of bottles, teats or pacifiers

Breast milk is the natural first food for babies, it provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child's nutritional needs during the second half of the first year, and up to one-third during the second year of life.

Breast milk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness. These effects can be measured in resource-poor and affluent societies (Kramer M et al Promotion of Breastfeeding Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus. Journal of the American Medical Association, 2001, 285 (4): 413-420)

Breastfeeding contributes to the health and well-being of mothers, it helps to space children, reduces the risk of ovarian cancer and breast cancer, increases family and national resources, is a secure way of feeding and is safe for the environment.

Data indicate that the rate of initiation and duration of breastfeeding in the United States are well below the Healthy People 2010 goals. Furthermore, many of the mothers counted as breastfeeding were supplementing their infants with formula during the first 6 months of the infant's life. Exclusive breastfeeding is defined as an infant's consumption of human milk with no supplementation of any type (no water, no juice, no nonhuman milk, and no foods) except for vitamins, minerals, and medications. Exclusive breastfeeding has been shown to provide improved protection against many diseases and to increase the likelihood of continued breastfeeding for at least the first year of life.

Pediatricians and parents should be aware that exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months of life and provides continuing protection against diarrhea and respiratory tract infection. Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child.

- Complementary foods rich in iron should be introduced gradually beginning around 6 months of age. Preterm and low birth weight infants and infants with hematologic disorders or infants who had inadequate iron stores at birth generally require iron supplementation before 6 months of age.148,188-192 Iron may be administered while continuing exclusive breastfeeding.

- Unique needs or feeding behaviors of individual infants may indicate a need for introduction of complementary foods as early as 4 months of age, whereas other infants may not be ready to accept other foods until approximately 8 months of age.193

- Introduction of complementary feedings before 6 months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk.194

- During the first 6 months of age, even in hot climates, water and juice are unnecessary for breastfed infants and may introduce contaminants or allergens.195 o Increased duration of breastfeeding confers significant health and developmental benefits for the child and the mother, especially in delaying return of fertility (thereby promoting optimal intervals between births).196

Source: PEDIATRICS Vol. 115 No. 2 February 2005, pp. 496-506 (doi:10.1542/peds.2004-2491)

The benefits of breastfeeding are well established — but the decision to use formula shouldn't lead to guilt.

Breast milk contains the right balance of nutrients for your baby, and the antibodies in breast milk boost your baby's immune system. But in some cases, exclusive breastfeeding isn't possible or practical. The decision to use formula shouldn't lead to guilt, says Jay Hoecker, M.D., a pediatrician at Mayo Clinic, Rochester, Minn.

Here, Dr. Hoecker answers important questions about breastfeeding and infant formula:

How long are mothers encouraged to breastfeed?

Breastfeeding for at least four months helps boost your baby's immune system. Breastfeeding throughout the first year is ideal. Most breastfeeding mothers in my practice wean their babies between ages 9 and 15 months. ...read the full article

From the article "Breastfeeding and guilt: Interview with a Mayo Clinic specialist" (pediatrician Jay Hoecker, M.D.)

The benefits of breastfeeding are well established. Breast milk contains the right balance of nutrients for your baby, and the antibodies in breast milk boost your baby's immune system. But in some cases, exclusive breastfeeding isn't possible or practical. The decision to use formula shouldn't lead to guilt, says Jay Hoecker, M.D., a pediatrician at Mayo Clinic, Rochester, Minn.

Here, Dr. Hoecker answers important questions about breastfeeding and infant formula:

How long are mothers encouraged to breastfeed?

Breastfeeding for at least four months helps boost your baby's immune system. Breastfeeding throughout the first year is ideal. Most breastfeeding mothers in my practice wean their babies between ages 9 and 15 months.

Is your baby ready?

Breast milk or formula is the only food your newborn needs. Within four to six months, however, your baby will begin to develop the coordination to move solid food from the front of the mouth to the back for swallowing. At the same time, your baby's head control will improve and he or she will learn to sit with support — essential skills for eating solid foods.