Weaning Problems

Breast or bottle feeding can be considered prolonged after about 18 months of age, but delayed weaning is not always a problem. The older toddler who only occasionally nurses or drinks from a bottle does not necessarily 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 6 months of age
• Anemia confirmed by a routine screening test at 1 year of age
• Tooth decay or baby-bottle caries
• Obesity from overeating
• Daytime withdrawal 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 babysitter because the child is exclusively breast fed and refuses a bottle or cup

If any of these criteria apply to your baby, proceed to the following section. Otherwise, continue to breast or bottle feed your baby when she wants to be fed (but less than 4 times each day) and don’t worry about complete weaning at this time.

How To Eliminate Excessive Breast Or Bottle Feedings

To decrease breast or bottle feedings to a level that won’t cause any of the preceding side effects, take the following steps:

1. Reduce milk feedings to 3 or 4 per day. When your child comes to you for additional feedings, give him extra holding and attention instead. Get your child on a schedule of 3 main meals per day plus 2 or 3 nutritious snacks.
2. Introduce cup feedings 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 too important.
3. Immediately stop allowing your child to 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 that “it’s not good for you” or “you’re too old for that.”
4. Immediately stop allowing your child to take a bottle to bed. Besides causing sleep problems, taking a bottle to bed carries the risk of causing tooth decay. You can offer the same explanations as in the above paragraph.
5. Once you have made these changes, you need not proceed further unless you wish to eliminate 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 (from illness or trying to achieve bladder control, for example). Weaning from breast or bottle to 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. Although there is no consensus about the best time to wean, there is agreement about the appropriate technique.

How To Eliminate Breast Feeding Completely

Offer formula in a cup before each breast feeding.

If your child refuses formula, offer expressed breast milk. 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 they’ve 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 complete cup feeding. About once every week drop one more breast feeding. The bedtime nursing is usually the last to be given up, and there’s no reason why you can’t continue it 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.

Since the breast operates on the principle of supply and demand, reduced sucking time eventually reduces milk production. 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 may also help relieve discomfort.

If your child asks to nurse after you have finished weaning, respond by holding her instead.

You can explain that the milk is all gone. If she has a strong sucking drive, more pacifier time may help.

How To 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 or 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 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 each day over the course of 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 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.

CALL OUR OFFICE During regular 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 trying it for 1 month.
• Your child is over 3 years old.
• You have other questions or concerns.