When a baby is born, and especially if a mother is dealing with common breastfeeding challenges like poor latch, making it to one year of breastfeeding can be a great challenge. But once she (and baby) gets to that one-year goal, and western culture pressures to wean, another giant question mark appears: How to wean when the baby clearly doesn't want to stop?
There are so many ways to wean, but some are definitely better than others. For generations, little regard was given to a baby's health and weaning age or method. Now, the prevailing weaning advice recognizes that breastfeeding doesn't have an expiration date and that toddlers who continue to breastfeed gain impressive benefits, not only physically, but psychologically too.
To get the latest scoop on weaning strategies - and just how healthy they are - I listened to a Lactation Education Resources lecture by Jane Bradshaw, RN, BSN, IBCLC, RLC, a La Leche League Leader-turned private lactation consultant whose specializations include nursing the older baby.
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When deciding when weaning may be appropriate, it's good to start with the current expert guidelines out there.
The American Academy of Pediatrics recommends exclusive breastfeeding for six months before introducing solid foods, and then continuing to feed solid foods and breastfeed concurrently for at least one year. The World Health Organization recommends the same thing, but pushes the limit to at least two years. And the American Academy of Family Physicians recommends that breastfeeding continue ideally beyond infancy, that weaning happen at no specific age, and that weaning be gradual.
The common theme in each of these expert guidelines is that breastfeeding continue beyond the first year. In the United States, babies are lucky to be breastfed at 6 months, per the CDC Breastfeeding Report Card; most mothers here who breastfeed past one year don't advertise that fact. I was one of those "closet breastfeeders" with my own third baby, who breastfed 3-1/2 years.
Western societal norms don't support breastfeeding beyond a year, sometimes much earlier than that such as when baby begins solids, pops the first tooth, turns 9 months old, or if the mom becomes pregnant again while breastfeeding. But according to the research, all of these "reasons" for weaning are unfounded.
The truth is, breastfeeding beyond one year continues to bestow valuable immune properties to toddlers. Plus, breastmilk composition changes in the toddler years, said Bradshaw - mothers who continue to breastfeed past one year begin making milk that has higher concentrations of healthy fats and protein per feeding. The fact that breastmilk changes, for the positive, gives even more credence to advice to continue breastfeeding beyond the first birthday. Babies who are weaned earlier than what nature intended - 2-4 years old - are missing out on important nutritional, immunological, and psychological benefits that include a possible impact on IQ and temperament and emotional development.
Moms of breastfed toddlers continue to reap the benefits, too, of lowered risk of breast, uterine, and endometrial cancer, osteoporosis, rheumatoid arthritis, and type 2 diabetes.
So many benefits, but what about weaning?
Ideally breastfeeding would not come to an end until the child is ready, physically and emotionally. Weaning should be child-paced, which means slow and gradual.
Sudden weaning is rarely necessary, reserved only for certain situations such as cancer treatments or psychotropic medications, long-term separation in custody arrangements, or another scenario that would require such a drastic measure. Methods include abrupt weaning where the mother refuses to breastfeed no matter the baby's protests, forcing the bottle, weaning by abandonment (mother going on vacation for a weekend away from baby), and painting the breasts with spicy sauce or nail varnish (yes, this happens).
Sudden weaning not only deprives the baby from the continued benefits of breastfeeding he or she would otherwise receive, but can create psychological trauma from feelings of abandonment, said Bradshaw. The mother typically suffers from painful engorgement and plugged ducts, which can progress to mastitis, breast cysts, or abscesses.
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Of course, we've probably all encountered situations that seem like good reasons for sudden weaning, such as pressure from family or increased night-feedings in an older child or even a nursing strike on the part of the baby under a year old. For mothers who are certain that sudden weaning is the best answer, Bradshaw recommends this weaning strategy:
- Put the baby on a formula-only diet.
- But continue to breast-pump every 3-4 hours for at least 2 weeks following suddenly weaning baby.
- Bottle-feed the baby with breastfeeding behaviors, including some skin-to-skin contact to continue the benefits of oxytocin, switching sides that baby is held halfway through the bottle-feeding to continue the development of baby's eye-hand coordination, holding the baby for feedings even if the baby is able to hold the bottle herself to continue the benefits of bonding and nurturing, and talking to and interacting with the bottle-feeding baby to continue social development.
The best approaches to weaning are those that take into account the baby's need for breastfeeding benefits, so that as a toddler, the child is able to developmentally wean off of breastfeeding. The end of breastfeeding is a developmental milestone much the same way as the end of crawling (before walking), the end of babbling (before talking), and the end of stranger anxiety (before venturing to preschool). Babies do not suddenly stop babbling to start talking in sentences; they go from babbling to a first word to more first words with pointing and gestures to phrases, and finally to sentences. And so it is with healthy, gentle weaning.
Healthy weaning goes at a pace so slow that the mother should not notice changes in her breasts, such as painful engorgement. It may even get to the point of a toddler whom the mother isn't even sure is still getting any milk when nursing. And this is okay. It's part of the process, Bradshaw said.
Gentle weaning methods include:
- Don't offer, Don't refuse - Don't offer breastfeeding, but when the toddler asks to nurse, don't refuse.
- Child-led - Allow the toddler to nurse as long as he or she wants.
- Distraction - Distract the toddler with a special activity or outing scheduled at the same time as a certain nursing session. It's better to cut out nursing sessions one at a time.
- Substitution - Substitute a certain, favorite activity for a certain nursing session. This also includes substituting coping mechanisms for nursings that happen when the toddler is angry or distressed. As with distraction, it's better to cut out nursing sessions one at a time.
- Postponement - Postponing nursing until after a shopping trip, for example, or offer a snack or drink to delay nursing.
- Shortening nursings - Make nursing sessions gradually shorter over time.
- Spot - Stop nursing in your usual spot. Maybe it's a rocking chair. Toddlers have strong nursing associations, and if you sit in the chair where you usually nurse, he'll be reminded to nurse. If you avoid that chair while weaning, the change in routine may quicken weaning.
By contract -- Some mothers set a certain end date, and then throw their toddler a weaning party on that date, with the intent of making weaning a celebration.
Bradshaw warns against weaning too fast. A child's perception of "too fast" may still seem very slow to the mother.
Signs that weaning is paced too fast for a breastfed child are increased tantrums or acting-out, regression, excessive sucking on fingers, an uptick in night-waking or refusal to go to bed, and neediness. These are all cues to stop the weaning process and return to it in a few weeks, or longer, when the child may be more ready.
So, how does a mother cope with trying to breastfeed a toddler when she's receiving a lot of pressure to wean suddenly? Here are Bradshaw's tips:
- Provide love and security in other ways in addition to breastfeeding, which can reduce the frequency of nursings.
- Teach nursing manners, such as asking to nurse, rather than engaging in very insistent, sometimes embarrassing or even rude or painful, behaviors to coerce the mother into nursing.
- Make up a code word for nursing that the mother finds appropriate for public settings.
Like with many decisions with our children, it's important for mothers to advocate for their toddler's needs during weaning, even when it means going against cultural norms.