Weaning

Anatomy or system affected: Gastrointestinal system, stomach

Definition: The training of an infant to accept food other than breast milk.

Indications and Procedures

Weaning describes the introduction of solid foods to the diet of an infant, but the term is also used to describe the discontinuation of breastfeeding. The American Academy of Pediatrics (AAP) recommends breast milk as the sole source of nutrition for approximately the first six months of life. After the introduction of solid foods, the AAP recommends continued breastfeeding until at least twelve months of age. Developmental signs of readiness for the introduction of solid foods include the ability to hold the head upright without support, reaching for food or opening the mouth when presented with food, the ability to move food from a spoon into the moth without pushing it out with the tongue, and weighing at least thirteen pounds or more. Other factors affecting a mother’s decision to wean her child include family or cultural pressures, pressure from the partner, and personal beliefs about when weaning should occur. Often, weaning takes place between periods of great developmental activity for the child.

Mothers who want to wean their children from breast milk to a bottle before nine months of age need to prepare the child for the process by introducing a bottle when the infant is about six to eight weeks old. They can do so without compromising the nutrition of breast milk by pumping and offering breast milk occasionally through a bottle. Infants who are not used to the bottle after that age are more reluctant to accept it later. If the mother decides to wean the baby before one year of age, a commercial formula should be used for supplementation. Cow’s milk is not appropriate for infants under one year of age. Honey should never be used to sweeten the formula because of the danger of infant botulism. The introduction of solid foods can be made easier by mixing pureed vegetables or infant cereal with breast milk or formula and gradually increasing the consistency. If the child cries or turns from the food, do not force the child to eat; instead, try again in a few days or weeks.

When a mother decides to wean her child under the age of one from breast milk, she should supplement one bottle (or cup) of formula for the least important breastfeeding session of the day. This should be done over a period of two days to a week. If weaning is conducted abruptly, the mother’s breasts may become painfully engorged with milk, which could lead to mastitis. Breastfeeding sessions associated with meals can be easily forgone, as the child has less desire for milk during those times. Gradually, the mother can substitute more breastfeeding sessions with bottle-feeding. Many mothers continue to breastfeed their infants in the morning and/or in the evenings for many months before weaning from the breast is completed. This has many advantages, in that both the baby and the mother will have time to adjust to their new feeding schedule as well as the continued health benefits of breastfeeding for both mother and child. Weaning mothers should continue to drink plenty of fluids, as restricting fluid intake will not prevent engorgement. Typically, this late form of engorgement passes in one or two days after the weaning process begins.

When bottle-feeding babies, mothers can assume the same position with their infants as they did when breastfeeding. Most women cradle their infants in the crook of their arm for comfort and intimacy. The bottle’s nipple should have a hole big enough to allow milk to flow in drops when turned upside down. Too big a hole, however, can lead to overfeeding and regurgitation by the baby. Cleanliness is important when bottle-feeding; appropriate methods of formula preparation and the sterilization of bottles must be followed.

There are a number of different approaches to weaning a child from breastfeeding. One method is to neither offer nor refuse to breastfeed. This involves not initiating a nursing session but not refusing the child's requests to nurse. This is the most gentle approach to weaning, but it also takes the longest to complete. Another approach is to drop one feeding at a time, beginning with the feeding that is least important to the child (nursing sessions before naptime and bedtime are often the last to be dropped). Some mothers gradually shorten the length of an individual session before dropping it completely. It can be helpful to offer the child a sippy cup or snack during this time or to make changes to the daily routine, such as leaving the house and playing outside. In this approach, eliminate one feeding for four to seven days before moving on and dropping the next feeding session. Talk to the child's pediatrician about vitamin D or iron supplementation. Weaning is a developmental milestone that is reached by different children at different ages. If the child is showing increased signs of clinginess or fussiness, the mother may decide to slow down the weaning process until the child adjusts.

Related to weaning is getting an infant to discontinue the use of a pacifier. Just as in weaning a baby from breast milk, this process should be gradual and gentle, taking the child's cues into consideration. The best time to wean a baby from a pacifier is when he or she becomes more mobile, in order to prevent the pacifier from becoming a habit. The parent can remove the pacifier after the baby is asleep. Gradually, pacifier use can be restricted to nap time and bedtime. Parents should encourage the baby to stop using the pacifier by offering praise and being patient.

Once a baby starts to use a cup, it is important to make sure that the cup is heavy enough to be stable on a flat surface such as a table or highchair tray. The cup needs to be small enough for the baby to hold properly. Special training cups with spill-proof tops are widely available. Using a floor mat often saves the parent time in cleaning up after a spill.

Uses and Complications

If both the mother and the child are comfortable with the timing of the weaning, it can be accomplished with minimal difficulty. Nevertheless, weaning is a time of emotional separation for mother and child, and they may be unwilling to give up the closeness that nursing offers. Hence, it is important to plan comforting, consoling, and play activities to replace breastfeeding. Some mothers are reluctant to cuddle their child during the weaning process because they are afraid it will encourage the child to nurse; however, offering the child lots of individual attention and physical affection can ease the emotional transition of weaning. Weaning is best conducted in a gradual manner.

One worry that mothers often express when switching from breast to bottle is uncertainty as to how much milk an infant needs. Parents should avoid overfeeding or feeding infants every time they cry. They should also avoid setting artificial goals such as “the baby must consume 8 ounces,” feeding the infant until the goal is reached even though the baby may no longer be hungry. Overfeeding results in obesity.

Perspective and Prospects

The AAP and other medical associations have emphasized the importance of breastfeeding through a baby’s first year. Physiologically, breast milk helps the infant fight infections by supplying antibodies and by coating the intestines with bacteria-fighting liquids. Developmentally, it has been found that breastfeeding mothers are more likely to engage in frequent interactive behavior with their infants, report that their infants have “easy temperaments,” and engage in more flexible caregiving. It has been found that infants who are breastfed retain an advantage in cognitive ability as measured by intelligence quotient (IQ) tests well into their third year of life. Extended breastfeeding also has a number of health benefits for mothers, including reduced rates of breast and ovarian cancer later in life.

For a majority of women who end breastfeeding prior to one year, inadequate milk supply and inflexible employment schedules are the major reasons cited. Whether the result of choice or necessity, weaning is a natural process and a milestone for both mother and child.

Bibliography

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