Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

Risk factors for early weaning from the breast...

Some mums want to breastfeed for a few days, weeks or months and others until the child naturally decides to stop feeding, often called "self weaning".

"Self weaning" according to Kellymom:
"What is self-weaning?
A baby who is weaning on his own:

  • is typically well over a year old (more commonly over 2 years)
  • is at the point where he gets most of his nutrition from solids
  • drinks well from a cup
  • cuts down on nursing gradually
Child-led weaning occurs when a child no longer has a need to nurse - nutritionally or emotionally. The solids part should rule out self-weaning in babies under a year since, for optimum health and brain development, babies under a year should be getting most of their nutrition from breastmilk."
I would like to add another (and I think significant angle) to this, that self weaning is also most likely to occur when the infant no longer needs immunological protection.  Levels of some antibodies increase over the period of lactation, ready to protect the infant from increased bacterial exposure once they are mobile - it makes little sense for the natural age of weaning to be prior to this? (Acta Paediatr Scand 72(3):461-2. Immunologic components in human milk during the second year of lactation.)  Not to mention of course HAMLET.

However it's very common to hear of infants in the UK & US "self weaning " at 9-12 months, or just over one year - despite WHO recommendations that:
Exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.
Despite anthropological discussion again suggesting this is unusually early, and despite the fact an infants own system is far from mature at this point.  For mums who planned longer, it can be a confusing upsetting time - so I think the question is....

What factors can influence weaning?
When we consider that extensive studies have shown breastfeeding to be "dose related" ie the risks are increased the earlier the infant weans before the "biological norm" - it's worth considering how the big picture can influence weaning.

It's interesting that 12 months is one of several "key weaning times" in the UK & US.  I hear a huge number of women state they plan to breastfeed for a year - after this baby can drink cow's milk right? (note can does not equate to should).  It's another date at which mums return to work and therefore it's very likely that social norms influence weaning, even when we are not aware of a direct relationship.

If an infant becomes ambivalent about nursing around this time (as some do with new found independence) parents can easily jump on these cues as waning interest, and feel they have followed the infant's lead - whereas if the baby was younger, they may have been more inclined to ensure nursing was encouraged.  With a younger infant, a nursing strike is assumed if baby refuses the breast - after 12 months this is often far more easily considered "self weaning".  Ultimately many do not recognise that in biological terms their infant is still a young baby, nor the value of same species milk to the developing brain and body.

However, what I also noted over a number of years on a "non mainstream parenting forum", was that it was extremely unusual for infants to "self wean" this early, almost unheard of - and so I began comparing the different factors linked with duration, both here and via other sources.

I discovered infants are far more likely to wean early if the breast is viewed purely as nutrition, with another item (perhaps a pacifier or lovey) as their comfort and security.  Although several studies link pacifier use with earlier weaning, some suggest it's only the case if there are underlying feeding problems, or reduced motivation to continue breastfeeding anyway.  Nothing suggests (in my opinion) that all infants with a dummy wean early - but I do agree how the pacifier, and indeed how the breast are used, can increase or reduce the risks.  A fractious baby comforted by a pacifier during a car journey is different to one offered it as as the standard soothing tool every time he needs comfort (and often at times when they don't).

If a baby is offered the breast to a schedule, or only when hungry ie purely for nutrition - it makes sense that once their nutritional needs are met elsewhere, they are more likely to cease feeding.  They can still have their pacifier (copy of the nipple) thumb or blanket for security going into the second year, and often beyond.

If baby has an underlying feeding problem such as tongue tie, that has been "worked around" but the baby has still found feeding difficult (perhaps very short feeds using hands/pacifier for comfort or stressful wriggly tense feeds) he/she may stop breastfeeding once nutritional needs are met elsewhere.

If a baby is fed on cue and "mothered at the breast" - mum is the comfort item, and those kept close to mum often have no interest in a random piece of cloth that may smell like her.  If baby takes advantage of the natural analgesic that is breastfeeding when they bump or fall, or turn to the breast for a hit of hormones when tired - they are far less likely to stop feeding just because their nutritional needs are met by other (inferior) foods.

That's not to say interest in the breast might not wane and wax, with the baby having periods of feeding far less or  more frequently than normal, nor is it a guarantee a toddler won't have a nursing strike.  But if we are looking at these as normal developmental patterns and not cues of weaning - how we respond may differ.

Something else I've noticed that can impact is a constant supply of water/juice/other milk in a sippy cup.  A portable drink can be popular for a toddler who is just becoming mobile - who is busy exploring the world.  Those without the "on the go" option. often become "pitstop feeders" - cruising over for a power feed before getting back to things, whilst those with (and indeed some without) can be more prone to cutting daytime feeds in favour of exploration.  Which brings me on to my next point of sleeping arrangements.

If a toddler has reduced day feeds, often if co-sleeping they make up for this by feeding more frequently at night.  By many mainstream measures this may not be considered desirable, however to the nursling from an immunological perspective it most definitely is.  Those who sole sleep are less likely to increase nightfeeds (although some will!) whilst others will take increased solids, alternative milk or gain may slow.

Solid introduction is another opportunity for "weaning risk".  If the infant has easy breast access and joins in family meals after their feed - their solids intake is often less than we typically note in those puree weaned and spoon fed by parents.  In contrast many out of date books still discuss "weaning schedules", which are built to directly follow on from scheduled feeding.  They actively drop feeds and replace them with solids, with breastfeeding restricted and reducing dramatically as baby heads towards a year (based on no evidence!).

Watch for subtle cues - once infants can ask to feed, some mums stop offering and wait for baby to ask.  However babies can get distracted and busy during the day and "don't offer, don't refuse" is a recognised weaning technique.  Around a year old, when a lot is going on developmentally, offering can remind your toddler they're thirsty - something that it can take time to recognise.

Nursing Strike V Weaning
Sometimes mums are confused as to whether their child is weaning or having a nursing strike.  Weaning typically happens gradually, although as discussed many infants will cut down and then step things up a gear during a developmental burst, when teething or unwell.  Infants can cut down and remain with a few feeds for a long time - so cutting down doesn't always equate to weaning full any time soon.

In contrast strikes often happen seemingly out of the blue when a child has been happily nursing several times per day or more - refusing or biting when the breast is offered.  A strike can however turn into weaning, even with the best intentions from mum.  Triggers can be anything from a sore mouth, to an overly firm "no biting" with perhaps a yelp for the very sensitive baby - and this excellent LLL article explores both outcomes and the emotions involved.

From personal experience and the mum's I've supported - strikes can also last longer than a few days.  My youngest didn't feed for 17 days when he was in his second year; painful attempts at feeding during an episode of hand, foot and mouth left him still not feeding long after they had cleared!  From this list of "Top Tips" the one I would echo most is ambivalence.  In the end what killed the strike for us was me reading a book and paying absolutely no attention - he decided eventually to latch and one he realised it didn't hurt, didn't look back.  Others may as mentioned not go back to the breast - but I hope by sharing my observations it may help parents avoid the common "weaning traps" if they want to.

RELATED POSTS: Is breastfeeding a six year old ok? Er where do you live?

22 comments:

  1. Clare Davidson10 July 2011 at 19:27

    I like this post, thanks a lot for writing it as its a subject I come across again and again.

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  2. Interesting article with lots to think about.

    I'm tandem nursing a 3 year old and a 7 month old - I'm *desperate* to wean the 3 yo. He's having none of it. The 7 month old has a dummy (something the elder one wouldn't accept - no booby substitutes for him, ever) and I am seriously considering giving him a bottle of cow's milk at bed-time to alter the bed time routine we currently have with the elder one.

    That said, I've noticed the younger one feeds very differently to his brother. He will refuse the breast if he's not bothered (that never happened with #1!), he's nowhere near as keen as comfort sucking at the breast etc. As such, he may stop feeding to sleep far sooner anyway.

    It's so hard to parent in a way that meets their needs but also meets your own. I will bear this article in mind...

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  3. V interesting. The day DD2 sat at the table with real food (rather than a toy!) I worried how food and BFing would work. After all for the 1st 6 months we are told any other food/drink will displace BM. That is still true after 6 months!! Its a balancing act but so far (9 months) she still likes boob! I do make sure, though, that I offer the breast if she sucks her thumb, before nap, after nap, before meals (as much as possible really!)I also co-sleep whenever I can sneak her into our bed (OH not overly keen!) So I am hopeful there will be no "nursing strike" or "self weaning" for a looooong time!!! Thanks AA xxx

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  4. Excellent article! What you say is so very true. Too many women view breastfeeding as purely nutritional, but it is SO much more!

    I will be posting a link to this article on my FB page for active duty military breastfeeding mothers. A number do make it to a year and this will be good info for them to know.

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  5. To add - a bottle of cow's milk at bedtime - once he hits 12 months!

    I may of course change my mind (again!)

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  6. Anon it sounds v intense for you right now. Some toddlers really step up their nursing when a new sibling arrives, or when the sibling starts doing new and interesting things - has this happened for you at all?
    Weird as it sounds, one of the quickest ways to cut down toddler nursing is offering very frequently. Generally toddlers up nursing at times they need extra security - they also sense when mum wants them to wean. The more desperate mum becomes, the more demanding they can be, as they seek reassurance that their security IS there if they need it. Offering frequently can flip this mindset and help them be reassured that even if they don't choose to have it often, it's there when they do want it.
    Does that make any sense?
    AA

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  7. A great article, as always AA. I fear that I have fallen into the trap of giving a dummy and also feeding only for nutrition. Now my 9-month-old is dropping feeds left, right and centre. :(

    I certainly agree when Anonymous says "It's so hard to parent in a way that meets their needs but also meets your own."

    Katrina

    PS. Can I just say that the first picture on this article looks like the woman has just one boob, right in the middle of her chest! I just can't seem to work out which boob it really is!

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  8. Anon 2: If you don't want your 9 month old to drop too many feeds try offering boob when he/she wants the dummy and always offer before food. Mine seems to be able to manage without (helpful when I have to go to work) but will take if offered. It is hard esp when work gets in the way! But I do find it useful if I'm in too much of a rush to fit breakfast in.....you can always rely on boobs!! ;-)

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  9. Great article, I will share on my page. :-)

    I have no plans to wean our now-almost-7 month old, however next year we would like to try for a third. There are a number of reasons that decision has been based upon, it is not just whim. I would hope to tandem nurse, but so far no sign of AF. I know my period still has plenty of opportunity to return, perhaps when he increases how much solid food he's eating or if he drops any of his night feeds at any point, but if it doesn't come back I am really torn, though my heart is telling me that our self-weaning plans would take precedence over our plans for a third child that year.

    I know it's a bit premature, but I'm just wondering if you had any tips on coaxing back AF when the time comes, or if it's just got to be a case of waiting and letting mother nature do her thing.

    Thanks,
    Holly
    earthmamadoula.wordpress.com

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  10. Holly, I saw a homeopath. My period came back just after #1 was 1 but I'd been back at work a few months and not expressing so that may have helped. Some women find night weaning helps periods return. However, it's very personal - some have no period at all whilst nursing, however little, others find it comes back after a few months despite frequent feeds.

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  11. Hiya EarthMD
    I would definitely not panic over next year just yet if babe is only 7 months and it's July - he will be 12 months by Xmas and as you say feed/sleep patterns can change lots. When did they return with number one? (did you bf?) The lack of menses is linked with ovarian cancer rates ie every month without reduces the rate I believe - so on the flipside it does have a bonus :)
    AA

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  12. mets33@yahoo.com13 July 2011 at 21:28

    Thankyou and fitting, my sons weaned themselves at just 10 to 11 months and iv often wondered why and what could have triggered it and came up with some the same points you have.
    son no 1 weaned at just 10 months soon after he started walking which started at 9 months, he was/is a hyper character and very independant and insisted on everything his way without any help no matter how frustrated he became. He became attached to his juice bottle! He became attached to his blanket as a comforter and teddy! He would not touch any other milk after bf. I assumed that because he didnt come to me for a feed he didnt want one and when i tried to hug him he wanted down to play so i felt that trying anymore than that would be forcing him?
    Son 2 also walked from 9 months and by 10 1/2 months he didnt feed any more, it happened gradually over the last month and didnt seem interested at all in feeding but did enjoy cuddles :) He too became attached to his blanket at bedtimes! something i did not encourage due to not thinking of using a blanket as a comforter at the time (i sucked my thumb until 16!)
    son 3 stopped bf at 11 months when i went into hospital and had to stay in overnight-when home i wanted to feed him and offered but he was not interested and more interested in the dinner that had just been prepared, i felt very sad and tried to feed by offering often but he had a 1 min feed at bedtime only for several days until not even that. He became attached to him monkey teddy (although a very affectionate child to mummy:) and was/does have a very big appetite. So in my comments you can see the factors that influenced the weaning process so this time I am very watchful and have offered feeds as much as possible from the start even though the hospital actually discouraged me whe she was early but thats another story!

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  13. metsx6@yahoo.com13 July 2011 at 21:40

    I forgot to add that i also tried controlled crying at bedtime to encourage a sleep pattern as suggested in all the baby magazines and books id read (i had never seen or heard of natural parenting anywhere and this was a time when we didnt have internet in our home to google-eldest is now 15).
    This was around 8 months and took less than a week for them to settle in their cots after a bath/massage/songs/feed. Although this will have been the time they bacame attached to their teddies & blankets and 2 month later weaned from bf :( Now i feel mortified that i didnt know more and their wasnt any info around(that i could see) telling me otherwise. It was all mainstream ideas that were/are based commersially and offcourse everyone with their wives tales of how it should be and everyone already telling me im molly coddling by bf instead of bottle and hugging too much!!! and talking nicely to explain things instead of spanking!!! I was also practically called a witch for using homeopathy to help my sons instead of conventional medicine!!! I did/do all i do out of what feels natural & right to me yet i seem to get judged massively!
    I guess im explaining because i feel bad i didnt see what was happening and stopped it and the controlled crying for that week which was hard and can not do with dd.
    Hope i have rambled too much

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  14. QUOTE Now i feel mortified that i didnt know more and their wasnt any info around(that i could see) telling me otherwise.

    We do the best we can with the information we have at the time I think? I know I'm far from the perfect parent, I did PUPD with DD and spent an eternity trying to get her to nap (because every book said she would if only I got it right/timed things right etc!) Hindsight is a v powerful thing! As one friend with lots of children said, feel sorry for the first few really and you get more right everytime lol

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  15. Nice article. Only thing I would point out is that you misquoted the WHO wrt their breastfeeding recommendations. You state that WHO recommends breastfeeding until at least 2 years of age. In fact the recommendation is to breastfeed 'for up to 2 years or beyond'. The mother/child who weans from breastfeeding at 18 months, for example, fulfills the WHO recommendation. Based on your interpretation, however, they would not. This misinterpretation doesn't detract from the post. I just figured the clarification would be appropriate.

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  16. Thanks Dr Flanders, I've updated the post to quote the recommendation verbatim.
    Having read it again I guess I do interpret it differently to yourself, so best to post the original :)
    Thanks for your feedback
    AA

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  17. I am very interested in your paragraph about how it's normal for toddlers to drop feeds in the day and make up for it in the night.

    My 16 month old is doing this exact thing, and seems to want feeding during the night like when she was a newborn! It's rather tiring...

    How long does this generally last?

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  18. OMG RaisinCookies, i am in the exactly same situation as you. 16 months old boy, doesn't go near the breast anymore during the day (about 3 weeks now) but at nighttime it gets so bad (he wakes up every hour for comfort and only gets it from myself with the boobs). i always end up bringing him into bed with us at around 2pm and even though he's inbetween me and my husband, he just keeps waking every 1.5/2 hours and looks for the breast!! i have given up on a full night's sleep anyway :-)

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  19. Great post!

    The "Top Tips" link in the last paragraph goes to a blog about losing a pet ... ?

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  20. This is very interesting, although your recommendations seem to be ones that would really only work for a SAHM. I was planning to nurse my twins to at least age 2 and they weaned at 14 months for DD and 19 months for DS. DD actually looked at me one day, pointed to the nursing pillow, and did the sign for "all done." From that day on she refused the breast. Unfortunately, they couldn't be offered the breast for every bump and boo boo because they received pumped milk while I was at work. I also couldn't co sleep and nurse at night because I work in the medical field and work some nights. I am currently nursing my 5 month old, and wondering if short of quitting my job (not an option) there is anything I can do to prevent her from weaning early.

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  21. Excellent article! What you say is so very true. Too many women view breastfeeding as purely nutritional, but it is SO much more!

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  22. My first child "self weaned" at 9 months. I was sad at the time, but figured it was good that she chose to stop herself. However as I prepared for my second child and become much more educated on the mechanics of breastfeeding, I realised there were a few things I had done that likely impacted on my supply and her desire to nurse. Firstly I had an idiot MCHN tell me I was overfeeding her at 3 weeks old!! She started out at 6lb 12oz, but gained rapidly in the early weeks. I mentioned to the nurse that she was unsettled in the evenings and wanted to be on the breast almost constantly. The nurse told me feeding her too soon after a big feed was like giving her a hamburger when she's just had a 3 course meal!! No joke! So as a first time mum who thought she must would know better than me, I started watching the clock instead of my baby, and would try to avoid feeding her if it had been less than 2 hrs since her last feed. She had a dummy from quite early on, and I would offer this before a feed through the night, figuring if she was really hungry she would refuse it. At four months I felt like my supply was dropping (now realise it was just my supply regulating and it's normal to have less milk in the evening), so started pumping in the morning and offering this milk before bed along with a BF to help 'fill her up' overnight. By 6 months I could no longer pump enough for this supplemental bottle, so this turned into a formula supplement before bed instead. Then we did the traditional puree weaning at 6 months, and she ate HEAPS. At 8.5 months she started refusing the breast except for first thing in the morning when I was reasonably full, and by 9.5 months refused altogether. So when I had my son I determined he wouldn't have a dummy except for in the car (he refused them altogether anyway), I would feed frequently on cue, I would keep up at least one night feed until 12 months (no problem there ;) ), no supplemental bottles, and would practice baby led weaning. So far we are at 14 months breastfeeding and no sign of stopping :) I completely agree with 'When you know better, you DO better'.

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