Weaning from breastfeeding

 

The reasons behind weaning

At around 4 to 6 months of age, most infants are developmentally ready to handle puréed foods. This is because they are developing the oral motor coordination necessary to accept different food textures. Sucking and chewing are complex behaviors with reflex and learned components. Infants are at risk of choking on chunky food pieces such as nuts, whole grapes and hot dog wheels that require advanced oral motor coordination not achieved before three years of age.

The learned component is conditioned by oral stimulation. If a stimulus is not applied while neural development is occurring, an infant may become a poor eater. There is a relationship between prolonged sucking without solids and poor eating.

Delaying the introduction of nutritional solid foods much beyond six months of age puts an infant at risk for iron deficiency anemia and other micronutrient deficiencies. By four to six months of age, iron stores from birth are diminishing, necessitating the introduction of iron-containing foods at six months of age for all infants. Iron from meat has the best bioavailability and can be readily absorbed from the gastrointestinal tract.

After six months of age, when breast milk alone cannot provide enough protein, additional protein sources (such as meat, fish, egg yolk, tofu, lentils and cheese) are needed. There is no conclusive evidence that delaying the introduction of eggs, fish and nuts (including peanuts) beyond four to six months of age helps to avoid food allergies. In fact more recent data suggests that it may be harmful to delay the introduction of such foods with implication in subsequent allergy and skin disease.

 

The process of weaning

As a greater variety of solids and liquids are introduced to a baby’s diet, weaning will progress. This can occur naturally and intentionally. However, the most common reason mothers give for weaning is perceived insufficient milk supply.

Four main processes of weaning can be described:

 

• Gradual / Infant-led weaning: onset with introduction of complementary food, completely weaned by 2-4 years of age.

• Planned / Mother-led weaning: no infant cues, and occurs usually because of insufficient milk, but can also be due to actual or perceived poor growth, painful feeding or mastitis, new pregnancy, wanting a partner to give feedings, tooth eruption (teething), and a return to work.

• Nursing strike: sudden refusal to nurse that is temporary and can be due to a variety of reasons (change in mom’s diet/soap/menses, infant illness, etc); Nursing strikes can occur at any time and may lead to complete weaning.

  • Nursing strikes can be managed by:

    • Making feeding time special and quiet; minimizing distractions.

    • Increasing the amount of cuddling and soothing of the baby.

    • Offering the breast when the infant is very sleepy or just waking up.

    • Offering the breast frequently using different nursing positions, alternating sides or nursing in different rooms.

    • No attempt should be made to ‘starve’ the infant into submission.

• Abrupt/Emergency weaning: unplanned, e.g. separation, severe illness

 

Management suggestions

• Mothers should continue to spend time in close physical contact with their infant, if possible, so that weaning is less psychologically traumatic for both her and the child.

• Try to remember that breastfeeding is a positive process, and any associated feelings of guilt/sadness are completely natural although blaming yourself is never the right action to take.

• Cold gel packs, cold cabbage leaves or breast massage are reported to relieve engorgement and may be worth a try, but it is important to note that studies have shown these actions to be no more effective than a placebo.

• Monitor for signs of a plugged duct (isolated pea-sized hard / tender area without local heat and systemic symptoms) during weaning, which can lead to mastitis.

• Wear a comfortable and supportive bra.

• Binding the breasts is not recommended and can cause blocked milk ducts.

• There is no need for fluid restriction.

• Reduce stressors, eat well and rest up.

• Visit you Family physician to discuss the possible indication for medications to help.

 

References:

Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel - December 2010Volume 126, Issue 6, Supplement, Pages S1–S58 JACI 

 

Matsumoto and Saito Allergology International 2013;62:291-6 

 

Du Toit , Katz & Sasieni et al J All Clin Immunol 2008;122:984-91 

 

Lack G. J Allergy Clin Immunol 2012; 129:1187-97 

 

 

Here are some helpful website links on this common topic:

 

Feeding your baby in the first year