Weaning

Promoting Healthy Growth and Development

It’s important not only for you to give your baby nutritious foods and drinks but also for you and your baby to interact with each other during mealtimes. These things help your baby's mind and body grow. Breast milk and formula give babies all the calories and nutrients they need until they are 6 months old. After that, babies need other nutrients and energy from solid foods. You can wean gradually or abruptly in order to get your baby what he or she needs for growth. When you make choices about weaning, always think of your baby's emotional needs, age, and readiness as well as your own needs.

The weaning process

The American Academy of Pediatrics recommends that babies be breast-fed for at least a year and as long after as mother and child desire.¹

• If you are not breast-feeding and your baby is younger than 12 months of age, use iron-fortified formula. Do not offer your baby cow's milk.¹ The iron in cow's milk is not well-absorbed, and iron is necessary for healthy development. Also, some babies may be more likely to react to the protein in cow's milk. In an emergency, you can give your baby whole milk for a short time until you can get more formula.
• If your baby is older than 12 months, you can give your baby whole milk. Do not use skim milk or 2% milk before your child is 2 years old. These types of milk provide too few calories, too much protein, and inadequate essential fatty acids.
• Switching from breast milk to formula may cause differences in how often your baby feeds and a change in the color and consistency of your baby's stools.

When you have decided that you and your child are ready to give up breast- or bottle-feeding, develop a plan for what you will do. Talk with other family members and get their help.

In general, you can start giving your baby solid foods at 4 to 6 months of age. Feed your baby at the table with the rest of the family. Follow your doctor's advice on when and what to feed your baby. At 6 months of age, iron-enriched solid foods should be introduced.¹ Usually, the more solid foods a baby eats, the less breast milk or formula he or she needs, and the easier it is for your baby to switch from the breast or bottle.

Weaning from breast- or bottle-feeding can be done gradually or abruptly. Watch for signs that your baby is ready to wean. To gradually stop breast- or bottle-feeding while you offer cup-feeding and/or solid foods, give up the least important feeding first, which is usually the midday one. Then stop the late afternoon and morning feedings. Stop the most important feeding (the one that provides the baby the greatest emotional comfort) last: this is usually the first or last feeding of the day. Whether you are weaning or not, the last feeding should gradually be moved up so that by 4 months it is no longer at bedtime and other soothing rituals can be established. Pay attention to whether your baby is sucking for comfort or hunger. If your baby uses a pacifier, think about replacing it with a blanket or a stuffed toy for comfort.

Gradual weaning

A gradual weaning slowly reduces the number of breast- or bottle-feedings. One feeding is eliminated every 5 to 7 days, giving the mother and baby time to adjust. Gradual weaning helps maintain emotional attachment, prevents breast engorgement, and allows the baby to learn other ways of eating. It is generally planned to suit both the mother's and child's needs.

Gradual weaning is best for both you and your baby. It is recommended for babies unless the mother has a medical condition that does not allow it.

Abrupt weaning

Abrupt weaning is a sudden end to breast- or bottle-feeding and can be difficult for both the mother and the child. The mother may experience painful breast engorgement and has an increased risk for a breast infection (mastitis). Both the mother and the child may miss the emotional attachment and closeness of breast- or bottle-feeding.

Your child may respond to abrupt weaning by:

• Refusing to drink from a cup for a period of time. Prolonged refusal to drink from a cup can lead to dehydration and nutritional deficiencies.
• Sucking his or her thumb.

Weaning a toddler

Gradual or abrupt weaning may work for 1- to 2-year-olds.

• A toddler who breast- or bottle-feeds 3 or more times a day may do better with gradual weaning.
• A toddler who breast- or bottle-feeds 2 times a day or less may do well with abrupt weaning.

You may find the following suggestions helpful as you switch to other types of feeding:

• Tips for weaning a baby from bottle-feeding may help you replace bottle-feedings with other comforting activities.
• Tips for weaning a baby from breast-feeding may help you switch from breast-feeding to bottle-feeding or using a cup.
• Tips for weaning a toddler from breast-feeding include distraction, postponing feedings, and not offering feedings.
• Tips for weaning a toddler from bottle-feeding may help you find ways to limit or replace drinking from a bottle.
• Abrupt weaning for toddlers may help you wean a child who nurses 3 times a day or less.

As your baby learns to feed himself or herself, keep in mind that your job is to provide a variety of nutritious foods, but your baby will decide how much to eat. This is sometimes called the division of responsibility.

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Author:	Debby Golonka, MPH	Last Updated: June 19, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Joy Melnikow, MD, MPH - Family Medicine
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