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Your Guide to Weaning, From a Pediatric Dietitian and International Board Certified Lactation Consultant
Since I shared my “last nursing session” video a few days ago I have received so many questions about how we weaned. To be honest, I don’t have any groundbreaking weaning tips but I will share a few of the things I did focus on.
Oh and briefly – if you are new around here, I am a pediatric dietitian and IBCLC who just weaned off breastfeeding with her second son at 27 months. I have nursed both my boys for 27 months, so at this point I feel like I have a lot of wisdom surrounding the weaning journey from my own experience and as a board certified lactation consultant.
Here is what worked for us this time around:
1. We SLOWLY weaned.
We were dropping one nursing session about every month. Sometimes due to illness or teething, we added a nursing session back. I didn’t have a set time or date that I wanted or needed to wean by, so there was a lot of flexibility in our weaning approach. Our total weaning journey started at around 18 months, and we officially weaned at 27 months. So yeah, we were not in a rush.
My top tip is to allow yourself and your baby time to gradually transition away from nursing versus doing it “cold turkey”, which can be a drastic hormone change for mom as well as potentially increase your risk for mastitis/clogged ducts, and it’s a HUGE change in routine for baby.
2. Replacing nursing with a snack or bottle.
When he requested to nurse, I would offer a snack or bottle of milk instead for MOST of the time. Children still receive a HUGE amount of nutrition from breast milk after the age of 12 months (more on this below), so I wanted to ensure that while we were weaning breastfeeding, he was still consuming adequate nutritional intake.
When offering snacks in replacement of nursing sessions, make sure they are NUTRIENT-DENSE to meet their high energy needs. Think avocado toast, boiled eggs with fruit, chia seed pudding, whole milk yogurt with ground flax and cinnamon, oatmeal with peanut butter and hemp seeds, spinach egg bites, etc.
Calcium is a nutrient your kiddo needs HIGH amounts of between 1-3 years of age, so check out my full blog post on ways to meet calcium needs here: Calcium Blog.
You can also find tons of toddler-approved snack recipes in our new TODDLER book from 101beforeone.
3. Trying other forms of comfort.
If I knew he mostly wanted to nurse for comfort due to being upset or overstimulated, I would try to offer another form of comfort, such as reading books or cuddling while we played with his toy trucks in bed. If he was crying and begging for milk, I may have to do the complete opposite to distract him from wanting the milk, like going outside or a tickle monster game, etc. Something to distract but also bring joy and intentional bonding.
4. Being out of baby’s sight.
For the nights that he really wanted to nurse to sleep, my husband would step in to rock or lay with him to soothe in other ways, and I had to completely remove myself from the situation. Normally if I was out of the picture, he would be 100% fine without me and would no longer be upset. Out of sight out of mind.
This may work for one kiddo and it may not work for another. Reminder, if you feel like you have made progress with weaning but need to take a few steps back on a hard day, give yourself grace to do that and follow your little one’s cues to make the weaning process gentle. There is no “right” or “wrong” way to wean!
5. Bottle instead of nursing to sleep.
We did for quite some time give him a bottle to go to sleep instead of nursing (which we know is not recommended due to the risk for dental caries and less than optimal tooth health), but it did help us in the transition period to move away from nursing.
Each family’s weaning approach will vary based on their specific schedules and circumstances, as well as the temperament of the child. Just know that I won’t be judging you if you swap our nursing for a bottle while you work transitioning away from milk being the primary sleep aid.
I think the overall best thing I did during the weaning process was to focus on filling his cup throughout the day in other ways, so he still felt like we were getting that oh-so-important emotional bonding time. That being said, he still has days where he requests to nurse and I get so emotional over it – but we are finding new ways to connect and show each other love apart from breastfeeding. This is just my approach and it may not work for every family!
Main Tips for Weaning
- If possible, wean slowly to avoid any drastic changes for you and your baby.
Most women say that weaning the nursing sessions that are not associated with nap time and bedtime are the easiest, so start there! Leave the bedtime or nap nursing sessions to be the very last ones you wean off from. Many of us rely on nursing to help our children go to sleep and we want to use that to our advantage as long as we can!
- Distractions!
Use fun new toys or have a special bin of toys reserved for only when milk is requested and we need to offer a substitute for a nursing session. Use this time to engage and play with your child to fill their cup in a new way.
- You may have heard the phrase “don’t offer, don’t deny” as another gentle approach to weaning.
We did this when we first started wanting to cut back a tad bit on nursing and this helped my kids feel a little more in control of the weaning journey. This approach focuses on not offering to nurse like we may be accustomed to, but allowing our child to request when they want to nurse – which may be just as much or much less than we had previously been offering. This could be used as your “first step” in your weaning journey.
- Avoid trying to wean during BIG developmental leaps or life changes.
If you just welcomed a new baby into the house, just moved, or your child is teething or ill, these may not be the BEST times to try to decrease nursing sessions. That being said, sometimes you have to wean quickly and it is out of your control – don’t feel bad if that is the case for you.
- Replace nursing with a cup of water or milk.
Other mothers reported that providing a sippy cup of water or milk in place of nursing sessions was an easy transition for them, and other moms said this didn’t work for their kiddos at all! Key point is that weaning off breastfeeding may be a lot of trial and error and that is okay!
- Reminder: if you are noticing excessive engorgement while cutting back on weaning, we need to remedy that immediately to prevent clogged ducts or even worse, mastitis.
We recommend pumping or hand expressing just until you are feeling “comfortable”, again to prevent amping up your milk supply and further contributing to excess milk above what your baby is removing.
Commonly Asked Questions for Weaning:
“How do you ensure adequate hydration and nutrition when weaning?”
This is a valid question, even after 12 months of life, breast milk can still provide a significant amount of nutrition to your toddler so we do want to ensure we are providing them with adequate nutrition intake while weaning.
If we can slowly wean, we should naturally start replacing breast milk with more solid foods and/or an alternative milk. When your child asks for milk, make sure to offer a replacement beverage or solid food snack to replace the nutrition they are no longer receiving from milk feeds.
At 12 months of age, it is recommended that solid food make up the primary source of nutrition at this time so if we are weaning after the age of 12 months we can increase solid food and cow’s milk or other plant-based milk to replace the breast milk they are no longer receiving.
That being said, if you are noticing decreased diaper output or any noticeable signs of dehydration or poor weight gain, and you are concerned that your child is not consuming adequate intake of foods during the weaning process – we highly recommend reaching out to your pediatrician and/or pediatric dietitian to evaluate.
For more information on meeting calcium needs after 12 months, read my Calcium blog post here.
“How to get them to go to sleep without nursing?”
This is a loaded question for sure! There are countless strategies that you can try to remove the breastfeeding and sleep association – but for the sake of this article not being one thousand pages long, I will defer this commonly asked question to my favorite gentle sleep consultation Alicia Dyshon who has multiple resources on how to do this in a gentle manner without crying!
“Is there any harm in allowing them to self-wean?”
Absolutely not! If breastfeeding continues to work for you and your little one then you can continue to let them nurse and decide for themselves when they want to self-wean. This approach is the one that provides your child with the most choice and independence and should be encouraged if it can be done!
“If I am still nursing past 12 months do I need to provide another type of milk?”
If you are still nursing on demand past the age of 12 months there may be no need to add any type of additional milk if the child is consuming adequate nutritional intake from their solid food diet + breastmilk.
Not sure if they are meeting their nutritional needs? Check out my calcium blog post for more information on this topic.
“If I wean from daytime feeds will I still be able to nurse at night or will I lose my supply?”
Most women, but not all, can successfully wean from daytime feeds and still provide milk at night or when at home in the evenings and weekends. Our bodies can regulate to the needs of the child if we do a slow and gradual weaning process and prioritize continuing to nurse when we are with our child.
In my personal experience, I slowly weaned from pumping at work between 12-15 months and continued to nurse on demand when I was home with him until my first son was 27 months. I would decrease the amount of time spent pumping until I could completely skip the pumping session, and then extend the hours between pumping sessions until I was fully weaned from pumping at work. I personally did not have any issues with maintaining milk supply with my son but that doesn’t mean all women can do it.
If you need support with this, feel free to set up a 1:1 consultation.
“Should I take medicine to stop nursing? Should I wrap or compress my breasts?”
In MOST cases, no medicine or compression of breasts needs to be done to successfully wean without complications. That being said, if you need to wean urgently and want to avoid complications related to engorgement, you should discuss with your healthcare provider what would be the most appropriate medical management for you. For women who may have large oversupply, we would highly recommend working with a lactation consultant to safely wean without causing clogged ducts or mastitis.
“How to avoid weaning blues? How long after weaning do hormones normalize?”
We may not be able to completely avoid weaning blues, but one strategy to prevent HUGE fluctuations in hormones is to use the gentle and slow weaning approach that I have mentioned many times in this article.
If you need to wean quickly, please discuss with your healthcare provider if you notice that you are struggling with mood swings and depression – this is considered a serious health condition and you need to advocate for appropriate support. There is no data that shows the exact amount of time it takes for hormones to normalize, it will vary from person to person and their specific weaning situation.
“When can you start tapering off feeds if you plan to stop nursing at 12 months?”
Between 6-12 months of age, we want to gradually transition away from a primarily milk-based diet to a primarily solid food diet. The average breast milk intake is around 800 ml/day during the first 6 months, and it continues to be an important source of nourishment for healthy growth and development during the second half of infancy and beyond.
Before the age of 12 months, at least 18 ounces/day of breast milk or formula is recommended to be consumed to ensure nutritional needs are being met. Some children will require much more than that and that is okay! 18-31 ounces of breastmilk/day is the average volume of intake from 6-12 months but is dependent on many factors and varies widely from child to child. We caution against weaning too much before 12 months of age to ensure adequate nutritional intake.
“Milk intake after the first 4 to 5 months varies even more widely. In U.S. infants who were breastfed for at least 12 months and were given solid foods beginning at 4 to 7 months, milk intake averaged 769 g/day (range, 335 to 1,144 g/day) at 6 months (N = 56), 637 g/day (range, 205 to 1,185 g/day) at 9 months (N = 46), and 445 g/day (range, 27 to 1,154 g/day) at 12 months (N = 40) (Dewey et al., in press).”
Source: Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Lactation. Washington (DC): National Academies Press (US); 1991. 5, Milk Volume. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235589/
Information on breastfeeding past 12 months of age:
While we are on the topic of weaning, let’s remember that current health organizations do recommend nursing up to 2 years and beyond or as mutually desired by the breastfeeding dyad. If you are not ready to wean breastfeeding at 12 months but feel like our society is pressuring you to do so, take a look at this information on breastfeeding past 12 months to help guide your choice.
“The AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO).”
“The WHO & PAHO report suggests that human milk provided to children after 1 year of age is a valuable source of energy and nutrients. Estimates across populations indicate that children breastfeeding for >1 year consume from ∼100 to 600 mL/day of human milk and that human milk can (but does not always) provide a substantial amount of energy to infants during this time.” PMID: 34115518
Studies show that:
- After 18 months of life, the concentrations of protein and lipids were higher and carbohydrates were lower.
- Protein concentrations were even higher after 2 years of life.
- Fat and total energy concentrations were higher in milk produced after 1 year of life.
- Milk produced after one year of life was found to have more protein but less zinc, calcium, iron, and oligosaccharides.
- After 18 months, concentrations of zinc, calcium, vitamin B6, vitamin C, and magnesium decreased.
- Sodium, lactose, and protein increased after 1 year postpartum.
In summary, human milk remains a source of macronutrients and micronutrients for children >1 year old, although there is substantial variation in milk volume and nutrient concentrations, likely due to changing infant demand and dilution effects.
Breast milk still contributes significant nutrition in the second year of life. Between 12-23 months, 15 ounces of breastmilk provides:
- 29% of energy requirements
- 43% of protein requirements
- 36% of calcium requirements
- 75% of vitamin A requirements
- 76% of folate requirements
- 94% of vitamin B12 requirements
- 60% of vitamin C requirements
Source: Dewey KG. Nutrition, growth, and complementary feeding of the breastfed infant. Pediatr Clin North Am. 2001 Feb;48(1):87-104. doi: 10.1016/s0031-3955(05)70287-x. PMID: 11236735.
“Human milk expressed by mothers who have been lactating for >1 year has significantly increased fat and energy contents, compared with milk expressed by women who have been lactating for shorter periods. During prolonged lactation, the fat energy contribution of breast milk to the infant diet might be significant.” — Mandel 2005
“Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins.” — Dewey 2001
What about immune benefits you may ask?!
There is consistency in the literature demonstrating increased concentrations of milk-borne immune components in late lactation, specifically secretory immunoglobulin A (sIgA), total IgA, lactoferrin, and lysozyme.
For children, breastfeeding for >1 year continues to provide immunological support, although it remains unclear what level of protection this would provide in the older, more developed child.
Maternal benefits include reduced risk of diabetes, certain cancers, hypertension, and cardiovascular diseases.
Most importantly, your decision to quit breastfeeding should be made by you and your little one (the dyad) and not by our culture’s standards/expectations. So nurse for two months or two years, remember it’s always beneficial.
Citations:
Dewey KG. Nutrition, growth, and complementary feeding of the breastfed infant. Pediatr Clin North Am. 2001 Feb;48(1):87-104. doi: 10.1016/s0031-3955(05)70287-x. PMID: 11236735.
Lackey KA, Fehrenkamp BD, Pace RM, Williams JE, Meehan CL, McGuire MA, McGuire MK. Breastfeeding Beyond 12 Months: Is There Evidence for Health Impacts? Annu Rev Nutr. 2021 Oct 11;41:283-308. doi: 10.1146/annurev-nutr-043020-011242. Epub 2021 Jun 11. PMID: 34115518.
Chowdhury R, Sinha B, Sankar MJ, Taneja S, Bhandari N, Rollins N, Bahl R, Martines J. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr. 2015 Dec;104(467):96-113. doi: 10.1111/apa.13102. PMID: 26172878; PMCID: PMC4670483.
Czosnykowska-Łukacka, M. et al. (2020) Changes in human milk immunoglobulin profile during prolonged lactation, Frontiers. Frontiers. Available at: https://www.frontiersin.org/articles/10.3389/fped.2020.00428/full
Czosnykowska-Łukacka M, Orczyk-Pawiłowicz M, Broers B, Królak-Olejnik B. 2019. Lactoferrin in human milk of prolonged lactation. Nutrients 11(10):2350
Perrin MT, Fogleman AD, Newburg DS, Allen JC. 2017. A longitudinal study of human milk composition in the second year postpartum: implications for human milk banking. Matern. Child Nutr. 13(1):e12239
Karra MV, Udipi SA, Kirksey A, Roepke JL. 1986. Changes in specific nutrients in breast milk during extended lactation. Am. J. Clin. Nutr. 43(4):495–503
Goldman AS, Goldblum RM, Garza C. 1983. Immunologic components in human milk during the second year of lactation. Acta Paediatr. Scand. 72(3):461–62
Silvers KM, Frampton CM, Wickens K, Epton MJ, Pattemore PK, et al. 2009. Breastfeeding protects against adverse respiratory outcomes at 15 months of age. Matern. Child Nutr. 5(3):243–50
Yan J, Liu L, Zhu Y, Huang G, Wang PP. 2014. The association between breastfeeding and childhood obesity: a meta-analysis. BMC Public Health 14:1267
Binns C, Lee M, Low WY. The Long-Term Public Health Benefits of Breastfeeding. Asia Pac J Public Health. 2016 Jan;28(1):7-14. doi: 10.1177/1010539515624964. PMID: 26792873.
Dieterich CM, Felice JP, O’Sullivan E, Rasmussen KM. Breastfeeding and health outcomes for the mother-infant dyad. Pediatr Clin North Am. 2013 Feb;60(1):31-48. doi: 10.1016/j.pcl.2012.09.010. Epub 2012 Nov 3. PMID: 23178059; PMCID: PMC3508512.
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Cinthia Scott is a Registered Dietitian (RD) and International Board Certified Lactation Consultant (IBCLC) with over 7 years experience in the field of dietetics. Cinthia focuses on ensuring optimal nutrition in the first 1000 days of life to ensure optimal growth and development as well as set the stage for long-term health. Cindy is an author, starting solids expert, and advocate for caregivers receiving evidence based education and support surrounding breastfeeding and starting solids.
Cinthia is co-author of the 101beforeone Starting Solids Book, “101beforeone -baby-led feeding cookbook,” and is the founder and owner of The Baby Dietitian LLC which is her private practice built to provide virtual 1:1 services for caregivers surrounding infant nutrition, toddler nutrition, and breastfeeding support. Cinthia is also the creator of the Starting Solids 101 Program which provides caregivers 1:1 support from a Pediatric Dietitian on how to provide optimal nutrition from the start and create healthy eating habits that will last their whole lifetime. To work with Cinthia, you can access her services here.
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