Weaning from the breast Flashcards
What is the recommendation regarding breastfeeding?
Exclusive breastfeeding for the first six months of life
Continued breastfeeding with complimentary foods for up to two years and beyond
What percentage of children in Canada were breastfed for some period of time in 2008?
87%
What percentage of children in Canada were exclusively breastfed for six months in 2008?
16.4%
What is the main reason for weaning?
Perceived insufficiency in milk supply
What is the main reason for weaning at three months?
Return to work
When are most infants developmentally ready ti handle pureed foods?
Around 4-6mo
When are infants ready to manage chunky foods without choking?
Not before three years of age
Why are complimentary foods required at six months old?
- Iron
- Protein
- Fat
- Zinc
- vitamin E
- Fiber?
What is gradual (infant-led) weaning?
As infants add complimentary foods they will gradually wean by age 2-4yo
What is planned (mother-led) weaning?
Mother stops exclusive breastfeeding without receiving infant’s cues, may cause premature complete
What are reasons for planned wean?
- Not enough milk
- Concerns re: baby’s growth
- Painful feedings
- Mastitis
- Returning to work
- New pregnancy
- Wanting a partner or alternative caregiver to give feedings
- Eruption of baby’s first teeth
What is a “nursing strike”?
When infant refuses to breastfeed and is usually temporary
What things can result in a nursing strike?
- Onset of menses
- Change in mother’s diet
- Change in mother’s soap
- Change in mother’s deodorant
- Teething
- Infant illness
What are simple steps to manage a nursing strike?
- 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.
What is abrupt or emergency weaning?
Prolonged, unplanned separation of mother and infant
Severe maternal illness
Drugs: antimetabolites, therapeutic doses of radiopharmaceuticals, most drugs of abuse
What are the problems with abrupt weaning?
Results in trauma for infant and discomfort in the mother as can develop blocked ducts, mastitis or breast abscesses
What are recommended to help mothers who have abruptly weaned?
- Analgesics
- Express just enough milk that breasts feel comfortable
- Wear comfortable and supportive bra
- No evidence for cold gel packs, cold cabbage leaves, or breast massage
What is not recommended to help mothers who have abruptly weaned?
- Binding breasts - increases discomfort, blocked milk ducts
- Fluid restriction
- Bromocriptine (prolactin suppressant) - seizures, strokes, death
What are the CPS recommendations for physicians regarding weaning?
- Support exclusive breastfeeding, with vitamin D supplementation, for the first six months of life.
- Encourage continued breastfeeding for up to two years and beyond while providing appropriate nutritional guidance.
- Advise mothers to introduce iron-fortified foods in the form of meat, fish or iron-fortified cereals as first foods, to avoid iron deficiency.
- Advise slow, progressive, natural weaning whenever possible.
- Inform and support breastfeeding mothers while ensuring adequate nutrition for their babies, regardless of the timing of weaning.
What is a gradual planned (mother led) weaning?
- Substitute child’s “least favourite feed” with complementary food, EBM, formula or cow’s milk
- Allow baby to feed until stops
- Cow’s milk only if >9-12mo
- In 1-2yo max 24oz cows milk or formula per day
- Introduce water at 6mo
- Max 100% fruit juice 4-6oz per day
- Start second subtitute feeding once one is tolerated well
- Hold and cuddle baby while feeding from bottle
- No bottle propping (increased risk of choking and early childhood caries)
- Cup from >6mo
- Introduce a few tsps of single ingredient solid foods q2-3d and gradually increase
- Consider partial weaning
- Starving the baby into taking the bottle is not recommended
