Weaning from the breast

Question 1

What is the recommendation regarding breastfeeding?

Answer 1

Exclusive breastfeeding for the first six months of life

Continued breastfeeding with complimentary foods for up to two years and beyond

Question 2

What percentage of children in Canada were breastfed for some period of time in 2008?

Answer 2

87%

Question 3

What percentage of children in Canada were exclusively breastfed for six months in 2008?

Answer 3

16.4%

Question 4

What is the main reason for weaning?

Answer 4

Perceived insufficiency in milk supply

Question 5

What is the main reason for weaning at three months?

Answer 5

Return to work

Question 6

When are most infants developmentally ready ti handle pureed foods?

Answer 6

Around 4-6mo

Question 7

When are infants ready to manage chunky foods without choking?

Answer 7

Not before three years of age

Question 8

Why are complimentary foods required at six months old?

Answer 8

1. Iron
2. Protein
3. Fat
4. Zinc
5. vitamin E
6. Fiber?

Question 9

What is gradual (infant-led) weaning?

Answer 9

As infants add complimentary foods they will gradually wean by age 2-4yo

Question 10

What is planned (mother-led) weaning?

Answer 10

Mother stops exclusive breastfeeding without receiving infant’s cues, may cause premature complete

Question 11

What are reasons for planned wean?

Answer 11

1. Not enough milk
2. Concerns re: baby’s growth
3. Painful feedings
4. Mastitis
5. Returning to work
6. New pregnancy
7. Wanting a partner or alternative caregiver to give feedings
8. Eruption of baby’s first teeth

Question 12

What is a “nursing strike”?

Answer 12

When infant refuses to breastfeed and is usually temporary

Question 13

What things can result in a nursing strike?

Answer 13

1. Onset of menses
2. Change in mother’s diet
3. Change in mother’s soap
4. Change in mother’s deodorant
5. Teething
6. Infant illness

Question 14

What are simple steps to manage a nursing strike?

Answer 14

1. Making feeding time special and quiet; minimizing distractions.
2. Increasing the amount of cuddling and soothing of the baby.
3. Offering the breast when the infant is very sleepy or just waking up.
4. Offering the breast frequently using different nursing positions, alternating sides or nursing in different rooms.

Question 15

What is abrupt or emergency weaning?

Answer 15

Prolonged, unplanned separation of mother and infant
Severe maternal illness
Drugs: antimetabolites, therapeutic doses of radiopharmaceuticals, most drugs of abuse

Question 16

What are the problems with abrupt weaning?

Answer 16

Results in trauma for infant and discomfort in the mother as can develop blocked ducts, mastitis or breast abscesses

Question 17

What are recommended to help mothers who have abruptly weaned?

Answer 17

1. Analgesics
2. Express just enough milk that breasts feel comfortable
3. Wear comfortable and supportive bra
4. No evidence for cold gel packs, cold cabbage leaves, or breast massage

Question 18

What is not recommended to help mothers who have abruptly weaned?

Answer 18

1. Binding breasts - increases discomfort, blocked milk ducts
2. Fluid restriction
3. Bromocriptine (prolactin suppressant) - seizures, strokes, death

Question 19

What are the CPS recommendations for physicians regarding weaning?

Answer 19

1. Support exclusive breastfeeding, with vitamin D supplementation, for the first six months of life.
2. Encourage continued breastfeeding for up to two years and beyond while providing appropriate nutritional guidance.
3. Advise mothers to introduce iron-fortified foods in the form of meat, fish or iron-fortified cereals as first foods, to avoid iron deficiency.
4. Advise slow, progressive, natural weaning whenever possible.
5. Inform and support breastfeeding mothers while ensuring adequate nutrition for their babies, regardless of the timing of weaning.

Question 20

What is a gradual planned (mother led) weaning?

Answer 20

1. Substitute child’s “least favourite feed” with complementary food, EBM, formula or cow’s milk
2. Allow baby to feed until stops
3. Cow’s milk only if >9-12mo
4. In 1-2yo max 24oz cows milk or formula per day
5. Introduce water at 6mo
6. Max 100% fruit juice 4-6oz per day
7. Start second subtitute feeding once one is tolerated well
8. Hold and cuddle baby while feeding from bottle
9. No bottle propping (increased risk of choking and early childhood caries)
10. Cup from >6mo
11. Introduce a few tsps of single ingredient solid foods q2-3d and gradually increase
12. Consider partial weaning
13. Starving the baby into taking the bottle is not recommended