Weaning

What Is Expected

Weaning is usually a gradual process. It starts when you begin feeding your baby in other ways than breast- or bottle-feeding. And it ends when the child no longer breastfeeds or takes a bottle. This process may last several weeks, a few months, or more than a year.

Your baby may begin eating solid foods at about 6 months of age. At this point, you may want to offer cup-feeding to supplement breast- or bottle-feedings. Over the next 6 months, your baby may show signs that he or she is ready to wean.

It is important to switch gradually to the cup. Although some mothers stop breast- or bottle-feedings abruptly, the baby may not be ready. Babies find comfort from sucking and also may need the closeness and comfort breast- or bottle-feeding provides. Always think about your baby's emotional needs, age, and readiness as well as about your own needs, when switching from breast- or bottle-feeding to a cup. Toddlers (ages 1 to 2) may tolerate abrupt weaning better than babies.

Weaning from breastfeeding

Start by replacing one daily breast milk feeding with a bottle or cup of formula. Pick your least favorite feeding. Every few days, replace an additional breast milk feeding until your baby is fed only with formula. (Use milk instead of formula if your baby is age 1 year or older.)

When you start to wean your young baby from the breast, replace your breast milk with enough iron-fortified infant formula to make up for fewer nursing sessions. After your baby stops breastfeeding, give him or her at least 16 fl oz (500 mL) to 24 fl oz (750 mL) of formula each day. When your baby is 6 months of age and older, give solid foods high in iron and vitamin C. Babies at least 12 months of age can also have cow's milk.

The following tips may help you wean:

• Slowly reduce the number of times you breastfeed each day. Replace a breastfeeding with a cup- or bottle-feeding during one of your daily feeding times. Stay with that routine for a week. Then the next week, choose an additional time of day to replace or shorten your regular breastfeeding time. Each week, choose one more breastfeeding time to replace or shorten.
• Offer the cup or bottle before each breastfeeding. Some babies may not accept a bottle or cup until they have nursed.
• If you breastfeed before bedtime or a nap, lay your baby down before he or she is asleep. Help your baby learn to fall asleep without the aid of breastfeeding. A new bedtime ritual can help.
• Hold and cuddle your baby to make up for the loss of skin contact during breastfeeding. If a baby asks for more breastfeedings, make them up through touching and holding.

Weaning from bottle-feeding

Your bottle-fed baby should continue to get nutrition largely from formula until he or she is 12 months old. After that, allowing your child to continue drinking from a bottle may lead to problems such as baby bottle tooth decay.

These suggestions may be helpful when you are trying to get your baby to stop taking a bottle.

• Get rid of one bottle-feeding every 5 to 7 days. Give your baby extra hugs and comfort during this change.
• Give a bottle only when your baby is being held in your arms. Do not allow your baby to crawl, walk around, or go to bed with the bottle. Doing so turns the bottle into a comfort item, may hinder two-handed development, and can lead to dental cavities.
• Offer the cup first, then the bottle. Put a little more liquid in the cup and a little less liquid in the bottle each time.
• Put liquids your child likes in the cup, and put liquids your child does not like as much in the bottle. Later, put only water in the bottle, and put juice, iron-fortified formula, or milk (if the baby is over 1 year old) in the cup. Juice is not recommended for babies 0 to 12 months.
• Start a new bedtime ritual. Read a story and then give the bottle while you rock your baby. At each bedtime, slowly decrease the time your child drinks from the bottle, and continue reading a story. Eventually replace the bottle with a comfort item, such as a favorite stuffed toy or blanket.
• Provide other sources of calcium, such as yogurt or cheese, if your baby is not drinking at least 16 fl oz (500 mL) of formula from a cup each day. Your baby needs calcium every day for growth.

Common concerns

• I'm pregnant. Should I stop breastfeeding my first child? No, you can continue to breastfeed your first child while you are pregnant. But talk to your doctor about your nutritional needs and other issues you should be aware of. For more information, see the topic Breastfeeding.
• I want to become pregnant. Should I wean my child? You can continue to breastfeed, but breastfeeding may make it harder to become pregnant. For more information, see the topic Breastfeeding.
• When I wean, should I be concerned about my baby's teeth? Be sure to give your baby adequate nutrition to build healthy teeth. And as you wean your baby from the breast or the bottle, limit sugary liquids, especially at bedtime. This can cause dental cavities. Don't put your baby to bed with a bottle. And after 12 months of age, stop night breastfeedings. For more information, see the topic Teething.
• What can I do if I want to stop breastfeeding, but my baby does not? If possible, continue breastfeeding a while longer. If this is not possible, offer breast milk or formula in a cup and/or give extra hugs.
• What can I do if my baby does not want to give up the bottle? Slow down the weaning process, or offer a stuffed toy or blanket for comfort, instead of the bottle.
• What if I develop pain and tenderness in my breasts while trying to wean? Breast engorgement is less likely to occur if you gradually wean your baby rather than suddenly stop breastfeeding. Weaning from the breast is easier when your baby is already taking solid foods and has been breastfeeding less often. The pain and discomfort from breast engorgement improve as your breasts stop making milk. You will likely feel better in 1 to 5 days. Home treatment, such as applying cold packs to the breasts, may relieve some of your symptoms. For more information, see the topic Breast Engorgement.
• Should I start or stop giving supplements to my child? Most doctors suggest daily vitamin D supplements for children. Talk with your doctor about how much and what sources of vitamin D are right for your child. Babies who are breastfed may also need a fluoride supplement starting at 6 months of age.

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 (with supplements) and formula give babies all the calories and nutrients they need until they are about 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 breastfed for at least a year and as long after a year as mother and child desire.^{footnote 2}

• If you are not breastfeeding and your baby is younger than 12 months of age, use iron-fortified formula. Do not offer your baby cow's milk.^{footnote 2} 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.
• Most children need whole milk when they are 1 to 2 years of age. But your doctor may recommend 2% milk if your child is overweight or if there is a family history of obesity, high blood pressure, or heart disease.
• 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 about 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.^{footnote 2} 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. Be sure your child gets the recommended vitamins and minerals for children.

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.

Tips for using a cup

Strive to have your baby using a cup instead of a bottle around 1 year of age. And help your child to start using a lidless cup by age 2. To help get your baby learn to use a cup, try these tips:

• Show your baby different types of cups and let him or her choose.
• Try to use cups with a spout, two handles, and a rounded, weighted bottom. If your baby accidentally bumps the cup, it will stay upright and less liquid will be spilled.
• If the cup does not have a lid and spout, put only about one sip of liquid at a time in the cup, in case your baby tips the cup over.
• Do not be upset if your baby just wants to play with the cup at first.

And to help prevent injuries from using bottles and cups during unsteady walking, have your child stay seated while drinking.

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 for mothers who are breastfeeding, and allows the baby to learn other ways of eating. Gradual weaning 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 hard for both the mother and the child. The breastfeeding 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.

Times you may not want to wean

You may not want to wean your baby:

• When a child is learning new skills. Learning new skills, such as crawling or walking, can be stressful for your child, and the breast or bottle may provide comfort and security.
• When there is stress in the home. A new tooth, an illness, a new day care center, or the caregiver starting back to work can all be stressful. Weaning at this time, or during any difficult time, results in more stress and more difficulty weaning.
• During unusually warm weather. During weaning, babies sometimes refuse any liquid other than breast milk or formula for 24 to 48 hours. So weaning your baby when it's very hot outdoors can put your baby at risk for dehydration.

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 toddler from breastfeeding 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 2 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.

When to Call a Doctor

Talk to your child's doctor about weaning if:

• Your baby refuses all solid food and is older than 6 to 8 months of age.
• Your baby has changed from sleeping through the night to waking up during the night hungry.
• Your baby develops dental cavities (caries).
• Your baby seems overweight for his or her age, size, or birth weight.
• Your toddler (1 to 2 years old) focuses on breast- or bottle-feeding and does not play with other children.
• Your toddler never wants to be away from you.
• Your baby is older than 18 months of age and is still drinking from a bottle.
• You are emotionally ready to wean your baby.

Who to see

Health professionals who can deal with your concerns about weaning include:

• Pediatricians.
• Family medicine doctors.
• Physician assistants with special training in the care of children.
• Pediatric or family nurse practitioners.
• Certified lactation consultants. Lactation consultants are sometimes on staff at hospitals.

Routine Checkups

A well-baby checkup is a good time to ask questions about weaning. During this checkup, your baby's doctor will:

• Compare your baby's current weight, height, and head size with measurements taken at birth to see if the rate of growth is normal.
• Ask how well your baby is eating and sleeping and whether any problems have developed.