Risk factors for early weaning from the breast...

Some mums want to breastfeed for a few days, weeks or months and others until the child naturally decides to stop feeding, often called "self weaning".

"Self weaning" according to Kellymom:

"What is self-weaning?
A baby who is weaning on his own:

• is typically well over a year old (more commonly over 2 years)

• is at the point where he gets most of his nutrition from solids

• drinks well from a cup

• cuts down on nursing gradually

Child-led weaning occurs when a child no longer has a need to nurse - nutritionally or emotionally. The solids part should rule out self-weaning in babies under a year since, for optimum health and brain development, babies under a year should be getting most of their nutrition from breastmilk."

I would like to add another (and I think significant angle) to this, that self weaning is also most likely to occur when the infant no longer needs immunological protection.  Levels of some antibodies increase over the period of lactation, ready to protect the infant from increased bacterial exposure once they are mobile - it makes little sense for the natural age of weaning to be prior to this? (Acta Paediatr Scand 72(3):461-2. Immunologic components in human milk during the second year of lactation.)  Not to mention of course HAMLET.

However it's very common to hear of infants in the UK & US "self weaning " at 9-12 months, or just over one year - despite WHO recommendations that:

Exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.

Despite anthropological discussion again suggesting this is unusually early, and despite the fact an infants own system is far from mature at this point.  For mums who planned longer, it can be a confusing upsetting time - so I think the question is....

What factors can influence weaning?
When we consider that extensive studies have shown breastfeeding to be "dose related" ie the risks are increased the earlier the infant weans before the "biological norm" - it's worth considering how the big picture can influence weaning.

It's interesting that 12 months is one of several "key weaning times" in the UK & US.  I hear a huge number of women state they plan to breastfeed for a year - after this baby can drink cow's milk right? (note can does not equate to should).  It's another date at which mums return to work and therefore it's very likely that social norms influence weaning, even when we are not aware of a direct relationship.

If an infant becomes ambivalent about nursing around this time (as some do with new found independence) parents can easily jump on these cues as waning interest, and feel they have followed the infant's lead - whereas if the baby was younger, they may have been more inclined to ensure nursing was encouraged.  With a younger infant, a nursing strike is assumed if baby refuses the breast - after 12 months this is often far more easily considered "self weaning".  Ultimately many do not recognise that in biological terms their infant is still a young baby, nor the value of same species milk to the developing brain and body.

However, what I also noted over a number of years on a "non mainstream parenting forum", was that it was extremely unusual for infants to "self wean" this early, almost unheard of - and so I began comparing the different factors linked with duration, both here and via other sources.

I discovered infants are far more likely to wean early if the breast is viewed purely as nutrition, with another item (perhaps a pacifier or lovey) as their comfort and security.  Although several studies link pacifier use with earlier weaning, some suggest it's only the case if there are underlying feeding problems, or reduced motivation to continue breastfeeding anyway.  Nothing suggests (in my opinion) that all infants with a dummy wean early - but I do agree how the pacifier, and indeed how the breast are used, can increase or reduce the risks.  A fractious baby comforted by a pacifier during a car journey is different to one offered it as as the standard soothing tool every time he needs comfort (and often at times when they don't).

If a baby is offered the breast to a schedule, or only when hungry ie purely for nutrition - it makes sense that once their nutritional needs are met elsewhere, they are more likely to cease feeding.  They can still have their pacifier (copy of the nipple) thumb or blanket for security going into the second year, and often beyond.

If baby has an underlying feeding problem such as tongue tie, that has been "worked around" but the baby has still found feeding difficult (perhaps very short feeds using hands/pacifier for comfort or stressful wriggly tense feeds) he/she may stop breastfeeding once nutritional needs are met elsewhere.

If a baby is fed on cue and "mothered at the breast" - mum is the comfort item, and those kept close to mum often have no interest in a random piece of cloth that may smell like her.  If baby takes advantage of the natural analgesic that is breastfeeding when they bump or fall, or turn to the breast for a hit of hormones when tired - they are far less likely to stop feeding just because their nutritional needs are met by other (inferior) foods.

That's not to say interest in the breast might not wane and wax, with the baby having periods of feeding far less or  more frequently than normal, nor is it a guarantee a toddler won't have a nursing strike.  But if we are looking at these as normal developmental patterns and not cues of weaning - how we respond may differ.

Something else I've noticed that can impact is a constant supply of water/juice/other milk in a sippy cup.  A portable drink can be popular for a toddler who is just becoming mobile - who is busy exploring the world.  Those without the "on the go" option. often become "pitstop feeders" - cruising over for a power feed before getting back to things, whilst those with (and indeed some without) can be more prone to cutting daytime feeds in favour of exploration.  Which brings me on to my next point of sleeping arrangements.

If a toddler has reduced day feeds, often if co-sleeping they make up for this by feeding more frequently at night.  By many mainstream measures this may not be considered desirable, however to the nursling from an immunological perspective it most definitely is.  Those who sole sleep are less likely to increase nightfeeds (although some will!) whilst others will take increased solids, alternative milk or gain may slow.

Solid introduction is another opportunity for "weaning risk".  If the infant has easy breast access and joins in family meals after their feed - their solids intake is often less than we typically note in those puree weaned and spoon fed by parents.  In contrast many out of date books still discuss "weaning schedules", which are built to directly follow on from scheduled feeding.  They actively drop feeds and replace them with solids, with breastfeeding restricted and reducing dramatically as baby heads towards a year (based on no evidence!).

Watch for subtle cues - once infants can ask to feed, some mums stop offering and wait for baby to ask.  However babies can get distracted and busy during the day and "don't offer, don't refuse" is a recognised weaning technique.  Around a year old, when a lot is going on developmentally, offering can remind your toddler they're thirsty - something that it can take time to recognise.

Nursing Strike V Weaning
Sometimes mums are confused as to whether their child is weaning or having a nursing strike.  Weaning typically happens gradually, although as discussed many infants will cut down and then step things up a gear during a developmental burst, when teething or unwell.  Infants can cut down and remain with a few feeds for a long time - so cutting down doesn't always equate to weaning full any time soon.

In contrast strikes often happen seemingly out of the blue when a child has been happily nursing several times per day or more - refusing or biting when the breast is offered.  A strike can however turn into weaning, even with the best intentions from mum.  Triggers can be anything from a sore mouth, to an overly firm "no biting" with perhaps a yelp for the very sensitive baby - and this excellent LLL article explores both outcomes and the emotions involved.

From personal experience and the mum's I've supported - strikes can also last longer than a few days.  My youngest didn't feed for 17 days when he was in his second year; painful attempts at feeding during an episode of hand, foot and mouth left him still not feeding long after they had cleared!  From this list of "Top Tips" the one I would echo most is ambivalence.  In the end what killed the strike for us was me reading a book and paying absolutely no attention - he decided eventually to latch and one he realised it didn't hurt, didn't look back.  Others may as mentioned not go back to the breast - but I hope by sharing my observations it may help parents avoid the common "weaning traps" if they want to.

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