When not to wean

When should I not wean my child?

There are some situations in which it is best to continue breastfeeding even though mothers may feel it is time to stop. The age of the baby is not a reason to wean as there is no recommended time limit on breastfeeding. Mothers with mastitis are advised to continue, because an important part of mastitis treatment is removing milk from the breast. Breastfeeding does that well. Similarly, most mothers with breast abscesses are urged to continue. Weaning can occur once the breast is healthy. Mothers who wean their baby should make sure the baby can tolerate whatever takes the place of breast milk. Some babies can’t tolerate regular infant formula and may not like the taste of speciality infant formula. They should not be weaned until their diet can give them the nutrients they need. Mothers must also ensure that their choice of breast milk substitutes is safe, available, and affordable. 

A) Mothers with breast infections

Continuing to remove milk from the breast is an important part of the treatment of mastitis and most abscesses. The best way to do this is to breastfeed. Expressing may be less effective

Accordingly, mothers who have mastitis are strongly encouraged to continue breastfeeding on the affected breast. Similarly, most mothers with breast abscesses are encouraged to continue breastfeeding if their baby is not in direct contact with pus or infected tissue and the baby is able and willing to breastfeed. 

Mothers who want to stop breastfeeding after a breast infection need to do so slowly and carefully and at least two weeks after the infection has completely cleared. If not, the infection can take longer to clear or come back. Mothers also have the option of continuing to breastfeed only on the healthy side while letting the infected one dry up.

B) Babies who are not ready or able to be weaned

Mothers who choose to wean need to ensure that they can feed their baby in a way that is safe, available, and affordable.

1) Tolerating other milk 

Mothers should not wean their baby until they are sure the baby can handle infant formula or, if the baby is older than one year, cow’s milk. 

Mothers can try to combine breastfeeding with the use of other appropriate milk for a week or so to see how this agrees with the baby.  

Mothers may also want to have some expressed milk stored in the freezer in case the baby reacts to the other milk when weaning is completed. This will provide the baby with milk until mothers can see what other options there are for feeding. 

If the baby cannot tolerate other types of milk, it is possible to resume making milk (re-lactate) and breastfeeding , but it is a lot of work and may not be fully successful, especially if the baby is unwilling to return to the breast.

2) Tolerating specialty infant formula

Some babies are allergic to cow’s milk protein. Their mothers need to be on a diet free of cow’s milk protein while breastfeeding.  

These babies cannot tolerate regular formula based on cow’s milk and need extensively hydrolyzed or amino acid formulas. These specialty formulas taste bitter and babies may refuse them. They should not be weaned until their diet can give them the nutrients they need.

Mothers who are vegan and wish to avoid giving their baby animal milk must ensure that the baby will accept and tolerate soy infant formula or other appropriate and acceptable milk. Drinks based on plants such as rice, coconut, almond, hemp, soy, or potato look milky, but nutritionally they are very different from human and cow’s milk. They are not suitable for babies and are dangerous or even deadly.

3) Tolerating other feeding tools 

The feeding tool must be acceptable and appropriate to both mother and baby. Under one year of age, most weaned babies are fed by bottle. Some babies cannot drink from a bottle and may need other feeding devices. Cup feeding can be tried in such situations.

It is recommended that bottles be stopped by one year of age after which the baby uses a regular cup. 

4) Tolerating weaning  

Toddlers and older children may be emotionally dependent on breastfeeding. This is normal. When denied the breast, they may refuse other foods and drinks and be upset for days. This is hard on the whole family.

If you wish to proceed with weaning, you may need to tailor your plan to the child’s needs.

C) Inaccurate information

Mothers do not need to wean because of a child’s age (Grueger 2013). National and international recommendations place no limit on the duration of breastfeeding, because there are many benefits to mothers and older children. If you and your child are comfortable breastfeeding, there is no need to wean.

There are very few medical reasons that require weaning and most mothers and babies who are ill can continue to breastfeed. Similarly, most medications taken by breastfeeding mothers will not harm the baby. If you have been advised to wean because of medications you are using, discuss this further with your health-care providers or consult a breastfeeding specialist.

D) Pressure from others

Some mothers face many barriers to breastfeeding. They may be gently discouraged from breastfeeding or clearly told to wean by health-care providers or family members without a medical need to do so. If you are in this situation, consider using other resources to support yourself in your breastfeeding journey.

References

Grueger B; Canadian Paediatric Society, Community Paediatrics Committee. Weaning from the breast. Paediatr Child Health 2013;18(4):210