Please read the Disclaimer at the end of this page.
INTRODUCTION — Breast milk is the optimal source of nutrition for virtually all babies. It meets essentially all of the nutritional needs of full-term babies until approximately six months of age, when solid foods are usually added to the diet. Partial breastfeeding is recommended until the baby is at least 12 months old, and thereafter for as long as you and your child choose to continue.
Partial breastfeeding is defined as breastfeeding while also providing other sources of nutrition, usually beginning at approximately six months of age. At this time, soft puréed meats, infant cereal, and then puréed fruits and vegetables may be introduced slowly. Cow's milk and fruit juice are not recommended until a child is at least 12 months old. (See "Patient education: Starting solid foods during infancy (Beyond the Basics)".)
In this article, we use the term "breastfeeding" to refer to feeding an infant at the breast or chest. "Weaning" refers to the gradual process of stopping breastfeeding.
More information about breastfeeding is available separately. (See "Patient education: Deciding to breastfeed (Beyond the Basics)" and "Patient education: Breastfeeding guide (Beyond the Basics)" and "Patient education: Common breastfeeding problems (Beyond the Basics)" and "Patient education: Pumping breast milk (Beyond the Basics)" and "Patient education: Health and nutrition during breastfeeding (Beyond the Basics)".)
THE WEANING PROCESS — Weaning is defined as the gradual replacement of breast milk with other sources of nutrition.
When should I wean? — Weaning may be initiated by you or your child, or it may be a shared decision. Most children who "self-wean" do so between two and four years of age; it is uncommon for a baby younger than 12 months to self-wean. The duration of the weaning process varies from child to child. Some children will wean quickly while others will take months to completely wean.
Do I have to wean? — There are many possible reasons for wanting to wean, although it is rarely necessary to do so. There is no particular age by which weaning should be complete, and continued breastfeeding is not harmful to a child's development. If a health care provider or other clinician tells you that you must wean, it may be helpful to consult with someone who is knowledgeable about breastfeeding to explore your options. (See 'Finding help with breastfeeding' below.)
The World Health Organization advises that partial breastfeeding continue for up to two years and beyond [1]. The benefits of breastfeeding persist for as long as it is continued. Some of the benefits persist even after breastfeeding is discontinued. The benefits of breastfeeding for both you and your baby are discussed separately. (See "Patient education: Deciding to breastfeed (Beyond the Basics)".)
Pregnancy and breastfeeding — Breastfeeding is not a reliable method of birth control. Most people are able to get pregnant, even while breastfeeding, within the first three months after giving birth.
If you do get pregnant, you will most likely be able to continue breastfeeding if you wish. However, you will need to consume extra calories to meet your body's needs and those of your developing fetus and breastfeeding child. This is especially true if breastfeeding is exclusive (meaning your baby is not eating or drinking other foods). (See "Patient education: Health and nutrition during breastfeeding (Beyond the Basics)".)
Weaning and guilt — You may find that weaning is an emotional time for you and your child. It is not just a transition to another feeding method, but is the conclusion of a special relationship. Even if you and your child are both are ready for the weaning process, unexpected feelings of sadness may occur.
Some people struggle with feelings of guilt when they wean. Although this is a normal reaction, you should feel proud of any breastfeeding you have done, knowing that you have provided a wonderful start to your child's health and well-being.
During the weaning process, your child may need more attention and cuddle time to take the place of nursing time. You may find that some days your child needs to nurse after having nearly weaned completely. Being flexible and understanding will go far in the weaning process and help make it more comfortable for everyone involved.
HOW DO I WEAN? — When you are ready to initiate weaning, one option is to gradually eliminate one breastfeeding session every two to five days. Other ways to wean include shortening breastfeeding sessions slowly or lengthening the time between sessions.
It may be possible to wean a child from nursing during the day and continue breastfeeding at night; this may be a good option if you are unable to pump breast milk and need to be away from your child (for example, while working or attending school). The midday feeding may be a good time to start as children tend to be most interested in nursing at the first and last feedings of the day, when their need for comfort is greater. Pre-bedtime or nighttime feedings are usually the last to be eliminated.
However weaning occurs, you should watch your breasts carefully for any sign of pain, redness, or tenderness. These can be signs of plugged ducts or infection (mastitis). (See "Patient education: Common breastfeeding problems (Beyond the Basics)".)
Stopping breastfeeding all at once is not recommended because the breasts will become engorged, painful, and may develop mastitis. If breastfeeding must be stopped immediately for medical or other reasons, it may help to hand-express or pump milk a few times per day until your breasts feel comfortable (not empty) and milk production slows, usually over a few days (figure 1). Do not wait until your breasts are painful or very full to express milk. Wearing a well-fitting, supportive bra can be helpful. (See "Patient education: Pumping breast milk (Beyond the Basics)".)
Bottle or cup? — A child can be weaned to a bottle then a cup, or directly to a cup, depending upon their age. Children under 6 months of age may use a bottle while children older than 12 months can usually use a cup. Children between 6 and 12 months may use either a cup or a bottle. Weaning directly to a cup avoids the problems that can happen with bottle feeding, such as an increased risk of tooth decay and difficulty giving up the bottle (especially at night). A trainer cup with two handles and a snap-on lid with a spout may be easiest to manage.
When introducing a bottle, it helps if the baby is not extremely hungry, so that they may be more patient. It also helps if a caregiver other than the breastfeeding parent introduces the bottle.
Initial feedings from a bottle/cup may be easier if the bottle/cup contains expressed breast milk. Breast milk is sweeter than formula. Babies may be more willing to accept the bottle or cup if the taste of the milk is familiar. If the child is older than 12 months, cow's milk may be given instead of formula. (See "Patient education: Starting solid foods during infancy (Beyond the Basics)".)
The child should not be left with a bottle of milk or formula while sleeping. Falling asleep while bottle feeding can lead to "baby bottle tooth decay" and is not recommended.
When partially breastfeeding, try to offer the breast before the baby is hungry and impatient. After bottle-feedings have started, some babies get frustrated with breastfeeding because milk flow is not as fast from the breast as from a bottle. This may be prevented by selecting a bottle nipple with slow flow. Another suggestion is to pace the baby with the bottle so that a feeding takes at least 10 to 15 minutes, similar to a nursing session.
LIFE AFTER WEANING — As weaning occurs, you may find that your breasts begin to feel less full and may begin to become smaller. Most people's breasts will remain slightly larger than pre-breastfeeding. Some people will have stretch marks similar to those on their abdomen from pregnancy. These will fade to pale, silvery-colored areas over time.
Once breastfeeding has stopped entirely, your breasts will stop producing milk. Even after breastfeeding has stopped, there may be milk in the breasts for several months to years. You may notice drops of milk on occasion or may be able to express drops by hand. If your breasts become painful, hard, or reddened after weaning, you may have a plugged duct or breast infection; talk with a health care provider to determine if treatment is needed. (See "Patient education: Common breastfeeding problems (Beyond the Basics)".)
As you produce less breast milk, you will need to reduce the number of calories you consume to maintain your body weight. This may mean eating fewer snacks or reducing portion sizes. (See "Patient education: Health and nutrition during breastfeeding (Beyond the Basics)".)
FINDING HELP WITH BREASTFEEDING — Resources for finding a lactation consultant, peer support (online or in-person), and other types of support are listed in the table (table 1).
WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients and caregivers, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Weaning from breastfeeding (The Basics)
Patient education: Breastfeeding (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Starting solid foods during infancy (Beyond the Basics)
Patient education: Breastfeeding guide (Beyond the Basics)
Patient education: Common breastfeeding problems (Beyond the Basics)
Patient education: Pumping breast milk (Beyond the Basics)
Patient education: Health and nutrition during breastfeeding (Beyond the Basics)
Patient education: Deciding to breastfeed (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Common problems of breastfeeding and weaning
Dietary history and recommended dietary intake in children
Poor weight gain in children younger than two years in resource-abundant countries: Etiology and evaluation
Introducing formula to infants at risk for allergic disease
Introducing solid foods and vitamin and mineral supplementation during infancy
Poor weight gain in children younger than two years in resource-abundant countries: Management
The following organizations also provide reliable health information.
●National Library of Medicine
(https://medlineplus.gov/healthtopics.html)
●The Center for Disease Control and Prevention
(www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/weaning.html)
●The United States Department of Health and Human Services
(www.womenshealth.gov/breastfeeding/breastfeeding-home-work-and-public/weaning-your-baby/)
●The United Stated Department of Agriculture
(wicbreastfeeding.fns.usda.gov/weaning-your-baby)
●American Academy of Pediatrics
(www.healthychildren.org/english/ages-stages/baby/breastfeeding/Pages/default.aspx)
●Massachusetts Breastfeeding Coalition
(https://massbreastfeeding.org/)
●Breastfeeding On Line
●Working and Pumping
●Working without Weaning: A working mother's guide to breastfeeding,
Kirsten Berggren
