Yes, I'm "Still" Breastfeeding My Toddler

My third son, G, is now 31 months (that's 2 years and 7 months for those less month-county than I am). I had originally thought I would nurse him until he was two, as I had his older brother. However, during my fourth pregnancy, my milk dried up for the most part, several months before G turned two. I allowed him to continue to comfort-nurse and drink any colostrum he could extract, but I knew he wasn't getting all the benefits of breastmilk I had hoped to keep providing.

After Baby Y was born, when G was around 25 months, my breasts sprang back to life, overflowing with milk once again. I hadn't planned to "tandem nurse" - breastfeed more than one child at a time - but it sort of just happened that way. I hadn't stopped G from comfort nursing, and when he was actually getting milk again, he loved nursing even more.

In the early days, when Y was very little and needed to nurse often, I tried a few times to nurse the baby and G simultaneously. It was awkward and uncomfortable for me, but it was also the easiest way to please both of them.

Now, though, five months on, I don't try to nurse them simultaneously anymore. I leave the baby somewhere safe and happy, and I take G to his bed or mine. I find I don't mind nursing G by himself once in a while. It's a wholly different experience from nursing the baby. G only nurses once a day, at naptime, and not even every day. It's so easy to get him to lie down in bed and try to take a nap if I offer to let him nurse! It's incredibly cute how excited he gets when I agree to nurse him. He races down the hallway exclaiming, "I gonna nurse! You gonna nurse me! I gonna nurse! I gonna nurse in my bed!"

I've asked him what the milk tastes like, but all I get in response is "milk." Which is hard to argue with.

For those who are concerned about having enough milk for a toddler and a baby, you can absolutely nurse two children. Remember that your body makes milk based on the demand, so if you have a toddler and a newborn both demanding milk, your breasts will produce enough milk for both. See my series on nursing through pregnancy for more information about tandem-nursing a toddler and a newborn. My milk supply this time around is copious, partly because of my daily pumping in the first few weeks postpartum and partly because I nurse my toddler several times a week in addition to the baby's exclusive breastfeeding.

I never set out to be nursing a 2-1/2-year-old. I didn't have a specific plan for how or when to wean him completely. When his baby brother was born relatively close to his second birthday, I didn't think it was fair to G for Y to usurp his place at the breast at the same time he usurped his place as "the baby." We had long since night-weaned, so I didn't have the stress of trying to nurse two kids through the night. That might have affected how I felt about continuing to nurse him. Now, I would rather just nurse him once every couple of days than to deal with the tantrum and tears when I refuse. I'm sure if I refused enough times in a row, he would stop asking, but I don't see a reason to put us both through that stress right now.

I think when we talk about nursing an older toddler, one who speaks in complete sentences and has a mouthful of teeth and eats plenty of healthy foods and drinks water and juice and other milks, it's hard for people who haven't been there to understand that we're not just walking down the street, picking up a random toddler, and nursing him. We don't start out nursing a toddler. In fact, many women don't plan to nurse a toddler. Some mothers can barely look beyond the next day or the next week when they begin nursing their newborns. The progression from newborn to infant to toddler is so gradual that it seems natural once we're doing it. There's no switch that flips at one year or two years or 27 months or 33 months or September 4th or July 17th when it is suddenly no longer appropriate, necessary, or reasonable to be nursing a child. Most children will gradually wean on their own between two and four years of age, too busy with life to stop to nurse. But those children who continue to ask for it obviously still have a deep-seated need for the closeness of Mom, the sweetness of milk, the comfort of suckling, their first memories of shelter from the big, bad, scary world.

I think there's also a perception that when we say we're "still" nursing our two-year-old, or 27-month-old, or 34-month-old, that we mean we are nursing him like we would an infant, that he's coming to us six or eight or 12 times a day to feed, but it's not so. Most older toddlers nurse maybe once or twice a day, perhaps to help them fall asleep, or to go back to sleep at a night-waking. They may nurse more when they're sick, and it is a wonderful gift to give your sick child, the warm, disease-fighting, easy-to-digest milk tailored to his needs. But it's not the same as a newborn nursing for his sole source of nutrition, or an infant who only supplements his milk diet with solid foods.

How old is too old to still be nursing? Some would say once a baby has teeth, he should stop breastfeeding. Some say when the baby can ask for it, she should be weaned. Some say once he can ask for it in a complete sentence, he's too old. I think there's no rule. A child is too old to nurse when his own mother decides she is no longer happy or comfortable nursing him. A child is too old to nurse when he decides he doesn't need it anymore.

There was a wonderful research article written by anthropologist Katherine Dettwyler almost 20 years ago in which she set out to determine when a human child would naturally wean absent social constructs and societal pressure. Using several different methods based on other primates' weaning ages, she concluded that humans would naturally wean between 2.5 and 7 years of age, probably closer to the 4-6-year range. This is when the first permanent teeth start to come in (six-year-old molars erupt and baby teeth start falling out). She also examined other factors such as weight, length of gestation, and immune system development. All methods agree on that range.

I did not expect to continue to nurse G this long, but now I understand how it happens. You just... don't wean. Allowing a child to decide when he is finished nursing is called "child-led weaning" and is the most gentle and biologically normal way to slowly back away from breastfeeding. I don't think it will be long before I'm back to nursing just one baby. Often, G pops off and says he's done without falling asleep and without prompting. Many times, he tells me that "it's the baby's turn now" and sends me on my way. Interspersed are the days when he peacefully drifts off to sleep, one hand holding his blanket-lovey, the other resting gently on my breast. On those days, I unlatch him carefully (mindful of that mouthful of teeth), with a finger between his molars. Sometimes, he wakes up and runs off. Other times, he smacks his lips and re-settles, then sleeps for an hour or two on his own.

Will I still be nursing him when he's three? I don't know. I don't think so. I don't have a plan for when he has to stop breastfeeding. I'm sure he doesn't either. But the day will come, probably sooner than later, when Y gets all the milk to himself, and then some day, a few years down the line, my milk will dry up for good and I'll be done nursing forever. I see no reason to rush toward that day, and neither do my babies.

So You Want to Stop Nursing

There will come a time in your baby's life when you no longer want to breastfeed, or he no longer wants to breastfeed, or you come to some kind of mutual agreement that breastfeeding needs to stop. Or, sometimes, it's out of your hands and a medical condition requires you to stop breastfeeding. What do you do?

Well, some of it depends on the age of your baby. Unless there is a medical condition that requires prompt weaning, I personally would not recommend weaning before at least three months of age. I encourage and champion mothers to continue to nurse exclusively until at least six months, as per the AAP, WHO, and other health organizations' recommendations. I also encourage and champion mothers to continue to nurse in tandem with feeding other foods from six months to one year, and I also encourage and champion mothers to continue nursing beyond a year until they are ready to stop.

Alternatives to Total Weaning:

A few points to consider before you decide to wean completely, whatever your reasons:

• Sometimes cutting back to just a couple of sessions a day can make nursing more enjoyable. If your baby is over a year and eats well, you can introduce whole milk and try to cut back to only nursing once or twice a day. (This is partial weaning, and some tips for doing this will follow.)
• Just because a doctor prescribes a medication and says you can't nurse while on it doesn't mean that it's true. Doctors don't always know which medications are truly compatible or safe for breastfeeding, and they tend to err on the side of caution. If you need to take a particular medication, first find out if there is a breastfeeding-friendly alternative, or double-check if that medication is truly dangerous to your child or your milk supply. You can check Dr. Hale's Medications and Mothers' Milk or go to the Infant Risk Center's website and look up the medication, or give the Infant Risk Center a call at  (806)-352-2519.
• While in the thick of it, nursing for six months or a year may seem insurmountable, but it's really a very short time in the scheme of things. It will get easier as you go along, and while you may never enjoy nursing, it should become less of a chore. Stick with it for just a little longer and see how you feel.
• It's normal to sometimes feel overwhelmed by nursing, especially if you have a baby who nurses frequently. Set yourself small goals, like one more week or one more month or even just one more feeding. Often after a few days, that feeling will pass and you'll again be content to continue nursing. Sometimes life gets complicated and it seems like weaning would be an answer to the complications, but once things lighten up, nursing won't seem like such a burden.

Okay, but you really do want to cut back or stop. How?

First of all, no matter the age of your baby, I recommend taking it in gradual steps (if possible), rather than stopping cold turkey. If you're going from mostly breastmilk to mostly formula, it's going to be very hard on you and your baby to stop very suddenly. You will become very engorged and risk developing plugged ducts and mastitis. Your baby's system will be shocked by the change and he may become physically uncomfortable as well as emotionally upset. After about three days to a week, both of you will feel better, but I do not recommend cold-turkey weaning if it can be avoided, especially with a young baby.

Immediate Weaning of a Young Baby:

If you do have to stop immediately, here are a few ideas to ease the transition.

• If the baby won't take a bottle from Mom, try to have other people around who can help feed the baby while you wean: Dad, a baby-sitter, grandparent, etc. Sometimes a baby won't take a bottle when Mom is around because the baby wants to nurse.
• Make sure you still give baby lots of cuddles, hugs, kisses, and love. Sometimes having to wean suddenly, especially if you didn't want to, can make it hard to find ways to connect to the baby, and you want to make sure you maintain your closeness even when you can't offer the breast. 
• Remember: Even if you can't nurse, you can still co-sleep, do skin-to-skin, wear your baby, and find other ways to support your baby physically and emotionally. 
• You don't want to bind your breasts because that could cause plugged ducts and mastitis. 
• Chances are, you will become engorged as soon as you've missed the first feeding or two. You may express a small amount of milk to relieve any immediate discomfort, but removing milk will encourage your body to make more, so be careful.
• Other ways to help with the engorgement and dry up your milk:
• Cold compresses will help slow blood flow (and milk production) and ease some of the pain. You may also take a pain reliever.
• Cold cabbage leaves in your bra. Buy a head of cabbage and keep it in the fridge. Pull off a leaf and break the veins, then put it on your breast inside your bra. When it warms up, put a new one. Repeat as needed.
• Avoid warm water directly on your breasts, as this will stimulate blood flow.
• Try to avoid foods that encourage milk production, such as oatmeal and the spice called fenugreek often found in Indian food.
• Some women find that herbs such as sage and mint reduce their supply.
• As a last resort, medications such as pseudoephedrine (Sudafed) may reduce milk supply as well.
• This may be a difficult time for you emotionally. Be sure to continue to care for your baby in other ways. Ask your family and friends to help you watch out for signs of depression.

Milk Donation:

If you as the mother are the one with the medical condition requiring weaning, there are ways to continue to provide breastmilk to your child if you want. There are several mother-to-mother milk donation sites that match up willing donors with mothers in need. These include Eats on Feets, Milkshare, and Human Milk 4 Human Babies. Typically, the agreement is that one or more women will pump for the baby and supply you with their milk, and you will cover the costs of any shipping (if the donor is not local) and for storage bags. This can be a great alternative to formula, or you can feed your baby a combination of donated milk and formula.

If your baby has a medical condition that requires you to wean from breastmilk but you are not certain you want to dry up your milk, you can continue to pump and save your milk to donate via one of the sites mentioned above, or you may be able to donate to a Human Milk Banking Association of North America milk bank (HMBANA), a nonprofit organization which provides donated breastmilk to preemies and other babies in need. Helping other babies via your breastmilk may help you come to terms with the emotional loss of having to stop nursing your own baby.

Gradual Weaning of a Younger Baby:

If you do not need to wean immediately for a medical reason, weaning can be a much more gradual process.

To gradually wean a very young baby (under three months), you may just have to offer a bottle of formula instead of nursing when your baby shows signs of hunger. Slowly give more bottles and nurse less often until you've found the balance you want. Keep in mind that you may not be able to maintain a partial supply if you wean before three months postpartum. Again, I do not recommend weaning such a young baby from the breast, as those first three months are vitally important to his development, the population of his gut flora, his brain and eye growth, his immune system, and his bond with you. However, if your health or your baby's health depend on your weaning from the breast, then it may not be difficult. Some babies will reject a bottle, and it may be a matter of basically forcing the issue (a baby won't let himself starve) or finding an alternative feeding method until he is ready to take a sippy cup instead. Also, sometimes a baby will prefer one bottle over another, so it may be worth trying a few different brands.

Gradual Weaning of an Infant:

For an infant, the ease of weaning will really depend on whether your baby is willing to take a bottle, and if he tolerates the flavor of formula. As above, it may be as straightforward as replacing a breastmilk feeding with a formula feeding. Remember that until six months of age, the only thing your baby should be eating is breastmilk or formula. If he takes a bottle but doesn't like the flavor of formula, you can try mixing expressed breastmilk with formula and gradually increasing the ratio of formula to breastmilk until he's completely on formula. You may also need to experiment with the temperature of the bottle. Some babies prefer a cold bottle, while others will only take it warm. Some don't have a preference. If he doesn't take a bottle, it may be difficult to introduce one. For a baby over six months, you may try to increase his solids intake or try mixing formula with his cereals or vegetables so he gets the nutrients he needs. You can also try offering formula in a sippy cup or straw cup, as some kids won't mind drinking from a vessel completely different from the breast even if they don't like the bottle. From six months to one year, gradually increasing solids and decreasing feedings from the breast may be all you need to do, and taking several months to completely wean will make it a very gradual and comfortable process.

Remember that until one year of age, breastmilk and/or formula should still make up the majority of your baby's diet, not solid foods. Also, do not introduce whole milk until one year of age.

If your baby relies on nursing to fall asleep or stay asleep, you'll have to take that into account when you decide to wean. You may need to have someone else put the baby to bed for a few nights so that you can break the association of nursing and sleep. I'm not saying it's going to be an easy process, but after three nights to a week, your baby should be used to falling asleep without nursing. It may take a few tries to find what new technique works best, but some ideas to try are rocking, shushing, singing, using a pacifier, putting white noise in the room, swaddling (for younger babies), and patting.

Weaning a Toddler:

For toddlers, weaning may be both more difficult and more simple. Since toddlers can get all the nutrition they need from solid foods and cow's (or other whole) milk, you won't need to worry about introducing a bottle or giving formula. However, toddlers also know how to ask for (demand) what they want, and they've learned to associate nursing with comfort, care, and closeness and may ask for it even when not hungry. However, toddlers also start to understand language, so it can help to talk to them about the weaning process (in an age-appropriate way). You can use phrases like, "No nursing right now. Do you want a snack?" or "You can nurse after ____ (we get home, you eat some peas, we read this book, whatever)," for example.

Many websites will suggest that, to wean, you eliminate one session per day and offer food or water instead. This is not so simple if you're nursing "on demand" still or do not have a predictable nursing schedule. Here are a few other suggestions I can offer for weaning a toddler. I suggest choosing one of the following techniques and sticking with it for a few days, rather than trying several at once or switching from one to another randomly. As with anything else with a toddler, consistency is key.

1. Have a designated nursing area in your house. Only nurse there. It could be a special chair, the living room couch, your bed, his bed, etc, but be consistent. "You want to nurse? Okay, let's go to the nursing chair (or Mommy's bed, or whatever)." Sometimes a toddler will be too busy to actually want to go somewhere else and nurse. This can also discourage nursing when out and about (if you want to do that) because the "nursing place" won't be available.
2. Make a rule about when you nurse that your toddler can understand. Only nurse at night or when the sun is up. Only nurse for sleeping. Only nurse after a meal. Only nurse when we get home from X. Whatever works for your routine.
3. Rather than cutting back on the number of sessions, cut back on the duration. Start counting, or sing the ABC's or other song, or something that your toddler will understand the "end" of. Say that when you get to the end, or when you get to X number, that he has to stop nursing, and then make him stop. You can start out by not beginning the countdown until he's been nursing for a solid amount of time, and then gradually start the countdown earlier in the sessions once he's used to stopping at the end of it. 
4. As a last resort, you can try purposely drying up your milk. This may not eliminate the comfort-nursing, at least not at first, but if there's no milk, nursing won't be as satisfying. Again, this would be a last resort. There are herbs (such as sage and mint) that can cause your milk supply to drop, as well as medications that may have a similar effect. This information may be more useful to dry up your milk after you've weaned.

Remember that as you wean, you'll need to replace nursing with something else. Nursing isn't just about food, it's also about comfort, closeness, love, reconnecting, and snuggles. You'll need to make sure he's getting his nutrition from other sources, but you'll also need to meet his emotional needs by allowing lots of cuddles, hugs and kisses, telling him that you love him, and reassurance. 

I want to reiterate that I'm not saying weaning will be easy. Indeed, weaning can be very difficult. Yes, some kids wean themselves. Some begin to prefer the bottle over the breast and simply don't want to nurse anymore. Some mothers find that their milk supply dwindles on its own (such as during pregnancy), which discourages their babies from nursing. Some toddlers are just too busy to stop and nurse. 

If your baby isn't one of those, then weaning will be a challenge. If you decide to say no, you have to stick with it. Your toddler may scream and cry. He may throw a tantrum (he's a toddler, after all). He may hit and kick and claw at you. This depends on your kid, of course, and how he handles being told no (and how attached to nursing he is). You may need to physically separate yourself until he calms down. You will need to find ways to handle the tantrums safely. You can treat nursing and weaning just like anything else you want your child to learn: manners, how to treat friends, sharing, picking up toys, not throwing food on the floor, cooperating during diaper changes. Be consistent and firm.

You may also find that once you have gained some control of the situation, nursing will become more tolerable or even enjoyable. When you're nursing on your terms instead of your toddler's, and you don't feel that your toddler is taking advantage of you, you may find that you don't need or want to wean completely. In this case, you may also want to try the "don't offer/don't refuse" method, whereby you don't ask your toddler if he wants to nurse, but if he asks, you consent. Over time, the child may simply ask less often as he becomes busier and more interested in the world. This is called "child-led weaning," as opposed to "mother-led weaning," and it is a method that works well for some women who are not in a hurry to wean but don't mind cutting back. It also depends on how attached your toddler is to nursing.

If you have weaned or partially weaned your baby or toddler and would like to share how it went for you, please comment with your story. If you have questions for those who have been through the weaning process, please post them in the comments as well. Weaning can be a touchy subject, but at some point, all kids stop nursing, so weaning is relevant and important to discuss.

Read my story about nursing and eventually weaning my middle son, S, here. I haven't started weaning G yet, but I have been known to tell him no or put him off for a bit, either by distracting him or by offering food. He's also used to mostly only nursing in bed, so that has helped keep him from asking to nurse 20 times a day.

On Labels

I've recently come up with a theory about parenting. That theory is that once you put a label on a parenting choice, once you name it, you've suddenly created a division or cause that never existed before, even if the practice itself is as old as time.

For example:

"Cosleeping."

I think waaaay more parents "cosleep" than are willing to admit it. The number of parents I've talked to who mention something about their child climbing into bed with them, sleeping on their chest, having to be coerced or bribed to stay in their own beds, only being able sleep cuddled up with one of them, only being able to fall asleep if Mommy or Daddy is lying in bed with them, only being able to go back to sleep if allowed to climb into Mommy and Daddy's beds, far exceeds the number of parents who simply say, "Yes, we cosleep." Cosleeping is a term that loosely refers to any arrangement whereby a baby, toddler, or small child sleeps with a parent. People who "cosleep" (and call it that) typically went into it on purpose; that is, they said, "Yes, we're going to let Jack sleep with us." On the other hand, plenty of parents "accidentally" cosleep, in that Jack will only fall asleep or stay asleep if nestled on Daddy's chest or with Mommy's arm around him.

I'll never forget baby-sitting a four-year-old girl when I was about 12, and part of my instructions in putting her to bed was to lie down next to her and put my arm around her until she fell asleep. I think it's fair to call that cosleeping, even if it's only for a brief period. And how many times had her parents fallen asleep like that, only to wake three hours later and groggily stumble back to their own bed? But I bet they never said "We cosleep."

Granted, there are plenty of parents who absolutely, positively do NOT allow their child to be in their bed EVER. But I bet it's fewer than you think.

But, suddenly, when you ask someone if they cosleep, or you tell someone that you cosleep, or coslept, or plan to cosleep, or are trying to stop cosleeping, it becomes a weird parenting "thing" that only some people do, the crunchy ones, the ones who can't let their kids go. Believe me when I tell you, I want nothing more than for my child(ren) to sleep in their own beds so I can stretch out comfortably at night. But I'm too lazy to wake up all the way to nurse somewhere else, so I'm stuck curling up with GI for a while longer. (I don't really mind that much. If I did, I'd have changed it by now.) But my husband and I also think it's good for our kids to know that if they need the security of Mommy or Daddy curled up next to them, they can have it. Certainly NJ and SB sleep the vast majority of nights on their own at this point, but it's a fairly common morning that sees all five of us in the same bed. But then, I'm one of "those" parents who actually admits to cosleeping.

What else?

"Extended breastfeeding."

I think waaaay more mothers continue to nurse past the first year than are willing to admit it. I think even mothers who desperately wanted to wean at a year or who think it's odd or wrong to nurse a toddler might find it more difficult than they expected to suddenly withhold the source of comfort and nutrition that their beloved baby has relied upon her whole life. I think plenty of mothers continue to nurse a couple times a day well past the first birthday, if only because they can't find a way to stop, or they realize that just because they've flipped another page in the calendar doesn't mean a switch has suddenly flipped in the baby's head that says "okay, I don't need to nurse anymore." I think plenty of toddlers get to cuddle up to Mommy's breast once or twice a day, even if Mommy doesn't come out and say, "Yes, I'm an extended breastfeeder." There's a lot of stigma against nursing a kid who can "ask" for it in the Western world, especially in the U.S., and I think it's entirely probable that if the "practice" of "extended breastfeeding" were more acceptable, we'd find out that plenty more women are doing it than we expect.

I know I purposely nursed SB long past his first year (I weaned him at 25 months). I know I have every intention of nursing GI just as long. So maybe I'm an "extended breastfeeder," but, really, I think I'm just a mom who sensed that her son still needed his "nur" well into his second year of life. Anyway, I had no idea how to get him to sleep without it.

I know other women who wanted to wean at a year. Some did it. Others found it not to be such a simple prospect, for whatever reason. Are they "extended breastfeeders"? I don't think they'd call themselves that. I think they'd just say, "Yes, I'm still nursing," if asked. And so what? Do we need to label every last parenting decision we make?

Perhaps the labels serve a purpose. If we have a label, we can bypass a great deal of explanation and jump right into the arguing. Maybe this isn't such a good thing. Maybe if we were required to still explain ourselves before the other person has labeled us, then that other person would be more understanding. Instead of saying "We cosleep because...", when the other person has already decided that you're a ridiculous person because you "cosleep," maybe we can say, "I let Horatio sleep with me for a few months because it was easier to nurse him back to sleep that way than to have to get up and traipse all over the house." See, with that second statement, you're not a "cosleeper," you're just another tired mom who's trying to get as much sleep as she can. Instead of "I believe in extended breastfeeding because...", where now the other person already thinks you're a crunchy weirdo for nursing a kid who can ask for it in a complete sentence, maybe we can say, "Esmerelda really needed to keep nursing after she turned one because I still couldn't get her to eat a lot of nutritious foods and she didn't like cow's milk." See, now instead of being an "extended breastfeeder," you're just a mom who's trying to make sure her child is getting all the nutrition she needs to grow, and who wouldn't want that?

Labels help us put people into categories, but there are so many directions to go when you're parenting, and so many ways to interpret any given practice, that we end up with a stack of labels that we carry with us everywhere we go. I'm a "cloth diapering, extended breastfeeding, extended rear-facing, cosleeping, natural-birth-having, WAHM." But, I don't cloth diaper because of any great environmental philosophy, which is the first thing that comes to most people's minds when you say you cloth diaper, and I don't even cloth diaper 100% of the time. I do it to save money and because it's kind of fun (except for the poop in the washer part...). I am an "extended breastfeeder" in the sense that I believe babies still need to nurse well into and possibly beyond their second year, but I also don't see myself continuing to nurse to three or four years, like some other "extended breastfeeders." I am an "extended rear-facer" because I know it's much safer for my child to rear-face as long as possible because his neck and spine cannot withstand a crash force when facing forward until he's at least two years old. I had a natural birth almost by accident because I was more afraid of having interventions than I was of the pain, and not because I had any kind of "earth mother" or spiritual need to have one. And, I work from home because we can't afford to live on one income at the moment, but we both feel it's important that I'm here and available to our children. And I happen to like my job, anyway. So now, see, all those labels? Worthless. Because I've explained myself anyway, and I don't exactly fit most people's idea of what those labels mean, and I'm certain that almost no one does.

Tell me, what are your parenting labels? :)

Starting Solids!

I promised a post about introducing solid foods, and here it is!

GI turned six months on March 5. I had been anxiously awaiting that day for several weeks, planning how we would introduce solids, what he should eat first, how we would balance nursing and eating. I should have known after three kids that things come together fairly naturally if you let them. I did know, after three kids, that there were many different ways to introduce solids, and many different theories about what is best. The only things I can see that anyone seems to agree on these days is that you should wait until the baby is six months old.

With NJ, we followed our pediatrician's advice and started solid foods at four months. We did rice cereal mixed with formula for a week or so to get him used to the spoon and see how he did. We then started on pureed vegetables and fruits, like sweet potato, squash, peas, banana, pears, and apples. We did one simple food at a time, starting a new food every three to four days, and slowly built up to the "stage 2" foods and mixtures by the time he was six months. From then on, he had at least one or two meals of solid foods per day in addition to his bottles. We went ever-so-slowly and carefully, and I was afraid to give him finger foods because I was sure he would choke. I did eventually start giving him finger foods, like Gerber's fantastic Puffs, Cheerios, pasta, and bits of bread. It was a long time before he was just eating regular food with the rest of us.

With SB, we were more experienced and less nervous about the whole thing. And a good thing we were, because SB wanted nothing to do with purees. We started at six months, attempting to give him rice cereal mixed with breastmilk. He didn't like it. I found it was way more trouble to prepare food for him and to figure out what to give him than it was to just nurse him when he was hungry. It's likely that if we had pushed it more, he would have gotten the idea and eaten more solids sooner. I'm not saying we should have, just that I was too lazy. He nursed a lot well into the second half of his first year. It wasn't until after he was a year old that he was actually replacing breastfeedings with solid foods. He would eat bits and pieces of solid foods, crackers, pasta, peas, Puffs, cereal, melon, and so on, but he wouldn't be satisfied until he'd nursed.

So with GI, I thought it might be nice to do a combination. Maybe he could have purees sometimes and finger foods other times, so that we'd have options. I wanted the freedom of being away from him for more than two hours without worrying if he was getting hungry, so I thought if my husband or a babysitter could give him a meal of a puree, that would help. So we started with rice cereal mixed with breastmilk, which he found yucky, of course. I then tried mixing rice cereal with purees instead, which he actually sort of took to. He was very interested in the spoon. I tried to make it a point to give him some puree at least once a day, but he didn't eat much of it. He kept trying to steal food off my plate. So I finally just started giving him bits and pieces of whatever we were eating - bread, a pea, cereal, etc. I stay away from anything too acidic - citrus, tomatoes - or things babies really shouldn't have, like honey, and I don't want him to have dairy yet, but almost anything else, I'll let him try. He had a bit of avocado today, and a few peas. Some days, he gets some tortilla or bread. My friend's son had a big birthday party the other day, and there were roasted vegetables, so GI got some scraped-out bits of squash and zucchini and a little carrot and a banana. Whatever seems soft and small enough for the toothless little guy to manage, I'll let him try. He seems to enjoy it, but he only takes a few bites before he starts refusing.

There is research to suggest that babies who are allowed to go at their own pace with finger foods are less picky and healthier eaters as they grow up. It seems that being fed purees means that the baby doesn't have control over what he eats, how much he eats, and he doesn't learn to differentiate foods by texture, shape, and color, since it's all just liquified. I'm not sure how much I agree with this, but it's interesting to think about. That's why I figured a combination of finger foods and purees might be the way to go this time. I'm not going to force-feed anything, and if he doesn't want something, he doesn't want it. He's still going to mostly nurse for a while. He's seven months old today, and I'm hoping to continue to slowly increase his solids intake.

I did try leaving him with a babysitter last week. I gave her about half a jar of squash puree mixed with a some rice cereal for texture, and he ate almost all of it for her. He'll eat solids for other people more than for me, which makes sense, since when he's with me, he just wants to nurse. I did find that he still practically leaped into my arms when I got home. It seemed like even though he wasn't necessarily terribly hungry, he didn't feel satisfied until he could nurse. It's kind of nice to be pounced upon like that. Makes you feel needed.

The process of introducing solid foods can be referred to as weaning, in the sense that you are slowly replacing breastfeedings (or bottle feedings) with other foods. By one year, babies can be taking in at least half of their caloric needs from solid foods, maybe more. It depends on your kid, of course. Some babies just aren't that interested in solids at 12 months, and that's okay too. Obviously, at some point, they're going to have to subsist solely on solids, but it doesn't have to be at one year, or even at two. Your breastmilk is still supplying vitamins, minerals, fats, proteins, and sugars, along with anti-inflammatory agents, antibacterial and antifungal substances, stem cells, and all the other things that make breastmilk so great.

And the realization will come, at some point after starting solids, that if you plan to replace nursing with solids, you'll actually have to prepare food for your baby instead of just sitting down and nursing! I'm realizing that I'll now have to cook for three kids, not just two. Why rush that?

Breastfeeding: All or Nothing?

I read an interesting point in a blog post recently, and I only wish I could remember which blog, because I read so many and rarely keep track of who said what (bad blog reading, I know). In any case, the point was that while you can choose not to breastfeed, you can't then later choose to switch to breastfeeding. However, you can choose not to formula-feed and then later choose to switch to formula if your situation calls for it. Basically, you've got to start out breastfeeding, and then make the choice either to continue or let your milk dry up and switch to formula.

This isn't exactly true, of course. It is both possible to relactate - that is, ask your breasts to start making milk again after having let your milk dry up - or to induce lactation - that is, ask your breasts to start making milk even if you never even had a baby. Some adoptive mothers do the latter, inducing lactation by tricking the body into thinking it's pregnant and then tricking the body into thinking it's delivered a baby through the use of hormone therapy and 'round-the-clock pumping. It's not easy, and it doesn't work for everybody, but it can be a very rewarding effort if you wanted to go that route. As for relactation, it's nearly as difficult. It's possible to bring your milk back in within the first few months after giving birth if you pump about every two to three hours around the clock for several weeks, as well as putting baby to breast as often as possible (if possible), but it takes serious dedication. After my first son was born and had been on exclusively formula for about four weeks, I thought about relactating. I spoke with a La Leche League leader about it, and she said I'd basically need to treat my breastpump like a newborn, pumping at least eight times in a 24-hour period (including in the middle of the night). She also said that since I had never established a full supply to begin with, it might never be possible to do so. I gave it a half-hearted effort, but never really was able to extract more than a few drops of milk, and I gave up after a couple of weeks of seeing no change.

So if you think you probably do want to breastfeed but you're not sure, you should start out doing so. Bring in your milk, breastfeed your new baby, and if for whatever reason you decide you don't want to do it, or there is a medical or psychiatric reason that you shouldn't or can't do it, you can always stop, wean to formula or bottles of donated breastmilk, and let your milk dry up. But, if you don't bring in your milk and start breastfeeding, it's pretty darn difficult, if not impossible, to change your mind six weeks in.

So in the beginning, yes, breastfeeding is "all or nothing." That is, either you do it or you don't. But, once you've established your supply and the baby has learned to feed effectively, and you give it a few weeks, or months, or years, things become a bit more flexible. For example, let's say that after six weeks, your maternity leave ends and you have to go back to work full time. You intend to pump and have your baby drink your milk from a bottle while you're separated from her. This would be ideal if you can't be with your baby all day, which many, many women can't. But, what if you just can't pump enough milk? Some women's bodies just don't respond well to the breast pump, and they can't produce enough, or they can't produce anything at all, or they can't keep up with their baby's needs by pumping. Other women's jobs are not ideal for pumping milk. Even though new federal law requires most workplaces to provide adequate break times and space for pumping milk, it still may not be entirely possible. Does this mean you have to stop breastfeeding and give your baby formula?

No!

Certainly, and I stress this because I believe it, it is most desireable to feed exclusively breastmilk for at least the first six months of your baby's life. That is the general recommendation from the AAP, the WHO, and other health services. Breastmilk is the best food for your young baby, and if you can provide it, and you will provide it, then you should provide it. The enormous benefits to your baby's (and your!) health, from nutrition to immune system to brain development to priming the digestive system, make exclusive breastfeeding the natural choice for every baby.

However, some breastmilk is better than no breastmilk. If you simply cannot provide exclusively breastmilk to your under-six-month-old baby, then continuing to nurse as much as you can is still good! Even if that means you only nurse at night, or in the morning and evening before and after work, or three times a day, or just for bedtime, some breastmilk is better than no breastmilk.

After six months or so, once you've introduced solid foods, you are no longer exclusively breastfeeding anyway. The benefits of breastmilk never go away, of course, so if you can continue to breastfeed as your baby's major source of nutrition, you should go on doing so. But, if you've given it six months and you're going a little nuts, backing off at this point is not as harmful, since your baby is eating other foods anyway. Remember that solid foods cannot and should not replace breastmilk and/or formula as your baby's major source of nutrition until after 12 months of age. Especially early on, six or seven months of age, solid foods shouldn't be more than 5 to 10% of your baby's daily intake. By one year, solid foods may be up to closer to 50% of your baby's intake. After one year, solid foods can be the majority of your baby's caloric and nutritional intake. Between six and 12 months, if you do decide to breastfeed less, you should replace most of the feedings with donated breastmilk or formula, not solid foods. One to three small meals of solids should be fine, but babies still need breastmilk or formula to thrive at that young age.

The AAP recommends breastfeeding for at minimum of one year. The WHO says two years. By one year of age, many babies are eating a fair amount of solid foods. At this point, you can choose to wean without taking away a significant portion of your baby's diet. However, if you want to continue to nurse, you certainly can. There is no psychological or physical harm to continuing to nurse to two years or beyond. The value of breastmilk and breastfeeding is not diminished just because the Earth has circled the sun one time since your baby was born. But, toddlers can survive on solid foods, assuming you are providing a variety of foods to create a balanced diet for your child. Children under two still need milk fats for brain development, either from your own milk, cow's milk, other dairy products, or another source. I am not a nutritionist or pediatrician, so I can't make a recommendation about what sort of milk to feed your toddler to replace breastmilk, but most pediatricians will tell you to give whole cow's milk to replace breastmilk or formula after one year of age.

If you do decide you want to wean at one year, you may need to start cutting back slowly. What you may find is that once you're down to two or three feedings a day, instead of six or seven, for example, or once you find that you no longer need to pump at work, breastfeeding may become an enjoyable break, rather than a burden or responsibility. Cuddling up with your toddler to nurse at bedtime or for an afternoon snack may be a time of closeness you and your toddler need during your otherwise hectic days. At this point, breastfeeding really isn't all or nothing. Weaning doesn't have to mean stopping completely, and weaning can be a slow, gentle process. I know of women who continue to nurse just once a day for months before they or their child finally drop that last feeding. I also know of women who continue to nurse six times a day, or more, throughout the second year. I found that SB gradually cut back over the course of his second year, until he was really only comfort-nursing at night. By the time I cut him off at 25 months, I didn't even get engorged, he was nursing so rarely and so little. A slow weaning process is more comfortable for both mother and child.

I don't really feel comfortable encouraging anyone to cut back on breastfeeding until her baby is at least one year of age. I wouldn't be writing this blog if I didn't feel that women should be supported and encouraged to choose exclusive breastfeeding. However, I also don't think it's fair to insist on breastfeeding as the only right choice, as if you either breastfeed or you don't. I think that places a lot of burden and blame on women who, for whatever reason, choose to use some formula. I also think it's important to let women know that breastfeeding some of the time is better than not breastfeeding at all. Just like some exercise is better than no exercise, and eating some vegetables is better than eating no vegetables, and getting some sleep is better than getting no sleep, breastfeeding some of the time is better than breastfeeding none of the time. To keep some supply, you have to breastfeed regularly, but if, for whatever reason, you don't breastfeed all of the time, that doesn't mean you have to stop completely.

I've been thinking about NJ's early weeks on this Earth, where he was getting perhaps 3 ounces of breastmilk per day when I pumped for him. I asked my LiveJournal audience if that measly 3 ounces a day mattered. I wish someone had said, "YES! Any breastmilk is better than no breastmilk!" I wish someone had said to me, "Try just nursing once a day. Maybe you'll find you want to try for a second feeding, and then a third." I wish I had known I could combination feed, or bring up my supply over time, as I healed, rather than just stopping. I wish I had known how important it could be in the future. I wish I had known how badly I would feel about stopping.

It is those regrets that drove me to two successful VBACs and two successful subsequent nursing relationships. (I've officially made it to six months of breastfeeding with GI, and we started solids a couple of weeks ago but are still mostly nursing. I'll be blogging about that soon.) It is also those regrets, and my subsequent successes, that drive me to write this blog. So I say, Yes! Do breastfeed! Give it a shot. Give it six weeks.  Breastfeeding some is better than not breastfeeding at all. Some breastmilk is better than no breastmilk. And it is not all or nothing.

Most importantly, find help and support so that you can meet whatever goals you have set for yourself. Knowing that you've reached or surpassed those goals will allow you to look back with pride rather than with regret or guilt.

Breastfeeding Basics - Part V: Six Months to One Year

Thanks for sticking with me so far. I recommend you read the previous posts in this series before jumping in here, unless you have a baby in this age range and you just can't wait to find out what wisdom I have to impart.

Introduction, Parts I, II, III, IV

By now, you should be quite comfortable with nursing. You've gotten this far, which means you've met the first part of the recommendations from the AAP, the WHO, and many other health agencies in exclusively breastfeeding for the first six months. Breastfeeding should be feeling quite routine by now. You know your baby's cues. You've gotten through growth spurts. Your baby may even have a tooth or two, or will very soon. Your baby is growing and healthy and doing all kinds of "tricks," like rolling over, and probably sitting without support. Some babies even begin crawling around six or seven months of age. Your baby is interactive, loves to play, grabs and holds objects of interest and brings them to her mouth.

Introducing Solid Foods


So what's next? Well, at six months of age, if you feel you and your baby are ready, you can begin to introduce solid foods! "Solid" foods means any food that is not breastmilk.

A few things you should know before I start:
First of all, you don't have to give solids if you don't want to or if you feel like your baby isn't ready. Some babies of this age still don't quite know what to do with food when offered, while others have been trying to grab and eat your PB&J for a month already. Breastmilk still provides all of the nutrients, fats, and sugars your baby needs. Before the age of one or so, any solid foods are just for practice, for baby to get used to new textures and flavors and to learn to bring food to the mouth, "chew" it, and swallow it. You don't have to worry if it seems like your baby isn't getting a "full meal" of solids at first. Getting a hunk of banana from the plate to his mouth is an accomplishment all by itself, and getting that banana into his mouth and swallowing it is another. That's why he needs to practice!

Do not give whole (cow's) milk until your baby is over 12 months old.


There are two ways to introduce solid foods. One is to begin with baby cereals and/or vegetable and fruit purees and feed your baby with a spoon. The other is to give your baby safe finger foods and let him learn to pick them up and eat them at his own pace. My first son insisted on being fed purees for a long time before he started understanding how to feed himself, while my second son wanted nothing to do with spoons and purees and wanted finger foods almost from the start. That's not to say he ate much at first, but he learned. Like I said, it takes practice!

So where and how to start? Well, you want to start with a simple food. Rice cereal (found in the baby food aisle - we're not talking about Rice Chex, here!) is a popular first food, for two reasons: 1) It is vitamin-fortified, so your baby is getting necessary nutrients (especially iron); and 2) Rice is basically a hypoallergenic food, meaning your baby is very unlikely to have any kind of adverse reaction to it.

The best way to prepare rice cereal is to put a small amount in a bowl and add some expressed breast milk until it reaches the texture you want. Then you feed it to your baby using a small spoon. He may not quite get the idea at first, or he may just not like the taste. Offer a small amount and see how he does. Give him a few tries before you give up. Try it in the middle of the day, when he is alert and happy, and offer the food after breastfeeding, or in between usual feeding times. You don't want solids to replace breast milk meals just yet!

You can also start with pureed vegetables or fruits. Bananas, avocados, squash, peas, sweet potatoes/yams, and pears are all great first foods. Most breastfed babies will prefer sweeter foods first, as breast milk is very sweet. You can peruse the baby food aisle at your local supermarket for ideas on first foods - the jars labeled "Stage 1" are generally bananas, pears, squash, sweet potatoes, or applesauce, all of which are good to start with. I don't have anything against jarred baby foods, but if you prefer to prepare your own baby food, simply steam your fruits or veggies until they are very soft, then put them in the blender until you achieve the desired texture. You can freeze the purees in ice cube trays and thaw one per meal (each cube is one ounce of food), or keep them in empty baby food jars in the fridge, or whatever other solution you like. There are lots of ideas out there on the web! Bananas and avocados don't need to be cooked. You can just mash them with a fork!

If you want to try the finger-food method, you want chunks of food that are big enough for the baby to grasp in a fist or between thumb and forefinger. Banana is fantastic for this, or steamed baby carrots. As your baby gets better at grasping and mouthing the food, you can offer other simple, soft foods, including well cooked pasta, peas, potatoes, etc. Always supervise your baby's eating!

When you introduce new foods, start with simple, one-ingredient foods at first so you can observe for any kind of allergic reaction or intolerance. Introduce one new food at a time and wait a few days before introducing another new food, so that if the baby does have a reaction, you'll know what he reacted to. For example, if you give banana on Monday as his very first solid food, give only banana for a few days. Maybe Thursday you'll introduce pears. For the next few days, only give either bananas or pears. Then on Sunday, you could add carrots. Then you can give bananas, pears, or carrots at any given meal, until you introduce a fourth food a few days later. And so on. Once you've accumulated a "menu" of options, you can offer mixtures, like a banana-pear puree, since you know he can tolerate both bananas and pears. As the baby gets older, you'll introduce more interesting and complex foods, but it's good to start simple and small.

There are lots of good websites out there with ideas on what kinds of foods to offer at what ages. Yogurt is an excellent food to offer around nine months of age. Hold off on allergenic foods like peanuts until after a year. There are also other baby cereals, such as oatmeal and wheat, that are good to add to your baby's diet, if you're going the puree route. Oatmeal has a much higher nutritional value than rice and has a more interesting flavor, as well. You can also just give your baby real oatmeal!

Also, don't give a baby younger than one year honey. Honey can cause botulism, a potentially fatal form of food poisoning, in babies under a year old. Cooking the honey does not kill the spores that contain the toxin. After a year of age, the baby's immune system is mature enough to handle the spores.

Other Developments


During the second six months of life, your baby is learning all sorts of things. His brain is developing incredibly fast. He'll start to recognize his name and other important words. He'll start crawling and maybe walking. Along with mobility and increased understanding comes distractibility! Your busy baby may not want to stay at the breast for a long time anymore, which may be good news for you. He'll eat fast and then hop off to go explore again. Most babies nurse faster and less often after six months, which means you're no longer "tied" to your baby. Plus, once you've successfully introduced solid foods, you can get away for a couple of hours without having to worry about leaving a bottle. Whoever is caring for your baby can give him solid foods to keep him busy until you get back to nurse him! Remember that babies under a year old should still be getting the vast majority of their calories from breast milk, so don't let solids totally replace breastfeeding yet.

By the time your baby is approaching 12 months of age, if he is eating solids well, you may be able to start cutting back on nursing if you want. There is no need to cut back or stop if you don't want to! "Extended" breastfeeding past 12 months is still very beneficial for both you and your baby. In fact, the WHO recommends continuing to breastfeed until at least two years of age! We'll talk more about "extended" breastfeeding in the next section on toddler nursing.

But, if you're ready to stop at a year, I'll still say congratulations! You nursed your baby for a year! You made it! If you want to wean, you can start replacing breastfeedings with whole milk (at 12 months) in a cup or bottle and/or with meals of solid foods. Your baby needs the fats from some kind of milk (breast milk, cow's milk, goat's milk, soy milk, almond milk... something like that) for his brain development, so you'll want to make sure he's getting some kind of milk to drink. Weaning from the breast should be a slow process, for yours and baby's sake. If you wean abruptly, your baby will be very unhappy, and you may have to contend with engorgement and other discomfort. Instead, try cutting back by one feeding every few days, to give your breasts time to adjust milk production to the new, lower demand. If you want, you can continue to nurse once or twice a day, e.g. before bed and first thing in the morning. If you want to stop completely, those two are probably the last ones you'll be able to eliminate. Mid-day feedings are the easiest to replace with other foods.

The next and last post in this series will be about toddler nursing, which is a whole new source of enjoyment and frustration. You may have a taste of toddler nursing already, with nursing gymnastics, distractibility, and new habits that may not be totally desirable. But hopefully you're also finding new reasons to enjoy nursing.