Expert: Sally Wendkos Olds - 9/12/2008

Question
Hi Sally! Please help me...my 10 month old daughter cannot get to sleep without breastfeeding. She even wakes up in the middle of the night looking for her "ninny". How do I get her to stop breastfeeding? She has teeth now and it is very painful because she like to chew while nursing. Thank you!

Answer
Dear Tiffany,

First, congratulations for giving your daughter the best start in life by breastfeeding her!

The first thing you need to do now is teach her to stop biting! Ouch. I am attaching an excerpt from my book (see below) about this. I'm also attaching an excerpt with suggestions for weaning her.

In terms of putting her to sleep, it sometimes helps if someone else can put her to sleep. For example, when I was taking care of my breastfed granddaughter who always nursed herself to sleep, I rocked her and sang to her and eventually she corked off. Maybe it will work for you too.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with pediatrician Laura M. Marks, M.D.
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How to Discourage Biting
A baby who is actively nursing cannot bite. Biting happens most often toward the end of a feeding, or when a baby is about to fall asleep. Babies are smart: Once they realize that every time they start to bite, they get taken off the breast, they learn that this kind of behavior isn’t getting them what they really want, and they’ll stop. The following suggestions work well:
• As soon as your baby starts to bite down on your breast, withdraw your breast. Break the suction by inserting your finger in the corner of his mouth.
• As you take your breast away, look your baby in the eye and say “No” firmly but gently . Do this every time your baby tries to bite.
• Do not smile when you say this; your baby may interpret this as a game you’re playing. You might even look at your baby with a sad expression. Any baby old enough to bite can read facial expressions.
• One mother we know begins socializing her children by saying, “That hurts Mommy. We don’t hurt other people,” as she takes her biting baby off the breast. She repeats this same litany over and over again as her children grow into toddlers, providing a continuing way to teach them not to kick, hit, or do other hurtful acts.
• If your baby is teething, give her a cold washcloth to bite down upon just before you nurse her. Also give her special teething toys and foods, such as biter biscuits and bagels. (Be sure to watch your baby closely to be sure she doesn’t break off a piece that she can choke on.) If the baby seems to be in pain you can use an over-the-counter pain reliever like infant acetaminophen (Tylenol ®).
• Try putting him down, walking away for a moment, and then returning to put him back on the breast. When you return, be gentle as you tell your baby “Be gentle.”
• If you can anticipate when the biting is likely to start, take your baby off your breast ahead of time.
• If your baby keeps biting, keep your finger close to her mouth and watch her carefully; as soon as she stops nursing actively or looks playful, remove your breast.
• Or quietly say your baby’s name while drawing him close to you; this distracts him and gets him back to nursing.  
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  HOW SHOULD YOU WEAN?
There may not be a right time to wean, but there is definitely a right way -- gradually if possible, sympathetically, and with a positive attitude. Weaning is a natural process; the natural way to help it along is to do it little by little, over a period of some weeks, or even months.
  Weaning represents a positive growth experience for both you and your child. It's a sign that your child is able to become independent of you in one important way and, as such, is the first step in a series of independent steps. It's best accomplished slowly, bit-by-bit. Gradual weaning is best for both of you. If you wean slowly, for example, you should have little or no discomfort from milk pressure. If you can possibly avoid the physical and emotional discomfort for both of you of doing it "cold turkey," do so. If there is no alternative, see the section on "Sudden Weaning" later in this chapter.
  You'll want to make yourself as available to your child as possible during the weaning process. Since she's losing something she has valued greatly -- the pleasure of suckling at your breast -- she needs the reassurance of your love and comforting. If you can devote extra time to her now, this should be heartening. While you don't need to feel guilty or apologetic, you do want to recognize the adjustment she's making and help her make it more smoothly through your loving understanding.
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MOTHER-LED WEANING
If you're ready to wean, but your child hasn't shown any sign of losing interest, you may want to start the ball rolling yourself.
  If possible, try to initiate weaning at a time when your child does not have to make other adjustments. If he's teething or has a cold, or you've just gone back to work, or there's a new babysitter, or you've just moved, or there's some other major disruption of routine, put off the weaning for a few weeks. It's always easier for children (and adults, too) to manage only one change at a time.
  First, pinpoint the nursing session your child shows the least interest in. It will probably be the early evening or noontime feeding. Eliminate this one first.
  If your baby is under a year old, you may want to substitute a bottle. Most babies enjoy sucking on a bottle until they're well past a year, but not all find them appealing. If your baby doesn't seem interested in drinking from a bottle, don't try to force it on him. Instead, substitute something else, like a cup of milk (formula if your baby is under a year) or juice, or a few spoonfuls of applesauce.
  For an older child, the substitution can be any of a number of things -- a game, a cuddle, a walk to the park, a reading session with a favorite book, a piece of fruit or other healthful snack. Most important is your involvement with the activity, so that you show your child that you can show your love for him in many ways. For suggestions on weaning the older nursing child, see Box 18-2.
  Wait several days, up to two weeks, and then eliminate the next lightest feeding of the day. Keep doing this until you're down to one nursing a day, probably the first one of the morning or the last one at night. By now, you'll be producing very little milk and your child may give up this last feeding easily. Or you may decide to continue this one favorite feeding for a while longer. Many babies wean easily during the day but want to continue nursing at bedtime for some time. Weaning this way should take from a couple of weeks to a couple of months or longer.
  
  BOX 18-2:  SUGGESTIONS FOR WEANING THE OLDER CHILD

  *  Make an agreement with your child about the places that nursing can take place. For example: only at home, in the car, or in a friend's house, but not in a restaurant or other public place.
  *  Make nursing sessions shorter.
  *  Use distraction. Before a child might ordinarily nurse or as you're bringing a brief nursing session to an end, involve her in an interesting activity.
  *  Offer something your child likes to eat just before he would ordinarily nurse. It's better to forestall a request to nurse than to deny it.
  *  Change your routine. At a usual nursing time, go out for a walk or a ride, or invite a playmate over, or bring out a new toy.
  *  Stay away from the places where you ordinarily nurse. If you're used to nursing in a special chair, hide it or move it out of your home temporarily. If you usually nurse in bed, sleep somewhere else or put your child to bed somewhere else.
  * Don't sit down in front of your child, since many little ones associate sitting down with nursing time. Just keep on the move in the early days or weeks of weaning. Think of it as another opportunity to exercise!
  *  Do not uncover your breasts in front of your child. This will remind him of nursing when he may not have been thinking about it.
  *  Lavish physical affection on your child in activities not associated with breastfeeding, such as reading a picture book, telling stories, or singing. Try one of these during the night.
  *  Enlist your child's favorite people. Ask her father, or grandmother, or an adored babysitter to get her up in the morning or put her to bed, or to go to her in the middle of the night, depending on which nursing session she asks for. [The first time I put my granddaughter to bed without her mother around, who had always nursed her to sleep, I got her to sleep by taking her into my arms in a rocking chair and singing every song I could possibly remember. I think she went to sleep in self-defense, so she wouldn't have to put up with my singing!]
  *  Focus on eliminating the nursing sessions that are least important to your child and most inconvenient for you, and let the others continue for a while.
  *  Talk to your child about weaning as a definite occurrence in the future (after the next birthday, perhaps, or after Santa Claus comes). Even if there's some backsliding after these events, your child will think of nursing as ending someday. One mother told her three-year-old a story about a little rabbit whose mother said, "I love you and I love to nurse you, but my milk is going away and it's really special milk for babies."
  *  Emphasize what a big boy or girl your child is. Stress some of the benefits of getting older, like going to nursery school, having play dates, not wearing diapers any more. Focus on the many things he can do for himself, like dressing herself and using the potty. Talk about nursing as something that's important for little children but not for big ones. One mother told her three-year-old that if she was old enough to chew gum, she was too old to nurse. The little girl was not about to give up her sugar-free bubble gum and never asked to nurse again.
  *  If your child is over three, you might be able to make a contract -- to promise some special "big boy (or girl)" outing or treat one week (or whatever time period you set) after the last nursing. A child younger than this won't be able to keep his end of the bargain -- and even a three-year-old might not be able to.
  * Ask your child to postpone a nursing; this will sometimes lead to his forgetting it. A child who asks to nurse in public, for example, can often accept waiting "until we get home." At some times he'll dash into the door and climb onto your lap to collect what's been promised; at other times he'll become interested in something else.
  *  While you're weaning, continue to be willing to nurse your child at times when she's especially needy. If she hurts herself or is sick or unhappy, depriving her of the comfort she's used to will only create more unhappiness for both of you. Once she's weaned, you'll be able to comfort her in other ways.
  *  Stay away from traumatic techniques like painting your breasts with pepper, soot, or evil-tasting substances. Allow your child to keep his happy memories and his trust in you. The best way to end this stage in your child's life is through an agreement between the two of you -- even if that agreement originates with you rather than your child.
  * Recognize those times when nursing is just what your child needs. As one mother said, "A lot of times when he asks to nurse I can distract him, but when he really needs it, I nurse -- and then she's in a super mood and so it's good for both of us."