Hey Laura, my doctor told me to wean my 18 month old

A friend writes:

So, at my son’s 18 month checkup, my doctor told me that there’s no point in nursing anymore because “don’t you know there’s no nutritional value to him anymore?” I was irritated because I’m pretty sure that’s not water coming out of my boobs! But I don’t have anything to back me up on that and hope you can help. Also, what are the nutritional needs of a toddler anyway? He eats well, but I definitely rely on nursing him to fill in the gaps. What will he need if/when he does wean? By the way, we’re mostly vegan but for an egg here and there.

Allow me to clamber up on my soapbox and rant a bit. It absolutely infuriates me to hear about doctors making offhand comments that are completely unsupported by scientific evidence. How many other things is he

lying to

mis-informing you about, based purely on his own prejudices or mental laziness? 

By saying discouraging things about your breastfeeding relationship with your son, your doctor is violating the guidelines presented here by the American Academy of Pediatricians (of which he is likely a member):

Babies should continue to breastfeed for a year and for as long as is mutually desired by the mother and baby. Breastfeeding should be supported by your physician for as long as it is the right choice for you and your baby.

If I were you, I’d mail him a copy of this blog post and your resignation from his practice. You can definitely do better!

Okay, done shouting. :)

The Facts
This is the nutritional value of breastmilk in the second year. Contrary to the all-to-common opinion of many doctors, grandmothers, and nay-sayers, breastmilk doesn’t turn to water at midnight on the 12th month!

In the second year (12-23 months), 15 ounces of breastmilk provides:
29% of energy requirements
43% of protein requirements
36% of calcium requirements
75% of vitamin A requirements
76% of folate requirements
94% of vitamin B12 requirements
60% of vitamin C requirements
(Resource: Kellymom.com’s excellent extended breastfeeding fact sheet.)

Besides nutritional value, your breastmilk will continue to provide immunological benefits to your child as long as you continue to nurse/pump. In fact, some immune factors in your milk become more concentrated* the longer you nurse (as if the body knows it has fewer chances to get the good stuff into your kid as he gets more distractible and nurses less!). Best of all, extended breastfeeding provides a much-needed emotional connection during the rocky toddler months ahead. Speaking from experience (I nursed my first until the eve of her 3rd birthday), nursing through the “Terrible Twos” can be an excellent strategy for avoiding meltdowns and prolonging the occurrence of the afternoon nap!


When to Wean, Then?
Ultimately, it is entirely up to you and your child. The World Health Organization recommends exclusive breastmilk (I don’t want to discount the exclusively-pumping mamas!) until 6 months. “Thereafter, infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.”

I like the way that last sentence is worded by the WHO, because it designates table food as complementary to breastmilk up to 2 years of age. From my experience and observation, that’s been pretty accurate - while table food is fun for babies, it is a rare child who consistently eats enough table food (especially before about 18 months!) to sustain him! Whether it’s breastmilk or formula (or just cow’s milk), many toddlers are still getting most of their fat and calories from a liquid source.

The La Leche League has an excellent article on the optimal age for weaning. It gives an overview of some optional weaning criteria based on the practices of other mammals (in particular, primates), and suggests that:

The human primate data suggest that human children are designed to receive all of the benefits of breast milk and breastfeeding for an absolute minimum of two and a half years, and an apparent upper limit of around 7 years. Natural selection has favored those infants with a strong, genetically coded blueprint that programs them to expect nursing to continue for a number of years after birth and results in the urge to suckle remaining strong for this entire period. Many societies today are able to meet a child’s nutritional needs with modified adult foods after the age of three or four years. Western, industrialized societies can compensate for some (but not all) of the immunological benefits of breastfeeding with antibiotics, vaccines and improved sanitation. But the physical, cognitive, and emotional needs of the young child persist. Health care professionals, parents, and the general public should be made aware that somewhere between three and seven years may be a reasonable and appropriate age of weaning for humans, however uncommon it may be in the United States to nurse an infant through toddlerhood and beyond.  [My emphasis.]

Isn’t that neat? I love that breastfeeding is so much more than just nutritional; by nursing your toddler, you’re providing for many other biological and emotional needs!

The truth is, weaning doesn’t have to be a huge ordeal. If you let him take the lead and let your nursing relationship run its natural course, you’ll probably have the easiest time of it. That said, since it is a relationship, you can have a say in how often and when (and where!) nursing occurs. By this age, he’s likely only nursing for at sleep times and wake-ups, with a few security suckles when the need strikes (and at this age, you will probably go through a few more developmental hurdles that will have him at the breast constantly for a few days or weeks at a time, as he processes his new view of the world!).

The longer you wait to wean, the easier it will be to communicate with your child about weaning. All I had to do was spend a week preparing my daughter for her Last Nurse before she became a Big Girl on her third birthday. We made a big huge exciting deal of it and because she was mature enough to cognitively understand the cut-off, she only cried once about it and recovered quite quickly thanks to creative distractions. The earlier you try to wean, the more work you’ll have to put into it. A lot like potty training, I think! :)

One last thing, though, I would not advise you to try to modify your nursing schedule, let alone wean, between 18 and 24 months. Not only is there just way too much going on developmentally that will not only interfere, but is so much easier to weather when you can nurse through it all! Read the comments on (my favorite parenting blogess) Moxie’s 18-month old commiseration post. If you’re not already in the thick of it, you will be soon. Just hang tight and wait until he’s past the major upheaval!

Toddler Nutritional Needs
According to a nutritionist at Parenting.com toddlers (children aged 1-3) need:
Toddler RDA

Those numbers can get a bit heady, so Dr. Sears comes to the rescue with handy-dandy charts of where to find those necessary nutrients.

Here’s the chart for the vitamins.

Here’s the chart for calcium. (Scroll down a ways.)

A lot of vegan parents get grief about calcium, since their little ones aren’t drinking milk, which the (lobbyist-influenced) FDA would have us think is the only and best way to get calcium. Here is a nice little write-up about vegan solutions for getting more calcium, by a registered dietician who is vegan.

Everyone ought to get most of their calcium from non-animal protein sources, by the way. The body uses calcium in the process of absorbing animal protein-derived calcium, so if you’re relying solely on milk and meat for your calcium, eventually you could become deficient even though you are drinking your 2 glasses of milk a day.

You also don’t want to rely on vitamin-fortified foods or highly processed food substances for your RDA. Go to the source, where nutrients are typically more easily and efficiently absorbed. If you’re up for it, you can absolutely offer pumped breastmilk in a cup to continue supplementing his table food; this might be a good way to eliminate one of the less (emotionally) important nursing without losing the nutritional benefits thereof.

One of the best online resources in this vein is the USDA National Nutrient Database. The mission statement of the USDA NND is:

To develop authoritative food composition databases and state of the art methods to acquire, evaluate, compile and disseminate composition data on foods available in the United States.

So what’s that? Well, for starters, there’s a search page where you can search for the nutrient content of a particular food. The search results will give you something that looks very similar to the commonly recognized Nutritional Facts label.

This is fantastic for figuring the nutritional facts of most of the food items in most vegan/vegetarian/whole food kitchens - things that come out of the ground or off of a tree, without handy labels attached.

Or here you can see my favorite - a list of foods “sorted either by food description or in descending order by nutrient content in terms of common household measures.”

Don’t drive yourself crazy with the numbers, though! As long as you are providing a wide array of colorful fruits and veggies with an emphasis on healthy fats (think avocados, nuts and seeds) and whole proteins (rice + beans, quinoa, edamame, egg - I’d keep those in his diet for a while, personally), he’ll have no trouble getting the right nutrition.

Hey Laura, I think... Hey Laura, my doctor told me to wean my 18 month old

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