Which suggestion is appropriate for the parent of a 3 year old client who is concerned that the child still insists on taking a bottle of milk at naptime and at bedtime?

I know of many young children who stopped nursing when their mother became pregnant with another child, which changed the taste or flow of the milk. Others simply outgrow it, dropping first one nursing and then another until they are nursing once a day, and then not at all. Anthropologist Katherine Dettwyler concluded from her research that:

So children often wean themselves when they're ready, and parents don't actually need to actively wean their nurslings.

But many parents do choose to encourage weaning at some point during the nursing journey, and even avid nurslings adapt. Breastfeeding is a relationship, which requires the good will of both people. Sometimes, mothers are ready to end that form of relating, eager to find other ways of meeting their child's needs for physical and emotional sustenance. In that case, it's the parent's responsibility to find ways to encourage their devoted nurser to move toward giving up the breast, without traumatizing him.

In the old days, mothers who had the financial means would sometimes go on a trip, leaving the baby behind. When they returned, the milk was dried up and the baby was weaned. We now understand that this kind of cold turkey approach is traumatic for kids, depriving them of the person who is usually their primary source of comfort just as they're experiencing the major loss of nursing. And sudden weaning IS a major loss for little ones, one that can make them feel so overwhelmed with desperate need that they bury those cravings deep in their psyches.

By contrast, gradual weaning still involves loss, but your child is able to do her grieving in small, manageable doses as she learns to meet her physical and emotional needs in other ways. In fact, gradual weaning becomes a series of healthy stepping stones in the child's development and in the mother-child relationship, in which the child "ripens." Here's how.

1. Remember that what your child really wants is loving, physical connection.

Your child is not just getting "food" from nursing. He or she is getting snuggles and reassurance and safety and love. Weaning is a transition from a specific kind of physical connection, but be sure you are offering plenty of other forms of physical connection.

2. Think gradual, meaning this process may take many months.

Consider yourself and your child to be "moving toward weaning" as you embark on this process.

3. Be sure she's getting enough nutrition from other sources.

If she's getting most of her calories from you, weaning will mean she's hungry but hasn't become accustomed to seeing food as the way to satisfy her hunger, which will mean frustration all around. Focus on helping her explore solid food so she learns to enjoy it.

4. Start by never offering, never refusing.

For some kids, this won't make a difference--they'll just ask. But for others, even those who habitually nurse at a certain time of day, if you simply move on with the schedule without offering, nursing won't occur to them.

5. Cover up.

The sight of your breast triggers your child's longing to nurse. This will last at least a year after she's weaned, and maybe longer. This isn't the time to wear low cut tops or sleep naked (presuming that your child ever awakens at night, as many do.) Don't worry, this won't last forever.

6. Stop nursing after injuries.

Most little ones want to nurse after they fall and hurt themselves. But that teaches them to "stuff" their feelings. Instead, when your baby or toddler gets hurt, hold him and empathize with him ("That really hurt! Tell me about it..."), helping him to experience the pain and to express it to you with his tears. If he asks to nurse, say  

"We'll nurse in just a minute, Sweetie. First show me your owie."

If you make a practice of this, your child will learn how healing his tears are. He won't ask to use nursing as a "pacifier" when he has big feelings, and so won't "need" it so desperately to manage his emotions as time goes on.

7. Stop nursing when your child is using it to manage boredom or other feelings.

Many kids ask to breastfeed when when they have emotions that they don't want to feel. For instance, often kids urgently want to nurse when they feel disconnected, or they aren't sure what to do with themselves -- that transitional time that we sometimes call "bored" -- before they figure out what to do next. Or if you turn off the TV, your toddler may protest unless you offer to nurse. Tell her

"This isn't time for mimi, this is time for the 'I'm hungry and I'm going to eat you up!' game!"

Then, roughhouse with her to get her giggling, so that she giggles out those bothersome feelings that she thought only nursing would soothe. Again, you're moving toward weaning by giving your child better tools to regulate her emotions, so she doesn't need to use nursing for self-regulation. Once kids don't rely on nursing for emotional regulation, they don't need it so desperately. For ideas of games to get your child giggling and fill her love tank, see Games for Connection.

8. Night Wean.

The first feedings you'll want to eliminate are any night feedings, if your child is still waking up at night to nurse. But if he's doing this, it's probably because he doesn't know how to go to sleep without nursing. You could keep nursing him to sleep, but just not nurse during the night. But then your child has to learn to go to sleep without nursing in the middle of the night when he's a bit rested and can stay awake longer. And you have to support him with patience to fall asleep in the middle of the night, which is when you have less patience and fortitude. Instead, I recommend that you start the weaning process by helping your child learn to fall asleep without nursing when you put him to bed at night. (You can keep nursing him to sleep at nap times for now.) That skill will allow him to fall back asleep in the middle of the night much more easily.

Explain that tonight you will nurse him in the living room instead of his bedroom, and then you'll snuggle with him to help him sleep. You might want to act this out with stuffed animals, so he understands what you're explaining. When he finishes nursing, say goodnight to the nummies. Take him into the bedroom and start the bedtime routine. He will naturally ask to nurse again. Tell him that the nursies are sleeping, and that it's time for him to sleep, and you'll help him. Expect lots of tears. Stay compassionate, and don't nurse him. Just hold him and commiserate

"I'm sorry this is so hard, Sweetie...I'm right here...You will nurse in the morning when the nonnies wake up."

Eventually, he will sleep. Is this sleep training? No. You aren't leaving your child alone. You're setting a limit (no nursing to sleep) to teach him a skill (falling asleep without nursing), and you're supporting him with compassion through all the feelings he has in response to your limit as he learns this new skill.

Often, learning to fall asleep without nursing helps kids to simply roll over and go back to sleep during the night without even asking to nurse. But if he still wakes up in the night and asks, there's no harm in nursing during the night, even after he learns to fall asleep at bedtime without nursing. Over time, though, you'll want to complete night weaning by explaining that the nursies sleep until morning light, and helping him fall back asleep without nursing.  Click here for more on helping your child sleep.

9. Expect -- and welcome -- crying.

If your little one has been managing her emotions with nursing, those feelings will now come up in other ways -- whining, grumpiness, reactivity, helplessness. Accept all your child's emotions with compassion and patience; she just needs to cry in the safety of your loving attention and those feelings will dissipate. Remember also that she's grieving. For your child, weaning is a loss. She's giving up something beloved. She'll need to cry, to tell you how sad that makes her. Your job is to NOT feel defensive (It's ok for you to make the decision to move toward weaning), to acknowledge how sad this makes her, and to love her through it. Consciously spend even more time loving your little one in other ways -- with snuggling, Special Time, and bonding games-- to make up for the loss of love she feels from less nursing.

10. Explain, don't shame.

If you tell your toddler or preschooler that he's too big to breastfeed, but he still wants to, he feels ashamed. Instead, explain that the nursies need to rest.

11. Reduce sessions; give choices.

By now, you are only nursing during the day, and you're probably down to those ritual times -- upon awakening, naptime, waking from nap, and before bedtime (although not to sleep.) If you find yourself nursing more often, cut back to these times by giving up one session at a time. It's usually best to start new rituals at the times when your child has come to expect nursing. For instance, start a new waking ritual that involves a soothing song and snuggle and maybe laughter.

If your child is old enough to understand the concept of making a choice, giving her some choices about the weaning process will help her feel less "pushed around" by your decision to move toward weaning. For instance, you might tell her that she can have three times each day to nurse. When does she want them?

12. Provide alternatives.

If you gently suggest other activities at those times when he wants to nurse, you'll find that the number of times you nurse in a day greatly diminishes. Offer a drink of water. Go outside to see if there are any butterflies. Discover a sticker that needs some paper. Become a bucking bronco who needs a rider.

13. Reduce the time spent at each nursing.

If you reduce the amount of time your child nurses at each session, then giving up that session will be easier on your child. To do this, respond to your child's request to nurse by saying "Ok, do you want ten nummies?" (Or whatever his special word is.) After he latches on, count from ten down to one, and then say "All done! Blast off!" If he insists on nursing on both sides, that's fine -- just count down from ten on each side.

14. Explain in a way your child can understand.

Your child has always nursed and can't imagine that someday he won't. Introduce that idea by reading books about breastfeeding and weaning. Many parents say that their child asked to nurse much less often once they began reading about weaning. There aren't a lot of great children's books on this topic, but some links are below. You can also read these and then make your child a personalized book, using pictures of her!

At what age are these suggestions for weaning appropriate? The World Health Organization recommends two years or more of breastfeeding. Extended nursing continues to offer your child tremendous emotional and physical benefits for as long as it lasts. Of course, nursing has to work for both mother and child, as mentioned above, and the benefit to your child is only one factor in your decision about what's best for your family. But there is no reason that mothers should feel pressured to wean toddlers if they want to keep nursing, since there are so many benefits to extended nursing.

Many parents night-wean their toddlers and continue nursing during the day.  I recommend that kids not be night weaned until after the child is at least twelve months old, both because I'm convinced they need to nurse at night for growth spurts and because they just don't understand what's happening before that, so it's harder for them to cope.

Listening to kids' feelings rather than nursing when they're injured or bored can begin before the baby is a year old, but I am not of the school of thought that says it should begin at birth. After all, human infants are designed to nurse when they're upset; their body benefits from the soothing of the anti-stress biochemicals.

Remember that even if you want to wean your child, some part of you experiences this as a loss. In fact, as our children grow, every exciting new development contains a measure of grief for us as parents.

Yes, as our child leaves each stage behind we receive the solace of the next, often wonderful, stage. But that doesn’t erase the profound loss of the infant’s earliest milky smiles, the toddler’s adoring gaze, the preschooler’s unmatched exuberance, the six year old still climbing onto our lap for a bedtime story. Part of loving our child is grieving as she moves on into the future, and we need to honor that grief.

Because if we don't allow ourselves to grieve, we sometimes give our child the message to stop growing up so fast. Kids can't learn to fly if we are, even unconsciously, clutching at their ankles. Our willingness to honor our mixed feelings about our children growing up is part of what frees them to try their wings...and to fly.