To wean or not to wean?
One short year ago
My son turned one June 10th! He is walking like a pro and can say six words: mommy, daddy, ball, bubble, water, and, “Wow.” (I don’t think he really understands what he’s saying with that last one, but it’s adorable.)
I have looked forward to this milestone for many reasons, and I can’t deny that one big reason was the promised end of nursing, as the AAP recommends breast feeding for one year. I don’t know if I 100% buy this recommendation, but hey, I made it a year, which is something of an accomplishment. So I’d like my certificate and my prize money, please, and then I’d like my old bras back. The only problem is that my son absolutely, positively hates cow’s milk. The first time he tried it, he threw the sippy cup right off the highchair table. I offered it again a little later, and he gave me a look that said, “Puh-lease. As if I don’t remember what that is!”
Nowadays it is in vogue to breast feed into toddlerhood. Women who have done this think it’s the greatest. Apparently, it’s quite moving to hear your kids tell you about how much the boob means to them. And hey, isn’t it “natural” to breast feed for several years? I keep hearing that all around the world, weaning takes place later than in the US. The WHO recommends breast feeding for two years, after all.
I have no hard and fast plan for weaning at this moment, and I have no answers about when it’s best to wean or how to do it. I have no judgement against people who accomplish extended breast feeding–as many of my friends have done–or against anyone who decides to switch to formula immediately–as many other friends have done. Heck, I don’t even judge this woman:
I’m not out to post the final decision on these questions, or even to dispel any popular myths on what is best. In this post, I just wanted to share some interesting information I’ve come across that’s informed my thinking about weaning. I hope that anyone reading this will take this post in the spirit of meandering intellectualism–or at least meandering Googlism.
First, it is always fascinating to think about what we’re “supposed” to be doing, biologically speaking. If we weren’t driving around in cars, sleeping in nice comfy beds, and having babies in hospitals (er, most of us anyway), what would be the age we’d “naturally” wean? I’m not saying I am a person who in any way tries to adapt my life to what’s natural. I like my iPhone and a grande iced latte, thanks. It’s just interesting to contemplate what is “normal” for us as human animals.
What would this mother do?
So I Googled “when to wean” and came across this article on BNET, originally from the Natural History Magazine, in which Kathy Dettwyler attempts to extrapolate, based on research into primate behavior, what the appropriate age of weaning for humans might be:
Studies of nonhuman primates offer a number of different means of estimating the natural time for human weaning. First, large-bodied primates wean their offspring some months after the young have quadrupled their birth weight. In modern humans, this weight milestone is passed at about two and a half to three years of age. Second, like many other mammals, primate offspring tend to be weaned when they have attained about one third of their adult weight; humans reach this level between four and seven years of age. Third, in all species studied so far, primates also wean their offspring at the time the first permanent molars erupt; this occurs at five and a half to six years in modern humans. Fourth, in chimpanzees and gorillas, breast-feeding usually lasts about six times the duration of gestation. On this basis, a human breast-feeding would be projected to continue for four and a half years.
Taken together, these and other projections suggest that somewhat more than two and a half years is the natural minimum age of weaning for humans and seven years the maximum age, well into childhood. The high end of this range, six to seven years, closely matches both the completion of human brain growth and the maturation of the child’s immune system.
I think it’s pretty obvious to point out that apes and monkeys do not use iPhones; therefore, it is difficult to make decisions about my life based on what a chimpanzee or a gorilla might do. As much as I enjoy nursing, the idea of doing it for four years makes my heart sink. Two? Okay, maybe I could make it to two years.
I don’t doubt the veracity of Dettweyler’s nursing statistics. However, the rest of the article gives more than a hint that it is biased towards breast feeding:
Substantial evidence is already available to suggest that curtailing the duration of breast-feeding far below two and a half years — when the human child has evolved to expect more — can be deleterious. Every study that includes the duration of breast-feeding as a variable shows that, on average, the longer a baby is nursed, the better its health and cognitive development. For example, breast-fed children have fewer allergies, fewer ear infections, and less diarrhea, and their risk for sudden infant death syndrome (a rare but devastating occurrence) is lower. Breast-fed children also have higher cognitive test scores and lower incidence of attention deficit hyperactivity disorder.
The copyright on this information is from 1997, which is a little dated by now, and as I posted once here, while breast feeding is great, to say that not breast feeding is “deleterious” is a specious claim. To claim that it’s harmful to cease breast feeding before two and a half years–that’s crossing the line into annoying. I mean, come on. Just come on.
Okay, okay, I know I’m always sending readers over to Mainstream Parenting Resources, and I’m like some little devotee of Esther. It’s always, “Well, Esther says this, and Esther says that.” But what can I say? She just says it so well. So while I was writing this post, I wondered what Esther had to say about natural weaning, and guess what? She is all over Ms. Dettwyler:
See, what Dettwyler’s overlooking is that it’s an inseparable part of human nature to create cultural rules – about weaning and everything else. Therefore, trying to extrapolate what humans would do if they were driven solely by biological forces is about as useful as speculating what humans would breathe if they had gills.
One of Dettwyler’s assumptions especially rankles in that regard: she claims that since the human immunological system isn’t fully developed until age 6 (true to an extent), some humans breastfeed until that age and beyond. However, if breastmilk were necessary to boost children’s immune system until it became fully functional, we’d expect all human societies – especially primitive ones with no access to antibiotics or modern hygienic practices – to nurse that long. The fact that the overwhelming majority of the world’s children don’t should be evidence enough that this assertion is bogus.
I would also submit that just because certain things may be “biologically correct”, doesn’t mean they’re actually the correct thing to do. For example, most girls in the western world develop reproductive ability between the ages of 8-16 years. Would any anthropologist be so bold as to suggest that girls as young as 8 should be reproducing, just because they can? It’s also biologically correct to walk around naked – after all, nobody is born clothed – but except for a handful of nudists, nobody actually walks around without clothing. Especially not outside, in mid-January!
I submit that it is possible, although not preferable, to walk around outside nude in LA, where I live, in mid-January. And I’ve seen people do it. But that aside, Esther’s rebuttal is solid.
Esther can’t stop picking on Dettwyler. She posts three times on Mainstream Parenting Resources about Dettwyler’s paper. The second post is what led me to this scholarly article by anthropologist G.E. Kennedy. And yes, I read the whole paper. Okay, I skimmed some of it. But I did make it through the entire thing, and in essence, there’s a slight problem with calculating a natural weaning age based on analogs to monkeys. See, we have bigger brains than they do:
If selection had targeted only the survival of the child, then humans would have continued to nurse long and wean late, like the other hominoids. Yet doing so would have prevented not only the development of our large brain, but would also have prevented increasing population numbers and the vital genetic diversity that accompanies population growth. It has been argued here that selection favored early weaning because the early shift to adult foods, despite the hazards to the weanling, supports the child during a critical period of neurological development; thus, selection in humans has favored not merely the survival of the child, but the intellectual potential of that child. The evolutionary tradeoff is harsh, but it was the only way we could have attained our large brain.
Esther’s third post on this subject (really, I had no idea she was so prolific on natural weaning age–and so irritated with Kathy Dettwyler–until I started this post) lists many sources that delve into rather morbid studies of the corpses of young children:
It appears that one can use the different proportions of various nitrogen, carbon and oxygen isotopes in teeth and bones to determine the diet of a person, in infancy and at the age of death (i.e, plant-based, animal-based, or mixed). When you have the remains of a large population at the same site and of varying ages, you can estimate the age of weaning by looking at when the children’s bones showed a shift from a breastmilk-based diet to an adult food-based one according to the different isotope patterns in rib bones, which have a high rate of material turnover and reflect the proteins (the source of the nitrogen) ingested by the individual close to death. As infant mortality rates in the past were abysmally high, you can often find the bodies of babies and young children at such burial sites.
I found a bunch of studies done on various populations all over the world and at different historical periods which attempted to determine the weaning age in those population on the basis of stable isotope analysis.
And then, she lists the studies. It looks like between two years and four years is about average for weaning age in most of the populations studied.
You know, I could maybe deal with two years. We’ll see.
Another big question of mine: how to accomplish said weaning? I know some babies give up the breast on their own. I can tell you with a high degree of certainty that my son will not be one of them. He is a mad fan of the boob. He latched on first try, and he has been a champion nurser since then.
On the plus side, I can eat a pint of American Dream Ice Cream with absolutely no fear of gaining weight.
On the minus side, my son has six teeth. Need I elaborate?
I admit I am not that great at being strict or setting my own boundaries as a mom. I think I’ve lapsed into what many might call Attachment Parenting practices, but it’s more out of being a softy than based on any kind of philosophical standpoint. I posted here about sleep training. I should recant that whole post. We sucked at sleep training, as it turned out. One more bout of croup, one more rough night of teething, and the whole thing slid down the drain. We’re back to night feedings, and we put up with early morning wakings. We’re exhausted. We might be teaching our kid he can manipulate us. Hey, what can I say? We’re just improvising over here.
So I don’t think I’m going to be very good at denying the breast. I keep hearing about child led weaning, and I really do hope things work out that way. I remember the swaddling thing sort of ended peacefully like that. I can’t quite remember the last time we swaddled. One day, I just realized we hadn’t done it in a while.
But it looks like in the animal kingdom, things don’t always go smoothly. I got this from Esther’s blog as well–just a little something about my cousin the rhesus monkey:
At about four months of age, rhesus mothers begin to resist the attempts of their offspring to nurse, and young rhesus macaques are fully weaned by the birth of their next sibling (Fooden 2000).
And it looks like the weaning thing is no picnic for rhesus moms:
Infants have their own repertoire of vocalizations which include “geckers,” which are harsh staccato sounds heard during weaning conflict. It is usually heard along with convulsive jerks of the body, and looks and sounds much like a human child’s temper tantrum (Lindburg 1971; Partan 2002).
Poor little monkey dudes. That’s harsh.
Then, Esther touches on the Gusii of Kenya. From Our Bodies, Ourselves:
Once weaned – a process that is assisted by painting the breast with bitter herbs, ignoring the pleas of a hungry child, or even slapping it when it reaches for the breast – the child is expected to contribute to the household. (p.95)
That’s the spirit. Quit your freeloading, hands out of my shirt, and get to work.
So far, that’s my Google weaning journey. I did hope to be done with breast feeding by now, but I’m still nursing, and it’s working out. I’ll keep you posted.
Stacy Said,
June 15, 2009 @ 6:15 pm
First, my son self weaned so I never had to force the issue, though I remember clearly the days when I felt not much more than a dairy cow. He weaned at about 18 mo (and half his intake was table sourced by then anyway) when I started forcing him to sign for “milk” before we’d nurse (at 3.5 he’s still very resistant to speech). He decided that being required to sign/ask first was too much trouble and within 3 days stopped bothering to ask. My boobs were VERY confused, let me tell you! We made it that long because I was VERY adamant about taking the boob away when teeth were inappropriately applied. He was really darn good about it really quickly.
Second, I wonder if yours would get along better with goat’s milk than cow. I’ve heard some prefer it, though I can’t taste the difference myself. Also, did you serve it to him warm or cold? Cold milk to those used to the high sugar warm breast milk can be… disappointing at least.
Frankly, I think this is one of those issues that more often than not comes down to “what drives mom least crazy?”. With the sleep, not having to listen to him whine/cough/cry/etc. makes you less crazy than getting up, so you’ve gone with that. We’re all improvising and we’ve all got different tolerance levels, so I say go with what makes you least crazy. For me, it was requiring communication, and that resulted in less dairy cow time.
If you just need to keep his hands (and face) out of your boobs for a few days to train him to wean, do it. If it makes you less crazy to keep nursing, do it.
Laurie T. Said,
June 15, 2009 @ 7:13 pm
(Sorry, didn’t mean to post right on top of you!)
So far as when to wean or not, do what is right for you and your boy. Wait until you are ready, then don’t offer and don’t refuse, and I bet he’ll wean himself. Don’t let anyone make you feel bad!
Estherar Said,
June 15, 2009 @ 11:24 pm
The book you mention is not “Our Bodies, Ourselves”, but the similarly named “Our Babies, Ourselves” by Meredith Small. The passage you quoted is one of the few in which she lets the “Oh, but of course AP is the most nacheralist ever way to raise babies!” line slip.
Also of note is the study in my first post on the subject http://jn.nutrition.org/cgi/content/full/131/10/2707 which found that when you look at real live human pre-industrial societies (and not extrapolated numbers based solely upon biological supposition, which is how Dettwyler arrived at her figure of a “natural weaning range” of 2.5-7 years), the real average age of weaning is 29 months, with a range of 1-5.5 years.
I got tired of comments quoting Dettwyler on mommyboardz, implying that if your baby self-weans at 9, 12, or 18 months, it’s got to be a nursing strike or something you did. That, and her disgusting, totally clueless letter in Salon (quoted at the bottom of this post http://mainstreamparenting.wordpress.com/2008/01/03/just-tools/ ). Yanno, Dettwyler had homebirths and nursed for the longest time, and we know that the latter is associated with a lower incidence of breast cancer. Dettwyler is a breast cancer survivor. Should I intimate that maybe she was doing it wrong?
Anyway, I had to laugh at the “less ADHD” in breastfed children. I don’t know any study claiming that, and in fact, my longest-breastfed kid (21 months) also happens to be the one with ADHD.
perceval Said,
June 16, 2009 @ 12:39 am
Y’know, I am a tandem feeder of a 3.5 and a 1 year old (I know). Both love the boob. But I successfully managed to get the 3.5 year old down to morning and evening nursing only – you will need to be very firm that these are the only times they’ll be nursed. From there, you can drop to once a day.
Really, what is often overlooked in discussions of weaning is the impact breastfeeding has on the mother. If you start to resent your child because you’re still tethered to him via the boob for a long time, it’s time to stop. Especially once the kid can go onto a milk substitute (what’s wrong with water, rice, or soy milk, by the way?).
catgirl Said,
June 16, 2009 @ 7:17 am
Of course every child is different, but an effective way of weaning is to just let dad take care of the kid. Let dad handle feedings and bedtime, and just don’t have your boobs around for the kid when he’s used to them. It’s also a great chance for dad to bond with the kid after being sort of left out from the beginning. I’ve known a lot of families that have had success with this method.
Deb Said,
June 18, 2009 @ 9:43 pm
This comment was getting monumental, so I’ve redone it a bit.
I’m another one feeding a 3 1/2 year old and a 1 year old, and I certainly didn’t expect to find myself in this position. I have to agree with Stacy, it’s about what causes you the least upset. My first daughter was weaned and actually came back to the boob, weaning again would have been a huge source of stress with a new baby who had reflux and still doesn’t sleep.
I actually see a consensus coming out of your post. All of them, including the WHO recommendations, seem to agree that babies have been fed for far longer than 12 months and probably 2 years, which gives you a starting point. After wading through the anthropology paper and from what you say of the isotope paper, I think there’s a bit of confusion about how toddlers feed. A study by Karleen Gribble (sorry, I can only find extracts or a summary ) found that most toddlers are only feeding once or twice a day, if that, and it is usually associated with sleep. I do wonder how much impact that would have in terms of brain development and bone formation, or if it would be ‘invisible.’ Put it this way – my daughter feeds at most once a day and often only every 2 or 3 days. Would that be swamped under the rest of her normal diet? But she’s certainly not weaned.
The thing I find interesting in these discussions is that they are really about formula. Hang on a minute you say, no-one’s even mentioned formula. Nursing a baby is not only about nutrition. It is about so much more, immunology, comfort, sedation, bonding, relationships. The Gribble study confirms that the decision to continue nursing toddlers is generally mutual, and children are doing it because they enjoy it. Formula does not give any of these other things, it only gives nutrition (I’m not saying some of them can’t be provided by bottle feeding mothers, just that formula itself doesn’t provide any of them). So formula manufacturers focus discussions on nutrition and ignore all the other bits (except immunology, that gets mentioned for some reason). When we look at weaning, or anything else to do with breastfeeding, and only talk about nutrition, then we are tacitly accepting the formula definition.
So in your thoughts about weaning don’t just think about moving on to cow’s milk, remember to consider all the other things you are going to have to replace for your son that he is currently getting from nursing. The best thing I’ve found about feeding a toddler has been being able to help her when she’s been completely over it, tired, or sick. In your weaning plan, remember to take into account his sleep, comfort and cuddling needs. I know the reason my daughter doesn’t want to give it up is because it is the only time in a very busy life that she can absolutely guarantee she has my undivided attention.
Jes Said,
June 19, 2009 @ 8:41 am
I just weaned my 13 1/2 month old daughter this week. Mostly by happenstance (I had cut back to breastfeeding once before bed, and forgot to do it one night….tired…LOL), but also because it was just time. Between her eight sharp little teeth, my longing to be able to have a tall glass of beer (or two…or three…), and the way she became a rather gluttonous and fabulous eater of solids, I just felt it was the right time. You know what? She actually started sleeping BETTER for me after I weaned. She was also a mad fan of the boob, as it was so aptly put, and I was very worried about stopping the before bedtime nursing session because I thought we would get nonstop screaming and protesting for weeks afterward. Luckily, she seemed not to mind very much. I try to give her a soporific snack before bedtime, such as yogurt or banana, and she now sleeps through the night whereas before she woke numerous times and would not go back to sleep without a nursing session. It was extremely tiring.
You just kinda have to wing it. That’s how I feel. I knew I could never be the type to nurse my kid for years, as I feel that once your kid has mastered the buttons on your blouse and can unhook your bra, nursing is SO OVER, but I’m not judging those who nurse longer. That’s just me and how I feel about it, and everyone is entitled to do what makes them comfortable. I’m so happy I was able to nurse for 13.5 months and plan on doing the same with the next baby I have, whenever that might happen. But I’m also happy that my boobs are mine again. And my husband is happy too.
Deb Said,
June 19, 2009 @ 8:18 pm
A lot of these points have nothing to do with breastfeeding, or are myths. Things like biting, or attacking your shirt, they are not nursing problems – they are problems with manners. My kids don’t have perfect manners, but there are rules and they learn breastfeeding manners the same as anything else – it’s part of normal toddler socialisation. If your toddler isn’t pulling on your top, they’ll do something equally annoying!
As for alcohol, it is fine to drink while feeding. Because breastmilk is produced from blood, it has the same blood alocohol level. So your baby is drinking (for example) 0.02% alcohol, which then is going into their digestive system, not directly into their blood stream. Of course this is an individual choice to make, but a lot of pressure is placed on women to be ‘pure’ while breastfeeding, which only makes it harder. A friend was recently told by doctors not to feed her son while on anti-virals because they could go through her milk, yet it was exactly the same medicine he was taking himself! When making decisions unfortunately you can’t just look at results, you have to ask what might be the attitudes that are influencing the questions being asked?
My boobs are always only ever mine. I choose to allow people – my toddler, my baby, my husband – to interact with them, but I have control of them. Perhaps that’s part of why I’m happy to feed for longer – I feel that I control it?
Jes Said,
June 22, 2009 @ 8:18 am
Deb, you seem upset by my comment. That was not my intention. I’d like to clear a few things up.
A. My toddler’s manners are fine. She wasn’t a biter, per se, but she was a vigorous nurser, and her teeth resting on my areola would unintentionally clamp down a bit, causing me some discomfort. It wasn’t anyone’s fault…our latching was perfect, she just happened to have sharp teeth.
B. When I said I didn’t want to nurse once a child can undo my blouse buttons or my bra, I wasn’t attacking folks like yourself who choose to breastfeed beyond the 1 year mark. In fact, good for you. It’s just not something I’d want to do. The remark was meant facetiously in the first place.
C. Drinking is not recommended. I listened to my pediatrician and played it safe (she’s the doctor, after all). I didn’t mind giving my occasional glass of wine or beer up for my child. I know in Europe and Italy, it’s not uncommon for a pregnant or nursing mother to drink a glass of red wine every day. For me, drinking wasn’t worth any potential risks. I’m not a big drinker anyway. “Myth” or no, I took my pediatrician and doctor’s advice and stayed away from the sauce.
D. And, my boobs are always technically mine, yes. But I loaned them out to my kid for 13.5 months, and now they’re back to being just mine (with the occasional date with my husband, ha ha). And that was perfectly fine by me. It’s just nice to be out of the nursing bras and back in the balconettes and demis.
I applaud you for nursing as long as you feel comfortable doing it. I don’t have anything against people who nurse longer than recommended (although I think age 7 is probably pushing it). It’s not hurting the child, and if the mother is OK doing it, then what harm comes of it?
Diane Said,
June 24, 2009 @ 5:48 am
I loved this post. I also question Dettwhatever. I remember reading about a study she did years ago and if felt like there was a lot of cherry-picking to support the theory that babies are supposed to nurse for a LONG time.
I nursed both of mine into toddlerhood. Somehow, they haven’t turned out to be geniuses yet, sadly. Wish breastfeeding would have conferred common sense…
As for the hows of weaning, good luck. There are nearly as many ways of weaning as there are of potty training, and some magical combination will work for you. Sometimes the child backslides a little, so expect that and decide which is more important to you–continued nursing or a temporary, very minor, developmental backslide.
I know that that’s completely unhelpful to read, but somehow or another they all do manage to wean. It ain’t always pretty, but I suppose that’s parenting for you.
Sarah P Said,
June 24, 2009 @ 10:41 am
My 3 kids, now happily well past baby years, all loved the boob. I weaned the first when pregnant with the second, because I was exhausted – I told her the boop was broken. And yes, it was boop. A speaking child yelling hey mom, I want boob is not cute. Ditto the second, although he was easier. The 3rd would still happily be nursing at 10 if I let him. I expect him to marry a woman of Pamela Anderson proportions. I cut him off at 3, because I had to. He talked about how much he’d liked my milk things for years – that was funny.
The nice thing about your choice is that you can make it gradually – stop feeding at night, for example. You don’t have to do it all at once, you don’t have to decide by a certain date what to do, and you certainly don’t have to decide based on dead baby teeth!
Lisa Said,
June 24, 2009 @ 1:03 pm
My son weaned himself sometime after his third birthday. For sure once he was two (I have trouble remembering exactly because he’s eight now) he only wanted “num num” during the day when he needed comforting, such as after a fall, or he was sad. We got into a bedtime routine where he got “pre-bath num num” as he liked to call it, and then I would nurse him to sleep in our bed and transfer him to his own bed once he was asleep. He just gradually became less interested until one night he latched on and said, “There’s no more num num.” I explained that it was because he hadn’t been nursing so I dried up, and that was that. I would do it again, but I won’t pretend that it was easy. It just felt right for me and my son, so I kept at it until he was ready. By the way, he still won’t drink cow’s milk – he says it’s not sweet enough. I guess the boob juice ruined him!
Erica Said,
June 25, 2009 @ 1:37 pm
I weaned Sophia off the boob at fifteen months. We were using formula instead of milk at first and took it really slow. I started with the afternoon feedings when she was about eleven months and just gradually removed one feeding at a time. At the same time we also combined a couple ounces of formula with a couple ounces of milk and gradually used more milk than formula until she was drinking regular moo cow milk. I don’t think she even noticed that she was being weaned. LOL
The last feeding to go was the one night time feeding.
Deb Said,
June 26, 2009 @ 11:39 pm
Jes I wasn’t upset by your comment, just came after it. And I hope I don’t upset anyone with this reply, but this blog supposed to be about questioning some of the information we are given and assumptions made, and there are a huge number of myths about toddlers who breastfeed and their mothers. I’ve found that while it is comparatively easy to find studies and unpack them, it is extremely difficult to question our own cultural baggage, because we are right in the middle of it. So all I’m trying to do is point out that the way we say things, even facetiously, carries a lot of information to people who are reading silently, and point out some of the things that are about culture, not breastfeeding. What people do with it is up to them.
In the most extreme form of the nursing toddler myth they are clingy, demanding creatures who pull open their mothers’ shirt at any opportunity, yell loudly and embarrassingly about booboo and bite. The mothers are either doing it because they don’t want to let their babies grow up, or they are martyrs keeping themselves pure and putting up with the biting and pulling because they think the extra 7 IQ points are important. I’m trying to point out that a) it ain’t true, and b) even if toddlers did have some of those behaviours, it’s not automatically a reason to wean. A reason to work on their behaviour, definitely.
To try and find a non-controversial analogy, think about taking toddlers out to a restaurant. Their eating ability and table-manners aren’t the best, they’re often fussy, and their ability to sit still for an hour leaves something to be desired. For some people, this means they don’t go out. For others, it means they teach their child the manners appropriate to the venue and think of lots of good ways to distract or entertain them. Neither is a better or worse response, but there is a choice we can make depending on our lifestyle and priorities. This is exactly the same as nursing toddlers, we can choose to wean or we can choose to teach them manners and arrange how and when they nurse. But it is more complicated thanks to cultural disapproval and the fact that there are benefits to nursing, which there aren’t really to going out. Plus many toddlers are very clear that they want to nurse, while I’ve never heard one say they want fine dining. Most toddlers can be taught not to hurt. Most toddlers can be taught not to pull on shirts. Most toddlers can be taught that milk is only available at certain times. It takes the same persistence and skills as teaching toddlers anything else.
To clear up the alcohol issue, I was pointing out the facts of how alcohol gets into breastmilk. You’re right, different parts of the world have different recommendations. And obviously it is going to depend on things like when and how much a mother drinks and the age of her baby. Here, it is considered that light drinking with an older baby is fine. As for listening to your doctor’s recommendations, unfortunately that’s not always the best path. This is a recent Australian study that shows that doctors themselves consider their breastfeeding knowledge to be inadequate and most are relying on their own experiences. Given the poor breastfeeding rates we have, it very much seems to be a case of the blind leading the blind. I’m pretty sure the US will be in a similar situation. While I listen to my doctor on health issues, because they’re the ones who’ve been to university, mine openly admits that I know more about breastfeeding than he does.