Transitioning a 1 Year Old

1. In-Service October 22, 2013 Elizabeth Olivares Transitioning a 1 Year Old

2. Introduction • BF recommendations • Reasons to wean • How to wean • Easing transition • Introducing cow’s milk • Milk alternatives • Introducing foods that may cause allergies

3. Breastfeeding: Weaning American Academy of Pediatrics recommends • First 6 months: breast milk exclusively (1) • 6 months to at least a year: combination of breast milk and solids (1) WIC does not suggest a mother should wean unless medically indicated. • Major surgery (2) • Certain Medication (2) • Radioactive compounds (2) • Infection on the breasts (2)

4. Reasons Mothers want to Wean • Returning back to work or school • Separation • Breastfeeding problems • No reason Counseling • Ask them to explain reasons for weaning. • Encourage mothers there are ways to continue to BF. • Encourage client to contact health insurance provider to receive a free pump. • Provide suggestions.

5. Returning back to work or school Encourage mother to continue to breastfeed as long as she is willing and able. • She can pump at work or school • Pump for 5-10 minutes every 3-4 hours • Store in lunch bag with ice pack • BF when she is with baby • Continue bonding • Caregiver • Provide with pumped or expressed milk • 2 weeks prior to returning to work (3): • Mother should learn how to express milk or pump her breast (3). • Introduce bottle to baby (3).

6. Separation Mother is leaving the country, or state for longer than a few days. Mother can store milk to provide for time away. Mother can continue to express while she is away. • Maintain milk supply. • Prevent mastitis. Or wean completely.

7. BF Problems • Provide referral to lactation consultant. • Encourage that BF problems can be resolved with help. • Latching • Insufficient milk supply • Pumping or expressing milk

8. Weaning Completely • Wean slowly over time • Few weeks • Slowly cut out feedings • Keep the best feedings Cues from Child • Expresses indifference or crankiness when nursed(1). • May nurse in shorter sessions than they did before(1). • Eating 3 solid meals a day plus snacks in between (1). Engorgement will decrease as the demand for breast milk decreases, so does milk production (1).

9. Easing the transition • Engage child in a fun play activity or an outing during usual nursing times (1). • Avoid sitting in usual nursing spots or wearing usual nursing clothes(1). • Delay weaning if your child is trying to adapt to some other change (1). • Introduce a bottle or cup during nursing times. • For an older child, try a healthy snack, offering a cup, or maybe even just a cuddle(1). • Changing daily routine so baby is other wise engaged during breastfeeding times(1). • Enlist partner's help to provide a distraction at a typical nursing time(1). • If child begins to pick up a comforting habit such as thumb sucking or becomes attached to a security blanket, don't discourage it (1).

10. Cow’s Milk The AAP recommends whole milk for 1-year-olds(4). • 2-2 ½ cups of milk per day • Children this age need the higher fat content of whole milk to maintain normal weight gain and to help the body absorb vitamins A and D (4). • Nonfat milk provides too high a concentration of protein and minerals for children this age(4). • Once child turns 2, they can switch to reduced-fat or nonfat milk as long as they are growing well(4).

11. Introducing Cow’s Milk • Try mixing milk with some breast milk or formula at first (4). • Serve the milk at room temperature (4). • Meeting the minimum requirement of 2 cups (4) • Cereal with milk • Yogurt • Cottage cheese • Pudding • Custard • Shakes for snacks • Make soup with milk rather than water • Add a milk-based sauce or gravy to casseroles

12. Transitioning to Cow’s Milk 25% Cow’s Milk 50% Cow’s Milk 75 % Cow’s Milk 100 % Cow’s Milk 75% Breast Milk or Formula 50% Breast Milk or Formula 25% Breast Milk or Formula

13. Milk Alternatives • Lactose Free Milk • Lactose intolerant • Soy Milk • Almond Milk • Rice Milk • Milk protein allergy • Cultural or religious preferences • Fortified with calcium and vitamin D.

14. Introducing Foods That May Cause Allergies • Milk • 1 year (6). • cheese and yogurt can be introduced before 1 (6). • Eggs • Fish and Shellfish • Peanuts and Tree nuts • Soy • Wheat • APP study revealed • No evidence to hold back after 6 months (6). • Average age in the study was 8 months (6). • Introduce • At home. • With a food they already have accepted. • One at a time. • WIC recommends • Egg whites after 1 year only and egg yolk before 1 year (7). • Fish at 8 months (7). • Peanuts and tree nuts should be avoided because they are a choking hazard (7).

15. References • Nemours.Weaning your child. Kids Health Website. Available at: http://kidshealth.org/parent/growth/feeding/weaning.html. Accessed October 20,2013. • Department of Health. CONTRAINDICATIONS TO BREASTFEEDING New Jersey Department of Health Website. Available at: http://www.nj.gov/health/fhs/wic/breastfeedingcont.shtml. Accessed October 20,2013. • Spangler, A. Breastfeeding: Keep It Simple. Atlanta, GA: Amy's Babies, 2012. Print • BabyCenter Medical Advisory Board .Cow's milk: When and how to introduce it. Baby Center Website. Available at: http://www.babycenter.com/0_cows-milk-when-and-how-to-introduce-it_1334703.bc?page=2. Accessed October 20,2013. • Shaw D. Understanding milk alternatives. The New Zealand Herald Website. Available at:http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11143522&ref=rss. Accessed at October 20, 2013. • Fleischer, DM. Early Introduction of allergenic foods may prevent food allergy in children. Academy of American Pediatrics News Website. Available at: http://aapnewsde.aap.org/aapnews-open/201302_o?pg=13#pg13. Accessed at October 20, 2013. • Montana WIC. Food Guide for Infants Handout. Choose Montana WIC. Revised July 2011.