Our night weaning experience

We co-sleep and DS has fed to sleep every night, and several times during the night until now, so teaching him to sleep in other ways has been our main challenge. We are really making progress now. DS gets his milk to go to sleep in the evening, but we don't do milk in the middle of the night any more. I choose when is it nearly morning and he is allowed some again. When he wakes, I tell stories, or do the "in the night garden" thing, sometimes continuing to make up a whole in the night garden episode (generally not the most challenging of plots).

To start with, things were tough, and I was happy to give in at 3 or 4 in the morning, but then one day I woke at 5 and realized he had gone without milk until then. After just a few weeks we are down to nursing at bed time and in the early morning, and sometimes to help him get off for a nap. Slowly he is asking for milk less often in the night, and sometimes when I do let him nurse he will let go when I ask him too -- handy seeing as he has developed a vice-like grip. I find his generosity humbling. I tell him that I am tired and sore and he takes this on and (sometimes) he can accommodate my needs. Sometimes I let him nurse at "disallowed" times, usually when I am very tired, and he is very needy. I really dislike the advice that you hear from everywhere about consistency with these issues. Yes, you need to keep working towards your goal, but surely there can still room for give and take?

I also went some way down the night weaning road at 18 months, and at this point I found he responded best to songs and physical stimulation: back rubs, leg massage (no oil, but otherwise as taught in baby massage class), and an action song that we learnt when he was little about how a leopard has spots and a tiger has stripes. I think we could have successfully night weaned at this stage, but I decided that the old way was so much easier all around and let it drop. This time is different though: although it has not been easy for any of us, weaning feels natural. Nursing hurts, I feel tired and delicate and I don't want to be touched. Supporting him though his disappointment and providing comfort in our ways seems the more attractive option. In July I watched two great big lamb twins nursing, their tails were wagging with excitement as they drank, just like the day they were born -- but mum soon shook them off. I bet she felt just like I do now.

I love the idea of letting the child decide when to stop bfing, but I feel that for my ds this would not be for many years, and I am not happy with that thought. Even though he is still so attached to nursing, I am no longer convinced that he *needs* it. He needs comfort, he needs security, he needs to feel loved, but I hope that we are gradually learning other ways to fulfill his needs. When I started I was unsure whether I would be successful, or whether ds's need to nurse would be stronger than my need not to feed him. It is only now that I have gone down this road and seen him cry for milk but then, reluctantly, but calmly, accept alternatives that I feel optimistic.

Now we are reaping the rewards. Last week I went out, and for the first time in over 2 yrs dh was able to resettle ds when he woke. This Saturday was my brother-in-laws' wedding. I though I might have to leave early to put ds to bed, but my mum took him to a quiet corner and cuddled and told stories, and lay on the floor with him until he fell asleep. Now he is talking about going to stay the night with granny and grandad! These things make me very proud.

How much alcohol passes to your baby when you breastfeed?

If you drink when you are breastfeeding, how much alcohol passes to the baby? A simple question, but I have not seen the answer published anywhere in the public domain. In every statement on the safety of breastfeeding and drinking, this basic fact is omitted. Once again we are given plenty of statements advising us on how to behave, but not the basic information that would help us to make an informed decision for ourselves!

I have done some research and come up with this answer: your baby should not get more than 1% of what you drink. So if, for example, you drink a 175ml glass of wine and continue to breastfeed as normal, your baby might consume, at most, the equivalent of 1.7ml of wine. If on the other hand you drink a whole bottle of wine (750ml), your baby could get the amount of alcohol in 7.5ml of wine (that's one and a half teaspoons). It is not my aim to condemn,condone or otherwise advise, but simply to inform you.

In the rest of this post, I will try to convince you that this answer is right, or at least in the right ball park. First I will use a very simple argument, which I will then follow with a more detailed analysis based on blood alcohol data which is widely published. This analysis will also show that this estimate is quite conservative, and in most cases, if you only drink 1 or two drinks, your baby will be getting significantly smaller doses of alcohol than the 1% maximum.

First, we need some background
Alcohol that you consume enters your blood stream and is distributed around your entire body, including your milk. In fact alcohol passes so quickly into mother's milk that the concentration in your milk is essentially the same as that in your blood. However, what goes in, can also come out. As you sober up, the amount of alcohol in your blood falls, and the amount in your milk falls simultaneously.

In order to calculate the amount of alcohol consumed by the baby we will need to have an idea of how much milk the baby will drink. Of course you never know how much breast milk your baby takes, but we can hazard that it might be similar to a bottle fed baby, so your baby is not likely to drink more than say 250ml (1/4l). It is believed that an average baby will consume 570-900ml of milk per day (see Kellymom), and this is pretty much constant as the baby gets older until significant quantities of solids are consumed. The quantity of milk remains pretty much constant while the consistency and quality of the milk adjusts over the months to meet your child's changing needs.

A simple (and not very accurate) argument
When you have a drink, be it large or small, the alcohol you consume enters your blood stream and circulates around you entire body. I weigh 55 kg, and this equates to approximately 55l of meat, bone, gristle and blood. If we assume that the alcohol is uniformly dispersed throughout the body, including mother's milk, then each litre of my body contains 1/55th (or 1.8%) of the alcohol I consumed. When my baby drinks 1/4l of milk, he will be getting 1/(55*4) =0.5% of the alcohol that I drank.

Further analysis
In the simple argument above, there are a number of assumptions which may not be accurate:

1. My body's density may not be 1 kg/l, so although it is true that I weight 55kg, this might not be exactly 55l.
   
2. Alcohol may not disperse to all body parts equally.
3. If you only have one drink, then probably 250ml is a safe upper limit on how much your baby might consume while you are under the influence. However, this might not be true if you drink several drinks.
   
4. Your milk alcohol content might not be at its highest when you feed your baby.
   

The first two limitations of my argument can be addressed by remembering that milk alcohol content (MAC) is the same as blood alcohol content (BAC), and using widely published data which relates number of drinks consumed to blood alcohol content. For instance, the table at:

http://www.statemaster.com/encyclopedia/Blood-alcohol-content/

Using this table we can see that after consuming a "standard drink" containing 18ml of alcohol, a woman weighing 55kg will have a peak blood alcohol content of 0.04%, or 0.4 ml alcohol /litre of milk. So, our 250ml feed would contain approximately 0.1ml of alcohol. This is 0.1/18= 0.6% of the alcohol that I consumed. So, very close to the original figure I suggested of 0.5%. (Note also, that the blood content increases linearly with the number of drinks consumed, which means that our argument applies equally well to one or many drinks).

Now, so far all these calculations have been based on my body mass, but if you are smaller, then the concentration of alcohol in your blood and therefore in your milk will be a little higher. For a 40kg (6 st 6 lb ) lady the 0.6% becomes 0.7%.

Addressing points 3 and 4 is more tricky since there are many possible drinking and feeding patterns that we could consider. I will discuss this further in a later post. For now you should note that the results stated here are assuming that you drink all your drinks in a short space of time, then feeding your baby when you blood alcohol content is at its highest, but also assumes that you will only feed a maximum of 250ml to your baby while you are under the influence and that you will be sober before any further feeds. I expect that the figures given above will be fairly relevant to more realistic drinking patterns, but as a precaution I have simply rounded the figure up to give the 1%, as quoted at the beginning of this post.

Other considerations

There are many things to consider when deciding whether you will drink alcohol while breastfeeding. These include underdeveloped liver in very young/small babies, dehydration of the mother, effect on the let down response, and the fact that babies tend not to drink as much when you have been drinking. These factors are outside the scope of this post, but most are covered at Kellymom: http://www.kellymom.com/health/lifestyle/alcohol.html

Weaning

When, at about 5 months, C started to show an interest in trying to eat real food, we let him try. No purees or specially prepared food, but he was able to take some of the food we were eating ourselves and suck or chew at it. Soft cooked courgette was a particular favorite in these early stages.

As the months went by we were keen to let C set the pace and let him eat as little or as much as he wanted. We ignored books telling us to introduce foods one at a time, giving several days to watch for allergies, and pressure from others to progress rapidly through the food groups. We knew that in some parts of the world babies are exclusively breastfed for a full year, and felt secure in the knowledge that breast milk would supply the bulk of C's nutritional requirement. We simply started cooking without salt, and offered him a wide range of our own food.

But, as time went on, I started to be curious. How much milk does a baby drink? How much food would a baby need to eat to fulfill his requirements? When is the best time to wean? How much salt is too much? Is sugar really "bad"? Here are some partial answers to these burning questions.

How much food a baby would need to fulfill his requirements? Breast milk becomes richer with every month that you breast feed but, as a rough guide, it provides 22 kcals per oz. If we assume that a breast fed baby takes on roughly the same amount of milk as a bottle fed baby, lets say 5 8oz feeds, that's approximately 750kcal per day. Of course, calories are only one measure of nutrition, but an interesting baseline, which can give us a rough idea of how much food would be required to completely substitute for mum's milk.

When is the best time to wean? The La Leche League argue that milk should be the primary source of nutrition in the first year. It is after all specially designed for your baby. The age at which humans wean seems to vary hugely from culture to culture, but the natural, or biologically optimal age appears to be somewhere around 2-5 years. Chimpanzees nurse their young for approximately 4 years, and some of the more relaxed of the remaining non-industrial human populations follow suit. The !Kung San of Namibia, for example, are reported to allow their children to become tired of the breast. Following their babies' lead, breastfeeding reduces gradually until by the age of 3 it is a rare activity reserved for times when extra comfort is required. Mothers who have breastfed their children for just a few months often look aghast at the thought of breastfeeding for so long, but I can assure you that feeding past 6 months is really not a big imposition. Yes, feeding a new-born is a huge commitment, but by 6 months, feeds are really quick and easy, and the look of adoration on you child's face really makes it feel worth while. I'm still not decided on when I will wean C, but he is already nearly 2 years old and still going strong.

How much salt is too much? I found the advice handed out by health visitors on salt very confusing. First we are told not to add any salt to our cooking, but then told that feeding bread, cheese, Weetabix, even Marmite, to our children is fine! The only more specific advice I have received on salt levels is that children under two should not eat take more than 1g. This might sound a lot, but start adding up how much is in a slice of bread (~0.5g) or a tablespoon of shop bought tomato sauce (~0.25g) and you start to realise that you really need to watch out. In the first few days of breast-feeding the salt content of the milk is quite high, presumably to meet some peculiar need of the newborn. But after a few days the salt content stabilise at about 1/4g per ltr. The average baby will drink approximately 1L of milk a day, so daily salt intake before solids are introduced will be about 1/4g per day.

Is sugar really bad? When C started eating solid foods, we wanted to start him on the right track with lots of nutritious foods, so we didn't want to encourage him to load up on sugary foods. However, sugar is not all bad. Fruits and vegetables can be high in sugar, but also provide a great all round package of nutrition. We decided fairly early on not to worry about sugar too much, but we tried to opt for foods close to their natural state, and limited the amount of refined sugar C ate to occasional desserts or chocolates, until he was better established on solids.