Paediatric neonatologist, Dr Letlhogonolo Sepeng

Paediatric neonatologist shares tips and what to expect

Breastfeeding is not only the act of a mother nourishing her baby; it is also crucial for bonding and development. Knowing how and when to wean, as well as the physical and emotional effects to be expected, can help ease this transition.

“For first-time mothers in particular, it can be daunting to start thinking about weaning your baby, and the World Health Organization [WHO] advises exclusively breastfeeding for the first six months,” says Dr Letlhogonolo Sepeng, a paediatric neonatologist practising at Netcare Park Lane Hospital.

“The timing of weaning is not set in stone, and often the mother’s breast milk supply gradually reduces over time. The WHO guidelines recommend that from the time the baby is six months old, you can start slowly introducing liquids to complement breastfeeding.”

Seven weaning tips for breastfeeding mothers:

1. Weaning should be a gradual process; breastfeeding should not be stopped suddenly.
2. From six months, start replacing one breastfeeding session per day with a bottle or cup of formula milk (for babies under 12 months) or cow’s milk (for older babies).
3. Over several weeks, progressively decrease the number of breastfeeding sessions.
4. Distract the baby with fun bonding activities, such as reading, playing, or going for a walk, to divert their attention away from missing the breastfeeding session.
5. Ensure that both mom and baby have time to adjust to the next stage of feeding.
6. It may be helpful to consider daytime or night-time weaning. Find the rhythm that works best for your little one.
7. Be aware that once you stop breastfeeding, there may be emotional and physical changes that may take some getting used to.

“Weaning too quickly can cause painful engorgement, clogged ducts, mastitis, and unpleasant hormonal shifts,” cautions Dr Sepeng.

“When a woman is lactating, hormones prolactin and oxytocin, known for their feel-good effects, are produced at higher levels. Therefore, when the baby is weaned and breastfeeding ends, the mother’s levels of these ‘happy hormones’ drop, and this can cause mood swings, sadness, and feelings of depression,” she says.

“It’s important to remember that the intensity of the symptoms can vary depending on individual factors, such as the speed of weaning, how long the mother has been breastfeeding, the baby’s developmental stage and the mother’s needs, among others.

“Once you stop expressing milk, your body also increases levels of the stress hormone cortisol, which may contribute to mood changes, night sweats, fatigue and headaches, or even migraines, which could become severe.

“Keep in touch with your maternity team and your loved ones about how you are doing, physically and emotionally. If you are struggling to cope, professional help is available to support you through this challenging time of transition. There is no need for you to feel alone.”

As a specialised maternity facility, Netcare Park Lane Hospital includes one of the country’s most respected neonatal intensive care units alongside caring and experienced obstetric teams.

Dr Sepeng says other changes to expect after breastfeeding are linked to the rise in the hormones oestrogen and progesterone, which trigger the return of fertility, ovulation, and the menstrual cycle.

What to expect from your baby:

• Food refusal is quite common initially. Gently persist in combination with breastfeeding.
• The transition from breast milk to other sources of nourishment may cause constipation. Keep in touch with your paediatrician and increase hydration by offering your baby water.
• Some babies may experience an upset stomach. Seek medical attention if this lasts for three or more stools and take note if the same foods consistently cause irritation.
• Regression in breastfeeding. Weaning may not be a straightforward linear process, as long as there is gradual progress this need not be cause for concern.
• Challenges with chewing, swallowing, or learning new textures. Always monitor your baby closely to ensure there is no choking. Your paediatrician or maternity team may recommend a speech therapist if needed.
• Potential changes in mood and sleep. The adjustment takes some getting used to, and this should improve in time.

What to expect from your body

• Your breasts will usually return to their pre-pregnancy size.
• You may have developed some stretch marks on your breasts, but these will fade with time.
• As the milk-producing glands are replaced by fatty tissue, you may notice your breasts feeling less firm.
• Stretching of the skin and ligaments supporting the breasts can also alter their appearance.
• The colour of your areolae and nipples will return to pre-pregnancy tones.
• Some women may experience hair loss due to hormonal changes.

“These cosmetic changes are nothing to be concerned about, although you can seek medical assistance if something is making you uncomfortable,” Dr Sepeng says.

“While breastfeeding is a precious, golden time of closeness between mother and baby, the next stage of development is equally rewarding and allows you to bond with your baby in new ways,” concludes Dr Sepeng.