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BOH III Northern Metropolitan Weaning and Sleeping Habits Cecilia Cao - Thu Chung - Sarah Cumming
 * Noah was breastfed at 6 months
 * Bottle at night to calm and settle - used for comfort and helps him sleep
 * Mum trying to wean Noah from the bottle
 * Gives Noah a bottle when she is ill (from current pregnancy)
 * Drinks milk, fruit juices and occasionally water from both cup and bottle

**What is Weaning?**

Wean: 'to accustom (a child or young animal) to food other than its mother's milk; cause to lose the need to suckle or turn to the mother for food' (Dictionary.com, 2010)

Weaning: 'a child's transition from breast milk to other nutritional sources'. The term is also used when a child moves away from bottle feeding to solid foods (Australian Breastfeeding Association, 2005).


 * Types of weaning**

__Mutual weaning __  As the child continues to grow and develop, and more solid foods are being introduced to the diet, the child will slowly begin to rely on bottle feeding less and less. Some strategies for this method is to introduce milk in a cup.

__Baby-led weaning__ Sometimes before expected, a child might decide to wean itself off the bottle when it feels as if it has had enough. The child may show signs of independence during feeding times and want to move away from bottle feeding and eagerly grab hold of a cup or use fingers to grab onto solid foods. The complete transition from a bottle to a cup may take a few months.

__Mother-led weaning __ Mother-led weaning is when the mother feels the need or is ready to wean the child off bottle feeding. The decision may arise from array of circumstances like work schedule, family situations such as expecting a second child or preparing for a second pregnancy, medical reasons, or simply because the child is bottle feeding into toddler years.

(Australian Breastfeeding Association, 2005) ( Harris, 2010 )

**When to encourage weaning**

=
Weaning can be a very emotional time for both mother and child. The intimate mother-to-child bond can be difficult to 'break' however weaning enables more time and flexibility. To some mothers, weaning may also be a significant mile stone that their child has reached (Hirsch, 2008). =====

Weaning can happen as early as when new nutritional sources other than milk is introduced into the baby’s diet. There is no set age or time when weaning should occur as it is a very personal decision and takes place when the time is right for both mother and child. However, Fraizer et al (1998) as cited in Kahn et al (2007) found that pediatric groups recommend different times for weaning, ie. The American Academy of Pediatricts suggests slowly weaning from the bottle at the start of the 16th month, and 80% of pediatricians preferring to have children weaned between 12 and 16 months. Current home, family situations and work schedules can also influence the weaning process (Australian Government, 2010).

Why is weaning important - Generally and Dentally?
Prolonged use of the bottle is associated with early childhood caries, anemia, overweight and poor diet (Kahn et al., 2007). Anemia may occur from excess cow milk consumption; increased weight/bmi was found in children who continued to bottle feed monthly past 18 months and when compared children drinking milk from cups
 * Sleep associations **: if babies get used to having a bottle-feed every time they fall asleep, they might develop an association between the bottle and sleep. They might then find it hard to fall asleep without a bottle.
 * <span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi;">Risk of ear infections **<span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%;">: when a baby drinks lying down, milk can flow through to the ear cavity, which can cause ear infections.

(Raising Children Network, 2006)

Dentally: Saliva is reduced at night, caries risk increases. Babies from birth should not be given bottles in bed with anything other than water in them. As we all know sucking on bottles with milk/juice overngiht is the biggest risk factor for ECC. Ideally the baby will not be used to having a milk bottle to go to sleep with. Labelling of baby foods during weaning is very important. Parents should be educated on how to purchase foods low in sugar. Toddlers do not need fruit juices or flavoured milks, parents should be advised to suppliments these with fresh fruit and plain milk (Holt, 1997)

<span style="color: #181820; font-family: Arial,Helvetica,sans-serif; font-size: 120%;"> Ward et al.( 2007) recommends involvement and shared responsibility between both parents to help with their child's sleeping problems. By balancing the responsibility it puts less stress on the family and child.
 * Recommendations on ‘how to wean’**
 * You will be more successful by introducing weaning gradually over weeks to months
 * In the beginning stages - stop offering bottled milk, only allow upon child’s request
 * Introduce other activities or tasks during the day as a distraction to the child, especially at feeding time
 * Introduce limitations - gradually reduce the amount and frequency of bottle feeding. Start to drop day feeds and gradually move to dropping night feeds as this is the one that the child is needy of it and finds it more comforting
 * Involve dad or someone close to feed the child during the day and especially during the night to not limit the feeding process to just the mother
 * Another approach is to leave the decision of when to wean completely up to a child. Once they're eating three meals of solid food a day (plus snacks in between), kids often breastfeed less and less.
 * It is up to the mother to decide when the best time for weaning is and if the child will cope. Some may choose to wean the child when changes are all happening at once for example, teething, walking, talking etc, or delay the weaning process so that changes occur one at a time.
 * This is a good transition time from bottle to a cup, although it may be ideal to do it gradually rather than all at once.

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">(Australian Breastfeeding Association, 2005) (Australian Government, 2010) (Raising Children Network, 2006)

<span style="color: #181820; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">**What are toddler's sleeping habits generally?**

According to Parentlink (2008), 41% of children between 2-3 years old, wake at least once or twice during the night. Also when children feel anxious due to separation, pain, earaches, not knowing how to return to sleep or teething, loud noises can wake them fully as children sleep in the light phase.

It has been found that children with sleep disturbances early in life may continue to suffer from chronic disturbances in the future (Mindell et al., 2006, Ward et al., 2007). __Table 3. Brief Guidelines for Practicing Healthy Sleep Habits__ Newborns (0 to 2 months), TST = 16 to 20 hours Infancy (2 to 12 months), TST = 13 to 14 hours associate falling asleep by himself/herself rather than being nursed or rocked to sleep Early childhood (3 to 5 years), TST = 11 to 12 hours
 * Place newborns on their back for naps and nighttime sleep
 * Place newborn on a firm mattress; pillows should NOT be used
 * Equivalent amounts of daytime and nighttime sleep
 * Sleep episodes 3 to 4 hours a day with 1 to 2 hours of wake
 * episodes
 * Place infant in the crib drowsy but awake. This enables the infant to
 * Naps two to three times per day
 * Self-soothing is a major developmental skill
 * Toddlers (1 to 3 years)**, TST = 12 to 14 hours
 * Establish a consistent nap schedule and bedtime for your child
 * Transition from two naps to one
 * Night wakings are common
 * Cessation of naps
 * Quiet bedtime environment
 * Bedtime routine is essential
 * Peak age for nightmares, sleepwalking, and nighttime fears

Note. TST = total sleep time. Data from A clinical guide to pediatric sleep: Diagnosis and management of sleep problems by J. A. Mindell and J. A. Owens, 2003. (Mindell et al., 2006; Adapted from table 3, cited in Ward et al., 2007)

Recommendations can we give to Noah's mum
- Noah is using his bottle at night for comfort and to go to sleep. This is important for his Mother who is having a difficult 2nd pregnancy. - Show sympathy toward mother as she is going through a hard time and is generally concerned for Noah's health. - Noah should stop being offered the bottle, and only given to him at night if he requests it. - To wean Noah off the milk in the bottle to just water the milk can be watered down over time to let Noah slowly adjust. - Only offer Noah milk or water during the day in a cup.

? Environment may be overheated due to heavy bedding material, clothing. Children should also feel safe wherever they sleep.

**Support, Referrals, access support (parenting hotline, families SA, internet)**
__<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">Local support networks/groups __ <span style="font-family: Symbol; mso-ansi-language: EN-AU; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msoansilanguage: EN-AU; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· ** Children, Youth and Women’s Health Services ** Website: [] Parent helpline: 1300 364 100 Parenting groups <span style="mso-bookmark: Metropolitan_North;">**<span style="color: #fc8917; font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman';">Metropolitan North ** <span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';">Elizabeth – <span style="color: #666666; font-family: 'Verdana','sans-serif'; font-size: 8pt; line-height: 150%;">Elizabeth City Centre, Playford Blvd Elizabeth, 5112 (next to Post Office) <span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Gawler – <span style="color: #666666; font-family: 'Verdana','sans-serif'; font-size: 8pt; line-height: 150%;">Gawler Health Services, 21 Hutchinson Road Gawler East, 5118 <span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Golden Grove – <span style="color: #666666; font-family: 'Verdana','sans-serif'; font-size: 8pt; line-height: 150%;">Primary School, Bicentennial Drive Golden Grove, 5125 <span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Ingle Farm – <span style="color: #666666; font-family: 'Verdana','sans-serif'; font-size: 8pt; line-height: 150%;">Ingle Farm/Ingle View Specialist Centre 23 Roopena Street Ingle Farm, 5098 <span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Modbury – <span style="color: #666666; font-family: 'Verdana','sans-serif'; font-size: 8pt; line-height: 150%;">75 Smart Road Modbury, 5092 <span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Munno Parra – <span style="color: #666666; font-family: 'Verdana','sans-serif'; font-size: 8pt; line-height: 150%;">Morialta Drive Smithfield, 5114 <span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Salisbury **–** <span style="color: #666666; font-family: 'Verdana','sans-serif'; font-size: 8pt; line-height: 150%;">23 Wiltshire Street Salisbury, 5108 <span style="font-family: 'Verdana','sans-serif'; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';">Settlers Farm **-** <span style="color: #666666; font-family: 'Verdana','sans-serif'; font-size: 8pt; line-height: 150%;">House 2, Du Villars Street Paralowie, 5108 <span style="font-family: Symbol; mso-ansi-language: EN-AU; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msoansilanguage: EN-AU; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· **<span style="font-family: Calibri; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-AU; msobidifontfamily: 'Times New Roman'; msofareastfontfamily: 'Times New Roman';">Parenting SA ** <span style="font-family: Calibri; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-AU; msobidifontfamily: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">(Parenting groups, parenting SA shop, web links, parent helpline, parent help guides, parenting SA grants) <span style="mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Website: [] <span style="font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Contact details: <span style="color: black; font-family: Calibri; font-size: 9pt; line-height: 150%; mso-bidi-font-family: Arial; msobidifontfamily: Arial;">295 South Terrace, Adelaide SA 5000 <span style="color: black; font-family: Calibri; font-size: 9pt; line-height: 150%; mso-ansi-language: EN-AU; mso-bidi-font-family: Arial; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-AU; msobidifontfamily: Arial; msofareastfontfamily: 'Times New Roman';">Phone: (08) 8303 1660 Fax: (08) 8303 1653

<span style="font-family: Symbol; mso-ansi-language: EN-AU; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msoansilanguage: EN-AU; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· **<span style="font-family: Calibri; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-AU; msobidifontfamily: 'Times New Roman'; msofareastfontfamily: 'Times New Roman';">Families SA ** <span style="font-family: Calibri; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-AU; msobidifontfamily: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">(Financial support and grants) <span style="mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Website: []

<span style="font-family: Symbol; mso-ansi-language: EN-AU; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msoansilanguage: EN-AU; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· **<span style="mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman';">Australian Childhood Foundation ** <span style="mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Website: []

<span style="font-family: Symbol; mso-ansi-language: EN-AU; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msoansilanguage: EN-AU; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· **<span style="font-family: Calibri; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-AU; msobidifontfamily: 'Times New Roman'; msofareastfontfamily: 'Times New Roman';">Raising Children Network ** <span style="font-family: Calibri; mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-AU; msobidifontfamily: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">(Newborns – grown up, behaviour, communication, nutrition, sleep habits, play & learning, development, safety, special needs) <span style="mso-ansi-language: EN-AU; mso-bidi-font-family: 'Times New Roman'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> Website: []


 * Weaning, starting solid foods**
 * []

References **

Australian Breastfeeding Association 2005, //Weaning,// viewed 9 March 2010, < []>.

Australian Government 2010, //Health Insite Weaning,// viewed 9 March 2010, < []>.

Dictionary.com 2010, 'Weaning', viewed 17 March 2010, < [] >

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 11pt; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; msoasciithemefont: minor-latin; msohansithemefont: minor-latin;">Harris, J 2010, //Teaching moms how to transition baby from bottle to cup without unnecessary stress and frustration!,// Bottle Weaning, viewed 15 march 2010, <[]>.

Hirsch, L 2008, //Weaning your child//, The Nemours Foundation, viewed 15 March 2010, <http://kidshealth.org/parent/pregnancy_newborn/feeding/weaning.html#>.

Holt R D 1997, //Weaing and Dental Health,// Nutrition Society, London, vol 56, pp. 131-138.

Kahn, R, Bonuck, K, Trombley, M 2007, 'Randomized Control Trial of Bottle Weaning Intervention: A Pilot Study', //Clinical Pediatrics,// vol. 46, no. 2, pp. 163-174.

Mindell, AJ, Kuhn, B, Lewin, SD, Meltzer, JL, Sadeh, A 2006, 'Behavioural Treatment of Bedtime Problems and Night Wakings in Infants and Young Children', //An American Academy of Sleep Medicine Review,// vol. 29, no. 10, pp. 1263-1276.

Parentlink 2008, //Sleep (0-6years)//, ACT government, viewed 9 March 2010, <http://www.parentlink.act.gov.au/parenting_guides/babies,_toddlers__and__young_children/sleep_0_to_6_years>.

Raising Children Network 2006, //Weaning toddlers from breastfeeding,// Raising Children Network: the Australian parenting website, viewed 9 March 2010, <[]>.

Ward, MT, Rankin, S, Lee, AK 2007, 'Caring for Children with Sleep Problems', Elsevier.