Is Six Months of Exclusive Breastfeeding Best?
The United States Surgeon General just issued a Call to Action to Support Breastfeeding and Health Canada is currently conducting public consultations on the Nutrition for Health Term Infants – Recommendations from Birth to Six Months. These initiatives have the potential to further entrench breastfeeding as the recommended and supported way to feed infants.
Just as these important initiatives in support of breastfeeding are unfolding, a group of scientists in the United Kingdom has released a paper in the British Medical Journal (BMJ) questioning the evidence behind the World Health Organization’s (WHO) recommendation that babies be exclusively breastfed for six months.
The paper, by Mary Fewerell, David C. Wilson, Ian Booth, and Alan Lucus, suggests that mothers should exclusively breastfeed for about four months (instead of six) and should start introducing complementary foods at about four months of age (along with continued breastfeeding).
The authors of the BMJ article point out that the evidence for breastfeeding is very strong and that they are not questioning whether babies should be breastfed. Rather, they are suggesting that complementary foods should be introduced earlier than is recommended by the WHO. Their review of some existing data on breastfeeding in developed countries points to an increased risk of iron deficiency anemia, a higher incidence of food allergies, and a higher risk of coeliac disease in babies who are breastfed exclusively for six months rather than four months.
However, other experts disagree with these findings. The WHO issued a statement reasserting the basis of its evidence for six months of exclusive breastfeeding in all parts of the world. Its statement indicates that there are many benefits to exclusively breastfeeding for six months, including “lower risk of gastrointestinal infection for the baby, more rapid maternal weight loss after birth, and delayed return of menstrual periods.” The only concern they noted was a reduced iron level in some developing countries, but not in developed countries.
Baby Milk Action in the United Kingdom has raised some concerns about the piece published in the BMJ. In its article entitled “WHO breastfeeding recommendations under attack from industry-funded scientists,” Baby Milk Action points out that:
- Three out of four authors of the article receive funding from the baby food industry, have opposed the WHO recommendations in the past, and have even appeared as expert witnesses in the defence of a baby food company that was being prosecuted for illegal advertising.
- The baby food industry will likely use this piece as a marketing strategy to encourage parents to introduce purees and cereals earlier than is recommended by the WHO.
- The BMJ article is not a systematic review of research. Rather, it is a critique of a few select pieces of literature that the authors chose to examine.
Interestingly, the BMJ article’s authors criticized some of the WHO findings about the benefits of breastfeeding exclusively for six months because they were based on observational data. However, the data in support of the claims made in the BMJ article is also based on observational data (more specifically, a small subset of such data) and could be faulty logic. For example, families with a history of food allergies and coeliac disease may be more likely to take the recommendation to breastfeed exclusively for six months seriously than other families. Therefore family history (rather than duration of breastfeeding) could explain the higher incidence of these conditions among babies who are exclusively breastfed for six months.
Beyond the potentially problematic issues in the BMJ article, there is also the problem of the findings being misrepresented in the media. Some articles reporting on the findings have implied that breastfeeding is not the optimal way to feed infants or that babies should be weaned before six months of age. The article did not make either of these statements.
The WHO still supports its recommendation that all babies be exclusively breatsfed for six months (whenever possible). It continues to follow new research findings and re-examine its recommendations as new evidence becomes available. A selective review of a subset of observational data by baby food industry funded scientists may be enough to make headlines in newpapers, but it simply isn’t strong enough for the WHO (and hopefully other health authorities) to be swayed in their recommendations. Unfortunately, a lot of damage has already been done in the “court of public opinion” due to misleading media reports on the BMJ article.
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Annie blogs about the art and science of parenting at the PhD in Parenting blog.
Photo credit: dlisbona on flickr