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Is Six Months of Exclusive Breastfeeding Best?

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.

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Photo credit: dlisbona on flickr

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30 comments

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6:10AM PST on Jan 30, 2011

There are many factors to consider. I don't think that to say it is ideal will help those mothers who are finding it difficult, for whatever reason. A calm happy mother is more help to a new-born. Do it if you are able the do it, but don't panic and fret if you're not able to do it! There are healthy alternatives.

8:51AM PST on Jan 26, 2011

Important article. TY.

7:41AM PST on Jan 26, 2011

Of course it is best...but then all those yuppie moms will have to stop dropping off their 1 or 2 month olds at day-care and rushing back to their all-important careers.

4:58AM PST on Jan 26, 2011

thanks to share with

9:42PM PST on Jan 25, 2011

It depends if it is possible the mother can feed as long as she can . Of course she should be healthy (no hereditary disease)

1:02PM PST on Jan 25, 2011

I loved nursing my babies. I feel sad for moms who can't. If you can produce adequate nourishing milk for your baby, breastfeeding is one of the great joys. It is also simple, easy to find, (I never wondered where I left that breast) always available when needed, and minimal cleanup! Unfortunately, not all moms can. Therefore, it is good that we have alternatives. Moms, if you have to bottlefeed, try to do yourself the favor of holding your baby and taking the tie to bond with her/him as though breastfeeding. When else are you going to get to sit down for that long at a time?

7:54AM PST on Jan 25, 2011

Eug F. thats good that your wife was able to breastfeed both of your children BUT not all women can breastfeed they may not produces milk/enough milk,they may not be able to pump and have to go back to work,something may be wrong with there baby and is in the NICU! There is nothing exactly LIKE breastfeeding that is for sure but formula is a good second option if you can't breastfeed what are you going to do let your baby not eat just becasue you feel formula will give them health issues? Both of my kids were/are formula fed and they are extremely healthy and are very smart babies, yes some children have reactions to formula but a lot of babies do not and i fell if you CAN breastfeed than you should but if you cant you should also be supported and not made to feel badly because you couldn't do something that you wanted for your children im not saying you im just saying in general i was told i was horrible and my poor kids would suffer and being restarted and sickly if i DIDN'T breastfeed and it stressed me out i cried every day! Now vaccinations and diapers are a totally different subject im not going to get into because this thread is not about that.

7:31AM PST on Jan 25, 2011

It just amazes me how we try so hard to fight nature. Breast feeding, regardless of what the know-it-alls say, is best. Im proud to say my wife breastfed our two children for almost a year. When she couldnt be there to feed, she left expressed milk for me to feed them. And we had no problem using cloth diapers either. Somehow we need to forgo the academics and decide for ourselves whats best for our children and use nature/natural as a guidepost. If you want to use formula, Pampers, toxin-laden vaccines, you child is losing some very important contact time and/or risks to his or her health. I agree with Shaheen!

10:03PM PST on Jan 24, 2011

Research changes regularly. Its best to consult with your doctor that you trust on what is best for your situation. However something to note is - as more foods are genetically engineered, more pesticides are added, environments change, technology develops and more and more is unknown, the research will continue to change. We followed guidelines to the "T" and still have food allergies. Is it the mom's fault - no. A loving mom is always trying to do her best for her kids based on what she knows at that time. So all of you loving moms - we salute you for loving your child and doing the best you can, whatever your choice is.
www.AllerDine.com - The Food Allergy Friendly (and Gluten Free) Restaurant Guide

7:53PM PST on Jan 24, 2011

I couldn't breastfeed i didn't produce ANY milk and i tried for 3weeks horrible time with both kids! But my daughter had reflux and still has it but my doctor recommended me adding cereal to her formula and thats the ONLY thing that worked to keep my daughters food down or she will throw the WHOLE bottle back up! She was 2months when i started she is now 6months and she is under weight and they yell at me all the time! So i dont believe being ONLY breastfeed will keep your baby from being over weight my neighbor ONLY breastfeed's her son and he is HUGE i think it depends on genes and the baby! But if you can breast feed that long MORE POWER TO YOU its a good thing i just couldn't do it :)

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