An article in the British Medical Journal made headlines earlier this week when its authors announced that exclusive breastfeeding for the first six months of life might not be best for babies.
The World Health Organization and UNICEF have responded: In a nutshell — rubbish.
The incindiary article suggested that the introduction of solids earlier in life for children in affluent countries might reduce iron deficiency, allergies and celiac disease, and might not have higher rates of infections in babies as a result.
Note: The authors conceded that infants in developing countries definitely should be exclusively breastfed for the first six months of life because of the dramatic health benefits for babies and the risks those babies face.
Randa Sandeh of the Department of Health and Development at WHO headquarters in Geneva responded:
“WHO’s global public health recommendation is for infants to be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health. Thereafter, infants should be given nutritious complementary foods and continue breastfeeding up to the age of 2 years or beyond.
“WHO closely follows new research findings in this area and has a process for periodically re-examining recommendations. Systematic reviews accompanied by an assessment of the quality of evidence are used to review guidelines in a process that is designed to ensure that the recommendations are based on the best available evidence and free from conflicts of interest.
“The paper in this week’s BMJ is not the result of a systematic review. The latest systematic review on this issue available in the Cochrane Library was published in 2009 (“Optimal duration of exclusive breastfeeding (Review)”, Kramer MS, Kakuma R. The Cochrane Library 2009, Issue 4). It included studies in developed and developing countries and its findings are supportive of the current WHO recommendations. It found that the results of two controlled trials and 18 other studies suggest that exclusive breastfeeding (which means that the infant should have only breast milk, and no other foods or liquids) for 6 months has several advantages over exclusive breastfeeding for 3-4 months followed by mixed breastfeeding. These advantages include a lower risk of gastrointestinal infection for the baby, more rapid maternal weight loss after birth, and delayed return of menstrual periods. No reduced risks of other infections or of allergic diseases have been demonstrated. No adverse effects on growth have been documented with exclusive breastfeeding for 6 months, but a reduced level of iron has been observed in developing-country settings.”
In other words: This is not good science and we stand by our recommendation.
UNICEF also responded, releasing a statement (read the PDF here) in which they reiterated that exclusive breastfeeding is best for the first 6 months of life for all babies.
They wrote in part:
There is a wealth of robust evidence that breastfeeding saves lives and protects both the short and long term health of mothers and babies in industrialised countries. Breastfeeding reduces the risk of infections, as well as the risk of diabetes and obesity in children and breast cancer in mothers. It is also associated with improved parenting capability among low-income women, and with reduced incidence of neglect and postnatal depression, thereby improving the life chances of children.
UNICEF went on to scold the BMJ, saying:
The UNICEF UK Baby Friendly Initiative supports continued research into improving infant health. However, any new research should then be considered as part of the whole body of evidence and any recommendations made should be based on the full evidence rather than on single papers. It is unfortunate that the BMJ press office and the UK media have focused on a single piece of comment which has resulted in sensational headlines and risks misleading parents and damaging infant health. When considering this analysis it should be noted that three of the four authors have declared an association with the baby feeding industry.
They concluded, saying:
Health professionals should continue to support mothers with accurate information based on DH and WHO guidance, helping them to recognise the signs of when their baby may be ready to try new foods, while continuing to breastfeed.
The WHO recommendation regarding breastfeeding remains:
Infants should be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health. Thereafter, infants should be given nutritious complementary foods and continue breastfeeding up to the age of 2 years or beyond.
For local breastfeeding support, visit LLL of Mankato and St. Peter.