HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fewtrell, M. S Articles by Kleinman, R. E Search for Related Content PubMed PubMed Citation Articles by Fewtrell, M. S Articles by Kleinman, R. E Agricola Articles by Fewtrell, M. S Articles by Kleinman, R. E

Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations?^1,2,3

¹ From the MRC Childhood Nutrition Research Centre, Institute of Child Health, London, United Kingdom (MSF and AL); the School of Biomedical and Molecular Sciences, University of Surrey, Guildford, United Kingdom (JBM); the Clinical Nutrition Service, Division of GI/Nutrition, Children's Hospital, Boston, MA (CD); the Center for Child Health Services, Reykjavík, Iceland (GG); the Clinical Research Institute, Tufts New England Medical Center, Boston, MA (PLH); and the Department of Pediatrics, Massachusetts General Hospital, Boston, MA (REK)

ABSTRACT

Before 2001, the World Health Organization (WHO) recommended that infants be exclusively breastfed for 4–6 mo with the introduction of complementary foods (any fluid or food other than breast milk) thereafter. In 2001, after a systematic review and expert consultation, this advice was changed, and exclusive breastfeeding is now recommended for the first 6 mo of life. The systematic review commissioned by the WHO compared infant and maternal outcomes for exclusive breastfeeding for 3–4 mo versus 6 mo. That review concluded that infants exclusively breastfed for 6 mo experienced less morbidity from gastrointestinal infection and showed no deficits in growth but that large randomized trials are required to rule out small adverse effects on growth and the development of iron deficiency in susceptible infants. Others have raised concerns that the evidence is insufficient to confidently recommend exclusive breastfeeding for 6 mo for infants in developed countries, that breast milk may not meet the full energy requirements of the average infant at 6 mo of age, and that estimates of the proportion of exclusively breastfed infants at risk of specific nutritional deficiencies are not available. Additionally, virtually no data are available to form evidence-based recommendations for the introduction of solids in formula-fed infants. Given increasing evidence that early nutrition and growth have effects on both short- and longer-term health, it is vital that this issue be investigated in high-quality randomized studies. Meanwhile, the consequences of the WHO recommendation should be monitored in different settings to assess compliance and record and act on adverse events. The policy should then be reviewed in the context of new data to formulate evidence-based recommendations.

Key Words: Infants • breastfeeding • complementary feeding • World Health Organization • public health

This article has been cited by other articles:

				L. Schack-Nielsen, T. I. Sorensen, E. L. Mortensen, and K. F. Michaelsen Late introduction of complementary feeding, rather than duration of breastfeeding, may protect against adult overweight Am. J. Clinical Nutrition, March 1, 2010; 91(3): 619 - 627. [Abstract] [Full Text] [PDF]

				Z E Meerlo-Habing, E A Kosters-Boes, H Klip, and P L P Brand Early discharge with tube feeding at home for preterm infants is associated with longer duration of breast feeding Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2009; 94(4): F294 - F297. [Abstract] [Full Text] [PDF]

				R. Barria, G. Santander, and T. Victoriano Factors Associated With Exclusive Breastfeeding at 3 Months Postpartum in Valdivia, Chile J Hum Lact, November 1, 2008; 24(4): 439 - 445. [Abstract] [PDF]

				L. Kuhn, G. M. Aldrovandi, M. Sinkala, C. Kankasa, K. Semrau, M. Mwiya, P. Kasonde, N. Scott, C. Vwalika, J. Walter, et al. Effects of Early, Abrupt Weaning on HIV-free Survival of Children in Zambia N. Engl. J. Med., July 10, 2008; 359(2): 130 - 141. [Abstract] [Full Text] [PDF]

				A. E Buyken, N. Karaolis-Danckert, A. Gunther, and M. Kersting Effects of breastfeeding on health outcomes in childhood: beyond dose-response relations Am. J. Clinical Nutrition, June 1, 2008; 87(6): 1964 - 1965. [Full Text] [PDF]

				D. J Raiten, S. C Kalhan, and W. W Hay Jr Maternal nutrition and optimal infant feeding practices: executive summary Am. J. Clinical Nutrition, February 1, 2007; 85(2): 577S - 583S. [Abstract] [Full Text] [PDF]