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Is Exclusive Breastfeeding Best for the First Six Months?

Katlyn Joy |17, January 2011


A paper published in the British Medical Journal in January 2011 calls into question the wisdom of The World Health Organization's recommendation to exclusively breastfeed all infants for the first six months of life. Exclusive breastfeeding means no supplementing with formula or solid food or other liquids, except for medicine, vitamins and minerals.

According to the authors, all experts in infant nutrition and health, the European Food Safety Authority conclusions that complementary foods may be safely introduced at 4 to 6 months of age might be better recommendations in light of more recent research.

The authors note that the study which the WHO policy of exclusive breastfeeding is based on did note the concern of anemia in exclusively breastfed infants. This is an even greater issue in the UK where there isn't an iron screening policy or program.

While studies have shown that infants who are breastfed have less incidence of infection such as pneumonia or recurrent ear infections as well as gastroenteritis, it appears that the introduction of formula into an infant's diet is the culprit rather than the introduction of solids along with breast milk.

Anemia is found more in infants who are exclusively breastfed for six months than those for five or five months and could be addressed with supplementation.

Another key issue is the formation of food allergies. Introducing potential allergens such as cow's milk, peanuts, seeds, eggs, gluten and fish must be timed properly. It appears introducing them prior to three months results in allergic reactions that persist, while waiting longer than six months also is linked to allergy problems. An ideal window according to recent research appears to be in the 3 to 6 month range.

Studies looking into the link between either exclusive breastfeeding or supplementing and later obesity have been inconclusive thus far and more research needs to be done. It may be a concern that faster growing and active infants require more nutrition than breastfeeding alone can meet around the six month mark.

The authors of the paper conclude that more research needs done, but that the EFSA recommendation to breastfeed and safely introduce solids or complementary foods at 3 to 6 months may be more in line with the best research findings.

So for mothers currently breastfeeding or considering exclusive breastfeeding, is would be best to discuss concerns with your pediatrician and watch your infant closely for growth patterns. As your baby gets older watch for signs that he may not be getting adequate nutrition or calories:

  • Is he fussy at the end of feedings or not seem satisfied?
  • Does she attempt to eat table food or seem very interested in what you are eating particularly if older than three or four months of age.

Also, have your baby checked for iron levels to guard against anemia.

To read more about the study, please visit British Medical Journal's Website 

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