O B J E C T I V E S
The primary objective of this review was to assess the effects on child health, growth, and development, and on maternal health, of exclusive breastfeeding for six months versus exclusive breastfeeding for three to four months with mixed breastfeeding (introduction
of complementary liquid or solid foods with continued breastfeeding) thereafter through six months. A secondary objective was to assess the child andmaternal health effects of prolonged (more than six months) exclusive breastfeeding versus exclusive breastfeeding through six months and mixed breastfeeding thereafter.
A U T H O R S ’ C O N C L U S I O N S
Implications for practice
We found no objective evidence of a ’weanling’s dilemma’. Besides their reduced morbidity due to gastrointestinal infection, infants breastfed exclusively for six or more months had no observable deficits in growth, and their mothers were more likely to remain amenorrheic for six months postpartum. No benefits of introducing complementary foods between four and six months have been demonstrated, with the exception of improved iron status in one
developing-country setting (Honduras). Since the latter benefitcan be achieved more effectively by medicinal iron supplementation (e.g., vitamin drops), it does not appear to justify incurring the adverse effects of liquid or solid food supplementation on infectious morbidity, and lactational amenorrhea. Thus, with the caveat that individual infants must still be managed individually, so that insufficient growth or other adverse outcomes are not
ignored and appropriate interventions are provided, the available evidence demonstrates no apparent risks in recommending, as a general policy, exclusive breastfeeding for the first six months of life in both developing and developed-country settings. In fact, in response to the original version of this review, World Health Organization and the World Health Assembly modified its recommendations for the duration of exclusive breastfeeding (WHO 2001b).
WHO put out this statement recently:
Exclusive breastfeeding for six months best for babies everywhere
WHO recommends mothers worldwide to exclusively breastfeed infants for the child's first six months to achieve optimal growth, development and health. Thereafter, they should be given nutritious complementary foods and continue breastfeeding up to the age of two years or beyond.
The latest systematic review of the evidence on this issue was published in 2009 ("Optimal duration of exclusive breastfeeding (Review)", Kramer MS, Kakuma R. The Cochrane Library, 2009, Issue 4). The findings of the review, which included two controlled trials and 18 other studies conducted in both developed and developing countries, support current WHO recommendations.
The systematic review's findings suggest that exclusive breastfeeding of infants with only breast milk, and no other foods or liquids, for six 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 six months. But a reduced level of iron has been observed in some developing country settings. ("developing countr[ies]" include places such as Honduras, not countries like the U.S. or Western Europe; these are considered "developed" and in most cases Mothers in these countries have good iron stores during pregnancy to give to baby. Go HERE to read more about Iron deficiency in infants and why exclusively breastfed babies tend to have normal iron levels.)
WHO closely follows new research findings 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.
For more information, please contact:
Christy Feig
Director of the Department of Communications
WHO Geneva
Telephone: +41 22 791 30 75
Mobile: +41 79 251 70 55
E-mail: feigc@who.int
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