Wednesday, 26 January 2011

In response to the BMJ article, WHO confirms the recommendation for exclusive breastfeeding up to 6 months for babies everywhere.

On January 13th, the BMJ journal published an article which briefly reviewed evidence on the optimal duration of exclusive breastfeeding. The study suggested that mothers in developed countries should not follow the official advice for exclusively breastfeeding up to six months. The study claimed that mothers could increase the chances for their babies to eat a healthier food later in life by introducing solid foods at three to four months of age. It also claimed that babies weaned before six months have lower chances to develop allergies and anemia (1).

WHO Head of Nutrition, Francesco Branca stated: “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.” (2)

Several academics have criticized the article for representing a critique of a partial selection of previous studies, and not being systematic. No criteria have been given for the selection of the studies taken into consideration and no details are given for the methodology selected.
The article seems to represent the interest of baby food industry, which has tried to push for an early introduction of weaning at 4 months rather than at 6 months as recommended by the WHO. To support this argument, Baby Milk Action reveals that three out of the four authors of the article (Mary Fewtrell, Alan Lucas and David Wilson) receive funding from baby food industry (3).  

Two days after the publication of this article, WHO responded by reaffirming that “exclusive breastfeeding for six months is best for babies everywhere”. The latest systematic review of evidence on exclusive breastfeeding is the review by Kramer & Kakuma (2009), which included two control studies and 18 other studies in both developing and developed countries worldwide. This study supports the WHO recommendation for exclusive breastfeeding up to 6 months of life and continuous breastfeeding up to two years. WHO affirms that it periodically reviews and follows research findings and re-examines its recommendations (4). 

The advantages of exclusive breastfeeding up to 6 months as compared to 3-4 months 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.” – says Branca (2).