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Optimal duration of exclusive breastfeeding

KramerMS, Kakuma R.

Cochrane Database of Systematic Reviews – 2007. Update

Plain Language Summary

Exclusive breastfeeding for six months (versus three to four months) reduces gastrointestinal infection, does not impair growth, and helps the mother lose weight.

The results of two controlled trials and 18 other studies suggest that exclusive breastfeeding (no solids or liquids besides human milk, other than vitamins and medications) for six months has several advantages over exclusive breastfeeding for three to four months followed by mixed breastfeeding. These advantages include a lower risk of gastrointestinal infection, more rapid maternal weight loss after birth, and delayed return of menstrual periods.
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Full Breastfeeding Duration and Associated Decrease in Respiratory Tract Infection in US Children

Caroline J. Chantry, MD, Cynthia R. Howard, MD, MPH and Peggy Auinger, MS

PEDIATRICS Vol. 117 No. 2 February 2006, pp. 425-432

OBJECTIVE. The American Academy of Pediatrics recommends exclusive breastfeeding for an infant’s first 6 months of life. When compared with exclusive breastfeeding for 4 months, greater protection against gastrointestinal infection, but not respiratory tract infection, has been demonstrated for the 6-month duration. The objective of this study was to ascertain if full breastfeeding of ≥6 months compared with 4 to < 6 months in the United States provides greater protection against respiratory tract infection.
METHODS. Secondary analysis of data from the National Health and Nutrition Examination Survey III, a nationally representative cross-sectional home survey conducted from 1988 to 1994, was performed.
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Effect of breast feeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies

A K Akobeng, A V Ramanan, I Buchan and R F Heller

Archives of Disease in Childhood 2006;91:39-43

Background: Coeliac disease (CD) is a disorder that may depend on genetic, immunological, and environmental factors. Recent observational studies suggest that breast feeding may prevent the development of CD.

Aim: To evaluate articles that compared effects of breast feeding on risk of CD.

Methods: Systematic review and meta-analysis of observational studies published between 1966 and June 2004 that examined the association between breast feeding and the development of CD.

Results: Six case-control studies met the inclusion criteria. With the exception of one small study, all the included studies found an association between increasing duration of breast feeding and decreased risk of developing CD.
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The Swedish epidemic of coeliac disease explored using an epidemiological approach—some lessons to be learnt

Ivarsson A.

Best Pract Res Clin Gastroenterol. 2005 Jun;19(3):425-40.

Sweden has experienced an epidemic of symptomatic coeliac disease that has no likeness anywhere else in the world. This is quite unique for a disease that is genetically dependent, immune-mediated and chronic, and suggests an abrupt increase and decrease, respectively, of one or a few causal factors influencing a large proportion of Swedish infants during the period in question.

We have shown that half of the epidemic was explained by an increase in the proportion of infants introduced to gluten in comparatively large amounts after breast-feeding had been ended. This was partly an effect of societal changes in national dietary recommendations and the food content of industrially produced infant foods.
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Guiding principles for feeding non-breastfed children 6-24 months of age

World Health Organization, 2005

According to current UN recommendations, infants should be exclusively breastfed for the first six months of life, and thereafter should receive appropriate complementary feeding with continued breastfeeding up to two years or beyond. However, there are a number of infants who will not be able to enjoy the benefits of breastfeeding in the early months of life or for whom breastfeeding will stop before the recommended duration of two years or beyond.

PAHO’s publication Guiding Principles for Complementary Feeding of the Breastfed Child (2003) provides guidance on appropriate feeding of breastfed infants from six months onwards. Some of these guiding principles are applicable to non-breastfed children, but others are not, or require adaptation.
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Feeding habits of breastfed and non-breastfed children up to 1 year old

Graciete O. Vieira , Luciana R. Silva , Tatiana de O. Vieira , João Aprígio G. de Almeida , Vilma A. Cabral

J Pediatr (Rio J). 2004;80(5):411-16

Introduction

Human milk offers the nutrients that a child needs to begin a healthy life and represents the essential food for infants until their sixth month of life, as an exclusive food, and from then onwards should be complemented with other sources of nutrition until at least 2 years of age (1,2).

Earlier World Health Organization (WHO) documents recommended exclusive breastfeeding for 4-6 months (3). Based on scientific evidence of the benefits of exclusive breastfeeding, many countries, including Brazil, officially adopted the recommendation of complementary foods at 6 months of age (4,5).
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Guiding Principles for Complementary Feeding of The Breastfed Child

Complementary feeding is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk. The target age range for complementary feeding is generally taken to be 6 to 24 months of age, even though breastfeeding may continue beyond two years. A review of feeding guidelines promoted by various national and international organizations has shown that there are inconsistencies in the specific recommendations for feeding infants and young children (Dewey, in press).

Some of the feeding guidelines are based more on tradition and speculation than on scientific evidence, or are far more prescriptive than is necessary regarding issues such as the order of foods introduced and the amounts of specific foods to be given.
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Feeding and nutrition of infants and young children : Guidelines for the WHO European Region, with emphasis on the former Soviet countries

Kim Fleischer Michaelsen, Lawrence Weaver, Francesco Branca and Aileen Robertson
WHO Regional Publications, European Series, No. 87
World Health Organization 2000, updated reprint 2003

The guidelines are designed for the WHO European Region, with emphasis on the countries that resulted from the dissolution of the former Soviet Union. Nutrition and feeding practices vary throughout the Region and these recommendations should be applied flexibly and be adapted to local and national needs and circumstances. Despite the wide range of socioeconomic conditions found between and within the Member States of the Region, it is believed that many recommendations can be applied universally. They are especially applicable to the most vulnerable groups of infants and young children living in deprived conditions.
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The Optimal Duration of Exclusive Breastfeding – A Systematic Review

MICHAEL S. KRAMER, MD, RITSUKO KAKUMA, MSc

World Health Organization, 2002

Abstract

Background: The longstanding debate over the optimal duration of exclusive breastfeeding has centered on the so-called “weanling’s dilemma” in developing countries: the choice between the known protective effect of exclusive breastfeeding against infectious morbidity and the (theoretical) insufficiency of breast milk alone to satisfy the infant’s energy and micronutrient requirements beyond 4 months of age. The debate over whether to recommend exclusive breastfeeding for 4–6 months vs “about 6 months” has recently become more intense.

Objectives: 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 6 months vs exclusive breastfeeding for 3–4 months with mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) thereafter through 6 months.
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Report of The Expert Consultation on The Optimal Duration of Exclusive Breastfeeding

World Health Organization, 2002

The objectives of the expert consultation were:

  • To review the scientific evidence on the optimal duration of exclusive breastfeeding;
  • To formulate recommendations for practice on the optimal duration of exclusive breastfeeding;
  • To formulate recommendations for research needs in this area.

Summary of the findings

A systematic review of current scientific evidence on the optimal duration of exclusive breastfeeding identified and summarized studies comparing exclusive breastfeeding* for 4 to 6 months, versus 6 months, in terms of growth, infant iron status, morbidity, atopic disease, motor development, postpartum weight loss, and amenorrhea. It should be noted that the review was based on two small controlled trials and 17 observational studies that varied in both quality and geographic provenance.
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