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Posted at 7:00 AM ET, 01/17/2011

U.K. experts question 6 months of exclusive breastfeeding

By Jennifer LaRue Huget

Is it really best for babies to be fed nothing but breast milk for the first six months of their lives?

That issue's explored in a new article in bmj.com, the on-line version of the British Medical Journal.

Let's be absolutely clear here: Nobody's questioning the value of breastfeeding babies in general. The benefits of that practice are well documented, the study's authors emphasize. What's less clear is whether all or even most babies, at least those in the developed world, are best served by consuming nothing but breast milk until they turn six months old.

The study notes that when the U.K. in 2003 adopted the World Health Organization's recommendation for exclusive breastfeeding through six months, the science behind that recommendation wasn't heavily scrutinized. In the U.S., the Department of Health and Human Services adopted a more nuanced recommendation, suggesting that "Infants should be exclusively breastfed during the first 4 to 6 months of life, preferably for a full 6 months," and many other U.S. institutions, including the American Academy of Pediatrics, recommend exclusive breastfeeding for "approximately" six months.

At issue is the balance between the benefits exclusive breastfeeding confers on the baby -- such as reduced risk of infection -- and its potential drawbacks, which may include lack of sufficient iron and increased risk of food allergies and of celiac disease, for example. In addition, the report suggests, babies who are exclusively breastfed till they're half a year old may have difficulty accepting new tastes, particularly bitter ones, which could shape their food preferences for years to come. A baby who hasn't learned to enjoy bitter tastes may reject such foods as leafy greens later on; that could lead to less-healthful eating habits and even overweight -- or, as the paper charmingly calls it, "fatness". (The new study does not look at potential benefits and risks to the mother.)

The bmj.com study calls for a new system for establishing such far-reaching public health policy in which recommendations are grounded firmly in scientific evidence.

How long, if at all, did you breastfeed your baby or babies? And parents to be, do you intend to breastfeed? For how long do you hope to keep that practice up?

By Jennifer LaRue Huget  | January 17, 2011; 7:00 AM ET
Categories:  Childhood obesity, Family Health, Infant health, Kids' health, Motherhood, Obesity, Parenting, Women's Health  
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Comments

Thank you for your blog entry. Please see this statement from the World Health Organization - Exclusive breastfeeding for six months best for babies everywhere - dated January 15, 2011:

http://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/index.html#

James Akre
Geneva, Switzerland

Posted by: akrej | January 17, 2011 7:40 AM | Report abuse

I breastfed my daughter for 11 months and my son for 14 months. I tried feeding both of them solid foods at a bit past 4 months, but they were absolutely and completely uninterested until six months, at which point they dove in happily. ::shrug::

I'm not saying that my anecdote proves anything, but I think that a nuanced stance is probably a good one.

What is the actual incidence of iron deficiency in exclusively breastfed babies? Both of my kids spit the vitamin back at me, so I gave it up quickly.

Posted by: marag | January 17, 2011 10:16 AM | Report abuse

I breastfed exclusively for 6 months and weaned at 15 months. My daughter is 9 and loves vegetables. She eats a wider variety of them than I do. She is quite slim too. I know that anecdotes aren't data. But it seems weird to discourage BFing when the rates in the U.S. are already so low. Maybe the trick is what foods to introduce at 6 months.

Posted by: drl97 | January 17, 2011 10:27 AM | Report abuse

I have three children. The first never had formula - was breastfed exclusively for 6 months and then we began her on rice cereal and other foods. The second was in child care from the time she was three months old, and had some formula to supplement what I could pump. She nursed whenever I wasn't working, and also started "solids" at 6 months. Neither of these kids showed any interest in eating before that time, and both were weaned completely at 18-19 months.

I'm currently nursing baby #3, who is not quite 4 months old. She has had some formula during the day when needed and still nurses. She is very, very interested in what the rest of us are eating at the dinner table. I'm inclined to start her on cereal sooner than my older children, because she is so interested and seems developmentally ready. But I will continue to nurse her for another year or more, as well. As with so much of parenting, I think we try to make the best decision for the particular child at particular the time, and take every "expert" recommendation with a grain of salt.

Posted by: kb1231 | January 17, 2011 10:50 AM | Report abuse

I nursed all three of my kids until they were about two years old; my oldest had no solids until 6 months and my twins started at 4 months.

My oldest is the least picky of the three, but all of them love bitter/sour foods (they fight over grapefruit and will eat anything with enough vinegar-based salad dressing on it).

Posted by: floof | January 17, 2011 11:09 AM | Report abuse

the size of the baby leads the cereal decision. mine were 9-lbs., and could not have made it to six months just milk.
FWIW, the "you must breastfeed" trolls are tedious. many factors in the decision and what is right for one mom might not be for another.

Posted by: FloridaChick | January 17, 2011 11:18 AM | Report abuse

My wife breast-fed my daughter for almost 3 years, although she did not exclusively receive breast milk. She is now 14 and eats and likes pretty much everything. There is one thing I believe is associated with her prolonged breast feeding--a stunning intellect that manifested itself when she was 6 and could read better than most adults. She is equally gifted in mathematics (could manipulate square roots and scientific notation in Grade 1). I firmly believe that the essential fats contained in breast milk are responsible for her gifted intellect. She also never gets sick.

Posted by: ihave4ducks | January 17, 2011 12:17 PM | Report abuse

My son was EBF until starting solids at 6 months, and then kept BF until after he turned 2. He eats almost everything ever presented to him: gobbled up all the solids as we introduced them at 6 months; ethnic cuisine; bitter foods like brussell sprouts and Greek olives. You name it, he eats it! I think a good part of it may be that he tasted a variety of flavors early on thru my milk versus the static flavor of formula. Or maybe he's just a foodie! :) In any case, we did not see the pickiness referenced in the article, nor did we have to give him iron supplements. (Did give Vitamin D for while though.)

Posted by: thriftygrrrl | January 17, 2011 12:53 PM | Report abuse

I breastfed my son for about six months until I was required to deploy with the U.S. Army. My husband and I decided to keep an open mind about breastfeeding, rather than dogmatically insisting on only breast. As soon as he was able to join us in a high chair at the dinner table, our breastfed son sat with us at meals and watched us eat. With increasing interest over time, he followed the food from plate to our mouths, and at about four months, he made it clear that he'd like to try some of that, too.

We didn't do anything to expose our son to solids other than having him at the table. He expressed his interest and we offered him baby cereal, which he liked immediately, so we began to supplement breastmilk with cereal. Around this time, because I knew he'd have to be weaned so I could deploy, we also began offering him formula as another supplement to breastmilk.

Our son is now 2.5 years and is a very healthy child. He has typical daycare sniffles, but otherwise doesn't get sick. He's quite verbal, physically agile, and generally on or above average developmentally. He also likes a wide variety of foods, to include tomatoes, broccoli, onions, edamame, all sorts of meats and fruits, and is willing to try nearly anything.

I really can only share our own observations, but I don't think he would have developed such a broad palate if he'd remained exclusively on breastmilk to 6 months or beyond. This is simply because I am not an adventurous eater, and my son probably would not have experienced those tastes until much later, when he was undergoing toddler negativity.

To each his own.

Posted by: jcline1 | January 17, 2011 1:41 PM | Report abuse

Exclusive breastfeeding for the first 6 months is the standard that all women should strive to achieve, regardless of the "science" behind WHO, BMJ, AMA, etc.

Mothers who will and are breastfeeding need to ensure that they are eating a balanced diet with sufficient nutrients for both them and their child. Extra iron and calcium are definitely called for.

Food allergies and celiac disease often arise because for too early exposure to certain types of foods, so extended breastfeeding isn't a problem. As long as the mothers are not over-sterilizing themselves with toxic chemicals prior to nursing, the child will pick up an appropriate amount of flora and fauna for their intestinal health.

As for babies who are exclusively breastfed for the first year having difficulty accepting new tastes, particularly bitter ones, that's not necessarily a problem. Bitter foods are an indicator of poisonous and toxic substances in the wild.

Review of current research and observations shows that 6 months exclusive breastfeeding is to be recommended, with mixture of "solid" foods supplementing breast milk for the next 6, should give all the benefits for western children.

Posted by: mhoust | January 17, 2011 2:36 PM | Report abuse

I breastfed my eldest for 3 months, then I weaned her and switched to formula since I was anticipating going back to college and working. My middle child was a preemie, and I pumped and mixed my milk with a preemie formula since her doctors told me to. I did that for about 7 months when I had to switch to all formula since my milk gave out. With my youngest, I breastfed him for a little over 2 years. Luckily, I was (am) a SAHM, since he wouldn't touch a bottle of formula or breastmilk. For my oldest and youngest, I didn't give them solids until they were around six months. Since my middle was a preemie, I didn't introduce real solids until she was between nine months and a year. I gave her a bit of cereal beforehand, but that was it.
When it comes to bitter flavors, kids are just picky. It takes time for them to learn to like complex flavors, and that food allergy increase is nonsense IMHO. My first child was allergic from birth. Her scaly eczema on her cheeks was our first clue, and she was only breastfed for 3 months, but she has allergies to fish, shellfish, soy, peanuts, and tree nuts. The two that were on breastmilk longer have no food allergies at all.

Posted by: fantasyjoker | January 17, 2011 3:47 PM | Report abuse

I breast-fed exclusively for 5 1/2 months. I did not wean my daughter entirely until she was 15 months old. My daughter does have celiac disease, so this new research is interesting.

Posted by: lhnorwalk | January 17, 2011 5:45 PM | Report abuse

Kids are all different, and I find that very few rules apply uniformly and unconditionally to all children.
I breastfed my son for one year - he weaned himself on his first birthday, simply refusing to nurse - and started feeding him solid foods at four months. (He appeared hungry for them, seemed to enjoy them when he got them, and I don't think they did him any harm.) He was a big baby - born an ounce shy of 10 pounds.

At age 4-nearly-5, he has no food allergies, is relatively healthy, quite bright and very articulate, and eats a wide variety of healthy foods. On the other hand, he does not have superpowers, is not a supergenius as far as I can tell, is occasionally ill (mostly minor preschool bugs), does not prefer Brussels sprouts and broccoli to pizza, and has some behavior issues (mainly related to being high-energy and stubborn - nothing awful). So I do not claim that My Way Will Make A Child Perfect! (TM) But I wasn't after having a perfect child anyway, and the one I have is just fine. So I think my choices have, on the whole, been good for him, or at least not actively harmful. But I don't claim they'd work for every kid, either.

Posted by: Catken1 | January 17, 2011 6:24 PM | Report abuse

I breast fed my daughter until she was nineteen months old along with breast feeding my sisters three month old son so that she could have cancer surgery, take the chemo, then return to the ability to breast feed him. You just keep pumping. Questioning a childs welfare because of breastfeeding past six months is specious. Every mother has the ability to nurture her child if she wants to.

Posted by: fabricmaven1 | January 17, 2011 6:45 PM | Report abuse

Out of 4 children:

1 - breastfed for 5 months

2- not breastfed

3 - breastfed 6 months exclusviely

4- breastfed 6 months exclusively: CELIAC DISEASE

So if breastfeeding caused Celiac in number 4, why didn't it cause Celiac in number 3?

Plus, he wasn't diagnosed for years, but I clearly remember his shaking in the mornings around 14 months - right after we introduced pasta (Celiac's can't eat gluten).

How is there this link? This article needs way more information to make any sense.

Posted by: Amelia5 | January 17, 2011 7:15 PM | Report abuse

Exclusively breastfed son#1 until 6 months, but might consider introducing solids a little earlier for next baby, if he/she shows interest. Son#1 dropped from 90th percentile in weight to 75th percentile in month 6, and then jumped back to 90th once we added the solids. I suspect that he had simply increased his calorie requirement between 5-6 months. We started supplementing with formula around 10 months, because my supply started going down. He weaned himself 2 weeks before his first birthday - no longer interested in sitting still and breastfeeding. Today, he's 2 years old and eats broccoli, spinach, kidney beans, green peas, string beans, edemame, etc., has no allergies (thankfully), and is you're all-round healthy, active toddler. I don't know what the right answer is, but this worked for him.

Two thoughts about breastfeeding:
1) it's not free. It's very time-consuming, and if you have a career, there's opportunity cost to pumping and nursing.

2) It's not a panacea. Breastfeeding does not cure all ills. Nor is formula the ultimate evil. It sounds like most of the respondants to this article are pretty balanced, though I've seen some radical breastmilk proponents out there.

Posted by: newmom2009 | January 17, 2011 7:49 PM | Report abuse

I nursed my oldest child until he was 4. He didn't start consistent solids until he was over a year old. I am still nursing my 2 1/2 year old, who also didn't start solids until about 1 year. They both eat everything and have no health issues or allergies. They have never had ear or intestinal infections or any illness other than a cold.

I really agree with ihave4ducks about the intellect. There is some research about IQ and breastfeeding/long chain fatty acids: http://www.breastfeeding.com/all_about/all_about_iq.html

My son started reading at age 3 and was reading adult novels by age six. He is also gifted in math. My daughter is miles ahead in speech and knows all the letters of the alphabet by sight, simple words, and is excellent at counting...knew all her colors before 18 months, etc.

You can't beat millions of years of evolution. Most traditional cultures don't start solids until after a year. The idea of strapping a young infant, who can't even sit up yet, into a high chair and shoveling processed food into it's mouth just somehow doesn't seem right. I highly doubt that early solids is the biologic norm for a human infant.

Posted by: flower5 | January 17, 2011 8:04 PM | Report abuse

I breastfed exclusively for six months. I breastfed in total for two years; this wasn't planned but I was a working mom and I think it was the close bond that I loved so much after being away all day. My child is not gifted but of normal intelligence, but she is rarely sick, even now and has no allergies or other medical conditions

Posted by: cagnav | January 17, 2011 8:16 PM | Report abuse

Usually, a baby's first solids are rice cereal, bananas, avocado, etc. The "bitter" greens and fruits come later, and I can't imagine that a few months on either side could impact a baby's food preferences "for years to come." Besides, babies get variety of flavor in breast milk- one night, pho; the next night, bbq.

Posted by: jaho | January 17, 2011 8:48 PM | Report abuse

I breast fed both my sons for one year. Their ages now are 35 and 32. Both are fond of all vegetables, no allergies, no problems with weight, activities nor learning. I gave them solids at 6 months all from fresh foods, no baby foods. Not enough information for me to show concern.

Posted by: janetmacnab | January 17, 2011 10:45 PM | Report abuse

What sort of funding is behind the article? Just seems like one more attempt to undermine natural parenting. Breastfed babies are exposed to all the flavors that their mothers eat, so why would they resist certain foods because of flavor? I have five children, including an infant. I breastfed my fourth the longest, for almost two years, and she is by far my best eater--she eats anything put in front of her, including all veg. She didn't have solids until 8 months. I think the article and "science" here are worthless and frankly detrimental to breastfeeding trends, which are already tenuous in this country.

Posted by: GrainofSalt1 | January 17, 2011 11:03 PM | Report abuse

What sort of funding is behind the article? Just seems like one more attempt to undermine natural parenting. Breastfed babies are exposed to all the flavors that their mothers eat, so why would they resist certain foods because of flavor? I have five children, including an infant. I breastfed my fourth the longest, for almost two years, and she is by far my best eater--she eats anything put in front of her, including all veg. She didn't have solids until 8 months. I think the article and "science" here are worthless and frankly detrimental to breastfeeding trends, which are already tenuous in this country.

Posted by: GrainofSalt1 | January 17, 2011 11:04 PM | Report abuse

‎"Three of the four authors of this study, Mary Fewtrell, Alan Lucas and David Wilson, receive funding from the baby food industry. Prof Lucas in particular plays a key role in advising the UK baby food industry, and has opposed the WHO r...ecommendation for many years. In 2003 he went so far as to appear for the defence when one of the largest baby food companies, SMA Wyeth was successfully prosecuted for illegal advertising by Trading Standards."
- http://www.lisanorthover.com/2011/01/more-on-that-breastfeeding-study.html

"When considering this analysis it should be noted that three of the four authors have declared an association with the baby feeding industry. Less breastfeeding and earlier introduction of solid food will lead to greater profit for this industry."
- Unicef UK response (http://www.babyfriendly.org.uk/pdfs/unicef_uk_response_to_BMJ_article_140111.pdf)

Posted by: gnatty_girl | January 17, 2011 11:59 PM | Report abuse


Very true that major brands do give out samples on their products, search online for "123 Get Samples" we just got ours today. You wont need CC.

Posted by: jessicajone18 | January 18, 2011 1:55 AM | Report abuse

I have 4 children and breastfed them for more than 2 years each--nearly 3 for my last one. I allowed them to try foods as they expressed interest (even for 6 months), but prior to 6 months of age those were more tastes (like sucking on a juicy plum for a while), rather than a serving. Part of my reason for doing this was because we have a family history for food allergies and another because I knew that nothing is more nutritious than breastmilk. Sure, eventually, the baby's iron stores become depleted and so they need iron supplementation, and vitamin D is important, but beyond that, breastmilk is superior to any other food I could have given my children. Furthermore, baby's tongue is designed to enjoy the sweet nuances of milk, with far more sweet receptors than adult tongues.

I am DEEPLY surprised that anyone who knows about breastfeeding questions whether children will learn to accept new flavors if they are exclusively breastfed. Do they not understand that the flavor of the milk depends on the mother's diet? Therefore, if a mother wants baby to try broccoli or licorice or curry, she need only eat those foods herself. And let's not forget introducing new foods via the sense of smell as those foods cook. Babies will smell the typical foods of their family's diet numerous times and become accustomed to them before they are ever offered them. Furthermore, babies are more likely to enjoy a new flavor if it is in a familiar setting, warm and cuddling with mom, and with come familiar flavors mixed in. We use this concept when we offer babies the familiar milk or formula with rice cereal and again when we mix the rice cereal with other flavors, but it is at its most primal form when mom eats garlic, leeks, seafood, peppers, celery, oregano, cumin or cinnamon and transmits those flavors via breastmilk. Maybe children become LESS picky with extended breastfeeding, since they try various flavors automatically?

Finally, some children are more open to novelty than others. This is a temperament issue and not as a result of the choice regarding breastfeeding versus formula feeding. Eventually, regardless of how they were fed, most adults enjoy some bitter foods (hence the popularity of coffee, tea, and dark chocolate).

Posted by: englishgal | January 18, 2011 7:25 PM | Report abuse

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