Study: Exclusive Breastfeeding For Six Months May Harm Infants?! Argh.

UK researchers are questioning the recommendation that mothers breastfeed their babies exclusively for six months. Their report, published in the British Medical Journal this week, suggests babies might benefit from being introduced to solids sooner. And in fact suggests that following the six month recommendation could even be harmful to infants’ health.

Current recommendations– that mothers breastfeed exclusively for six months (meaning no food, just breastmilk) and then continue to feed both food and breastmilk for at least a year– are based on a systematic review of breastfeeding data conducted in 2001 which found that the exclusively breastfed babies had fewer infections and fewer growth problems than those who were not.

A team of child health experts, led by pediatrician Dr. Mary Fewtrell, revisited this data and came to a different conclusion.  They found a higher risk of iron deficiency anemia for exclusively breastfed babies and a possible increased risk for celiac disease and food allergies if infants aren’t exposed to certain solid foods (including nuts and gluten) before six months.

They also wonder if six months of exclusive breastfeeding might limit taste associations, particularly a taste for bitter things such as green leafy vegetables. Though I’m not sure how this computes with studies showing how food flavors penetrate breastmilk and make an impact on a child’s developing taste preferences. Some studies even show that fetuses exposed to certain flavors in utero will show preference for them later in life.

Fewtrell’s team are adamant that they are very pro-breastfeeding– they do not advocate weaning to, or supplementing with, formula– but they do think it’s time to review the UK’s guidelines about the introductions to solids. They suggest that exclusive breastfeeding might suitable for four rather than six months.

Of course this study has already kicked up a lot of sand in the breastfeeding community. According to The Guardian, three of four of the researchers have been on formula and/or baby food payrolls at some point in the past three years. Breastfeeding advocates wonder whether these affiliations taint the study. Perhaps. But is this reevaluation necessarily anti-breastfeeding? It seems entirely reasonable to me.

For one thing, advice about breastfeeding and weaning *must* be looked at in context.

Feeding exclusively for a long time can be life-saving in countries where food and water sanitation is a real issue. In the UK and US we don’t have to worry about this so much. For another, US babies are screened for iron deficiency whereas UK babies are not. Plus, though the American Academy of Pediatricians (AAP) recommends feeding exclusively for six months in it’s breastfeeding guidelines, in it’s nutrition guidelines it suggests introducing iron-fortified cereals between 4-6 months.

This is a contradiction I wish they’d resolve. But the fact is a lot of pediatricians and lactation consultants say that solids can be introduced sometime between 4-6 months. A lot of babies also express interest in solids at around four or five months. Parents may benefit from adjusted recommendations that include a bit more flexibility. Less stringent guidelines might encourage us– as the best breastfeeding and weaning books do– to look at our babies to see where they are and what they’re doing. Babies shove their tongues out if you try to feed them solids too soon.

Though this study will get people riled up, because everything about breastfeeding always does, try to keep in mind that though we should always take recommendations seriously, obsessing over them can be a bit, oh I don’t know, joyless? Just to zoom out a little bit: Babies love nursing so much and then express such incredible curiosity about food. Feed that curiously. Feed that warmth and joy, rather than looking too neurotically in a book for the PRECISE day and time you’re allowed to spoon feed. Our medical guidelines can take the fun out of caring for our babies, so we need to keep them in perspective. Food is so fraught in our culture already. Celebrate diverse tastes and talk to your pediatrician about things like iron and Vitamin D deficiencies. If the recommendations change, we’ll get the news soon enough. For now, I think it’s safe to say that there’s a window to start solids; not a cut-off.

photo:  Etolane/Flickr

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