This is very cheering indeed, researchers and experts are commenting on the the ‘Six months of exclusive breastfeeding, how good is the evidence’ article using phrases such as
“just a respectable opinion based on shaky grounds”
“Why don’t we concentrate on physiology and neuromuscular development to advise mothers on when to start solids, instead of wandering in search of doubtful evidence?”
“Breastfeeding is more than infant nutrition”
“The health benefits for the mother, both short and long term, are not explored, and the risks and expense of formula feeding, even in industrialized settings, are brushed aside.”
“it might be noted that three of the four authors declare receiving funding from the infant food industry, which would benefit from policy that dictated a significant increase in the need for infant formula.”
This is the page on the British Medical Journal website where experts can reply to published articles.
http://www.bmj.com/content/342/bmj.c5955/reply
On Twitter the BMJ Group have said to the Leaky Boob “I’ll suggest a follow up piece to editorial team following press interpretation. BMJ always strives for balance in our content”.
How much can we blame the press though? The information they got about it was a press release from the BMJ which included snippets like
‘Dr Fewtrell argues that the evidence that breast milk alone provides sufficient nutrition for six months is questionable. She says there is a higher risk of iron deficiency anaemia if babies are exclusively breast fed and that there could also be a higher incidence of celiac disease and food allergies if children are not introduced to certain solid foods before six months.”Here are some of the replies to ‘Six months of exclusive breast feeding: how good is the evidence?’
Not so good- Adriano Cattaneo, Epidemiologist
Finally, I am amazed by the rapid spread into the popular press and media of the questionable messages posted by Fewtrell and collaborators in their paper. Less than 24 hours after publication, newspapers in Italy (and I guess in UK and other countries; TV will follow suit) are already talking about a “new study” showing that exclusively breastfeeding infants to six months may be dangerous. Am I wrong if I ask the authors to make a quick public statement to transparently say that theirs is not a “new study” but just a respectable opinion based on shaky grounds? Competing interests: None declared
Breastfeeding is more than infant nutrition
- Miriam H. Labbok, Professor/Physician
Carolina Global Breastfeeding Institute, Dept of Maternal and Child Health, University of North Caro
January 14, 2010
Dear Editors:
With thanks to my friends and respected colleagues for addressing the importance of six months of exclusive breastfeeding, it would seems that their argument considers breastfeeding primarily as a replacement for formula feeding. The health benefits for the mother, both short and long term, are not explored, and the risks and expense of formula feeding, even in industrialized settings, are brushed aside.
For the most part, this article actually presents substantial additional data supporting six months for the infant and child health outcomes while noting the few findings that might speak against it. One possibly new issue raised, based on a single Swedish study, is coeliac disease; the article itself notes that gluten load, rather than timing, might well be the culprit. Concerning iron stores, we know that much of this problem could be addressed with proper delay of cord clamping, giving infants greater iron stores from birth, or if still needed, later micronutrient supplementation might be considered. This birth-related issue and other maternal issues are disregarded: six months (vs. four) exclusive breastfeeding has many advantages for maternal health and birth spacing in less developed and industrialized countries alike. Also, the large body of published research on later maternal and child obesity, cancer and related diseases is barely considered. In sum, there is little here to argue against the definition of optimal feeding practice, for mother and child, to remain exclusive breastfeeding for six months.
As to the research from developed countries, such research on exclusive breastfeeding in developed countries is very difficult to interpret in part due to small self-selected numbers and in part due to inadequate definitions of breastfeeding practices. The WHO nutrition section and other nutrition groups tend to define the term exclusive breastfeeding only in its role as a food, and therefore the definition of exclusive breastfeeding generally includes the feeding of expressed milk and/or pasteurized donor milk. Such milk feeding may not be creating the same physiological, hormonal and gut floral/fauna responses in the mother and child as is created by direct breastfeeding, and, in situations where there may be considerable separation of mother and child, the immune composition of the milk may no not address the child’s environmental exposures. We are far from understanding the differences in health outcomes for mother and child with the use of pumps and expressed milk, a very common practice in the US. Other concerns, such as delayed exposure to food flavors, would not appear significant, given recent research that has confirmed that breastfed infants are already exposed to the flavors of foods ingested by mother through her milk.
On a different issue, it may also be important to correctly the statement on US government support. USG policy has noted the importance of six months, rather than 4-6, since the preparation of the US DHHS Blueprint for Action on Breastfeeding, published in 2000, and has been supporting six months exclusive breastfeeding for more than 5 years with the Healthy People goal for the Nation to increase exclusive breastfeeding through six months.
Finally, it might be noted that three of the four authors declare receiving funding from the infant food industry, which would benefit from policy that dictated a significant increase in the need for infant formula.
Rather than calling for truncation of exclusive breastfeeding, limiting its myriad of positive immediate health, child spacing and long- term health effects, let us instead call for 1) delayed cord clamping for iron stores, with iron supplements as needed in later infancy, 2) research on the impact of exclusive breastfeeding vs. expressed milk feeding on the health of both mothers and their children, and, most of all, 3) unbiased, informed, and mother-centered support – clinical, social and economic – so that women may make an unbiased, informed infant feeding choice, and succeed in six months of exclusive breastfeeding.
Sincerely,
Miriam H. Labbok, MD, MPH, FACPM, IBCLC, FABM
The Carolina Breastfeeding Institute (CGBI) Professor, and Director, CGBI Department of Maternal and Child Health Gillings School of Global Public Health
The University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7445
Note:
–Labbok is on the Board of the Academy of Breastfeeding Medicine and North America Representative on the Board of Directors, World Alliance for Breastfeeding Action
–CGBI is a member of The North Carolina Breastfeeding Coalition; The United States Breastfeeding Committee; The Partnership for Maternal, Newborn and Child Health.
–CGBI is a component of The WHO Collaborating Centre for Research Evidence for Sexual and Reproductive Health at UNC
Competing interests: None declared
Competing interests
- Alison E Powell, Former midwife
Cambridge
I note that three of the four authors of this paper (MF, AL, and DCW) “have performed consultancy work and/or received research funding from companies manufacturing infant formulas and baby foods within the past 3 years”.
Such companies stand to gain directly and indirectly from a national policy recommendation for earlier weaning – or indeed from media coverage that undermines breastfeeding.
Competing interests: None declared
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