Study Suggests Exclusive Breastfeeding Leads to Infant Health Problems
Breastfeeding provides many health benefits for baby, including decreasing the risk of such conditions such as ear infections, respiratory infections, both type 1 and type 2 diabetes, and atopic dermatitis (eczema). Because breast milk is rich in nutrients and antibodies, organizations such as the American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life. A new British study challenges that guideline, stating that newborns need more variety in their diets after four months to protect them from iron-deficiency anemia and risk of celiac disease and food allergies.
Dr. Mary Fewtrell, a pediatrician at the UCL Institute of Child Health in London, and colleagues conducted a review of several observational studies about breastfeeding practices. While the researchers agree that mothers in developing countries should heed the advice of the World Health Organization for exclusive breastfeeding for six months due to inadequate access to quality food and clean water, the rest of the developed world should consider the addition of solid foods earlier.
Dr. Fewtrell says there is “no compelling evidence” not to introduce solid foods between four and six months of age, and it might help reduce the risk for iron-deficiency anemia. Breast milk is not an adequate source of iron and children who are breastfed exclusively are often given an iron supplement beginning around four months of age to prevent anemia which could lead to mental, motor, or behavioral problems. The introduction of iron-fortified cereal can be introduced at this time to reduce the risk.
The researchers also suggest that children who are exclusively breastfed are at a greater risk of food allergies, including celiac disease which is an autoimmune disease where the intestinal lining reacts to the consumption of gluten and other proteins found in wheat, barley, rye, and possibly oats. They note the results of a Swedish study that found that the incidence of early-onset celiac disease increased after a recommendation to delay the introduction of gluten until age six months and fell to previous levels after the guidelines reverted to recommending solid food introduction at four months.
The researchers of the Swedish study found that there was a “window of opportunity” for introduction of solids. Before the age of 3 months and after the age of 7 months, those who were introduced to gluten for the first time had an increased risk of celiac disease autoimmunity (CDA) over those who were exposed between the ages of 4 to 6 months.
However, the scientists also found that the introduction of solid foods containing gluten while continuing breastfeeding was better than weaning a child first and then introducing gluten and resulted in a 52% decrease in developing celiac disease.
Dr. Fewtrell and her team also indicated concern that not introducing foods early in life can lead to “a decreased window for introducing new tastes,” particularly the bitter taste of leafy green vegetables “which may potentially affect later food preferences with influence on health outcomes such as obesity.”
The authors are quick to point out that they are not suggesting that women forgo breastfeeding entirely. Babies can continue to nurse even after the introduction of solid foods and women should discuss their child’s nutritional status with their pediatricians. First foods for babies are single ingredient foods such as thinned rice or other "baby" cereal, and pureed and soft-cooked fruits and vegetables. It is often suggested to introduce foods one at a time and monitor for allergic reactions such as diarrhea, rash or vomiting.
Certain foods and textures carry risks to the infant as well, such as poor digestion due to gut immaturity and choking because the swallowing mechanism is not fully developed enough to cope with solid foods.
When introducing solid foods, always ensure that the baby is sitting upright. If your child cannot sit upright unassisted and does not have proper head control, it is not the right time to begin solids. Babies should always eat in a high chair or other infant-specific chair to reduce the risk of choking and never leave a child unattended when eating.
"Six months of exclusive breast feeding: how good is the evidence?"
Mary Fewtrell, David C Wilson, Ian Booth, Alan Lucas.
BMJ, 2011; 342:c5955; Published online 13 January 2011.