Exclusive breastfeeding should continue to six months

Paediatr Child Health 2005;10(3):148

Reaffirmed February 2009

Parent handout: Breastfeeding

Index of position statements from the Nutrition and Gastroenterology Committee

By Margaret Boland, MD, FRCPC
Chair, Nutrition Committee, Canadian Paediatric Society

The Canadian Paediatric Society recommends exclusive breastfeeding for the first six months of life for healthy, term infants. Breast milk is the optimal food for infants, and breastfeeding may continue for up to two years and beyond. 

This recommendation, proposed by the CPS Nutrition Committee and adopted by the Board of Directors in March 2005, extends the duration of exclusive breastfeeding from the former range of four to six months.(1) It is also consistent with recently published recommendations from Health Canada (2) and the American Academy of Pediatrics Section on Breastfeeding.(3) These changes follow the World Health Organization’s 2001 recommendation that exclusive breastfeeding continue for six months.(4) The WHO defines exclusive breastfeeding as the practice of feeding only breast milk (including expressed breast milk) and allows the baby to receive vitamins, minerals or medicine. Water, breast milk substitutes, other liquids and solid foods are excluded. (5) 

The reasons behind the new recommendation include strong protective effects for infant gastrointestinal infection, prolonged lactational amenorrhea and increased post-partum weight loss in mothers. There were concerns that this recommendation could result in iron deficiency, other micronutrient deficiencies and growth faltering in susceptible infants. These concerns were directed particularly at populations where maternal nutrition was suspect, and infants had high rates of iron, zinc and vitamin A deficiency. However, an 8% global increase in exclusive breastfeeding to six months is estimated to have reduced infant mortality by 1,000,000, decreased fertility by 600,000, and saved countries billions of dollars in unneeded breastmilk substitutes (6). While the data for benefit in industrialized countries is limited, it does exist.(7, 8)

Nutrient-rich complementary foods, with particular attention to iron, should be introduced at six months. Breastfed babies should also receive a daily vitamin D supplement until their diet provides a reliable source or until they reach one year of age (9, 10).

The Nutrition Committee recognizes that more research in infant feeding is needed. However, there is no evidence of harm in the new recommendation, and promoting exclusive breastfeeding to six months has the potential to improve health for infants who are economically and socially disadvantaged. We must acknowledge the need to provide adequate social and nutritional support to lactating women.

References

1. Canadian Paediatric Society, Dietitians of Canada and Health Canada. Nutrition for Healthy Term Infants. 1998. Ottawa: Minister of Public Works and Government Services, 1998.
2. Health Canada. Exclusive Breastfeeding Duration: 2004 Health Canada Recommendation. Ottawa, 2004.
   
3. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics 2005; 115(2): 496-506.
4. World Health Organization. Global Strategy for Infant and Young Child Feeding, The Optimal Duration of Exclusive Breastfeeding. Geneva, 2001.
5. World Health Organization. Promoting proper feeding for infants and young children. Geneva: 2004.
6. UNICEF. Facts and Figures. www.unicef.org/programme/breastfeeding/facts.htm (Version current at February 22, 2005)
7. Kramer MS, Guo T, Platt RW, et al. Infant growth and health outcomes associated with 3 compared with 6 months of exclusive breastfeeding. Am J Clin Nutr 2003;78:291-295.
8. Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding. A systematic review. Geneva: World Health Organization, 2002.
9. Health Canada. Vitamin D Supplementation for Breastfed Infants: 2004 Health Canada Recommendation. Ottawa, 2004.
10. Canadian Paediatric Society, Indian and Inuit Health Committee. Vitamin D supplementation in Northern Native communities. Paediatr Child Health 2002;7(7):459-63.

Posted March 2005