- The World Health Organization (WHO) and other international health agencies have recommended that babies should be fed breast milk exclusively for their first six months of life.
- Scientists reporting in the BMJ suggest that six months is too long and that babies should begin solid food at four months, supplemented with continued breast milk.
- Breastfeeding advocates point out that three of the four co-authors of the dissenting study in the BMJ received some funding from commercial baby food and formula companies.
Citing the latest “systemic review of the evidence, the World Health Organization (WHO) has reiterated its 2001 recommendations1 for “mothers worldwide to exclusively breastfeed infants for the child’s first six months to achieve optimal growth, development and health,” adding, “Thereafter, they should be given nutritious complementary foods and continue breastfeeding up to the age of two years or beyond.”
The WHO statement was supported by “two controlled trials and 18 other studies conducted in both developed and developing countries.”2 The policy was echoed in 2012, by the American Academy of Pediatrics (AAP), which agreed that babies should be exclusively fed breast milk for their first six months, with continued breastfeeding along with supplemental nutrition for at least the first year.3
With such authoritative recommendations, it is not surprising that medical professionals and new mothers alike have considered six months of exclusively feeding breast milk to be the gold standard in baby care and nutrition for the past few decades. What, then, of claims by some scientists contradicting the WHO recommendations and stating that six months is too long to feed a baby only on breast milk and that, in fact, such a diet could be harmful to infants?
Do Babies Need Solid Food Before Six Months?
A study published in the BMJ claims that the evidence to support giving six months of breast milk as the only source of nutrition “was never there” and that waiting that long to introduce solid food could be detrimental to the developing child. This report suggests that evidence, not available when the WHO made its recommendation, shows that exclusively breastfed babies have an increased risk of developing iron deficiency anemia, which may “be linked to irreversible adverse mental, motor or psychosocial outcomes.”4
The study further claims that waiting to introduce solid food until later than six months could lead to an increased risk of food allergies and celiac disease. Mary Fewtrell, one of the authors of the study, said that since so few mothers actually breastfeed at all by six months, let alone exclusively, probably few children are harmed.
However, since evidence also shows that babies breastfed exclusively for six months had a lower risk of dying from infections such as pneumonia,5 the authors proposed that the six-month policy may merit support for poor countries with a high rate of infant mortality from infection, but that four months of exclusive breastfeeding might be more appropriate for developed nations.
Breastfeeding advocates have called the motion “a regrettable and backward step that is out of step with current scientific thinking” and pointed out that three of the four authors of the study accepted some sort of funding from the commercialized baby food and infant formula industries.
WHO Stands Firm for Six Months of Exclusive Breastfeeding
The most recent recommendations from the WHO continue to support the idea that six months of exclusive breastfeeding is best for babies and does provide all the nutrition and immune system support they need for the best start in life. Joint policy guidelines of the WHO and UNICEF state that the best, healthiest nutritional course for infants includes:
Early initiation of breastfeeding within 1 hour of birth;
Exclusive breastfeeding for the first 6 months of life; and
Introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond.6
Dr. Fewtrell counters that it is not their job to offer new advice, but that “…our own opinion is that currently the balance of data would favour introducing solids alongside continued breastfeeding between 4 and 6 months—when the mother feels her baby is ready.”5 In the end, parents must look at the evidence themselves and decide when to introduce solid food based on the individual needs of their own baby.
1 World Health Organization. Exclusive Breastfeeding. Report of an Expert Consultation March 2001.
2 WHO. Exclusive Breastfeeding for Six Months Best for Babies Everywhere. World Health Organization Statement Jan. 15, 2011.
3 Breastfeeding and the Use of Human Milk. Pediatrics March 2012.
4 Boseley S. Six Months of Breastmilk Alone Is too Long and Could Harm Babies, Scientists Now Say. The Guardian Jan. 13, 2011.
5 Gilbert N. Is Breast Not Best for Babies? Nature Jan. 14, 2011.
6 WHO. Infant and Young Child Feeding. WHO Fact Sheet September 2016.