Minta petunjuk menerangkan kepada mertua perlunya ASI ekslusif 6 bulan
From: Imelda Santos
Mon Jan 2, 2006 1:53 pm
Dear dokter dan SPs,
Mau minta petunjuk nih… Sebelumnya saya harus menerangkan dahulu
bahwa saya tinggal dengan mertua dan mertua perempuan saya adalah
seorang guru biologi di salah satu SMA favorit di jakarta dan beliau
sudah mempunyai pengalaman mengajar selama lebih dari 30 tahun. Dan
almarhum mertua lelaki saya adalah seorang dosen mikrobiologi di UI
Saya mengalami sedikit kesulitan dalam menerapkan ASI ekslusif untuk
si kecil di rumah. Beliau memang sangat menganjurkan pemberian ASI
untuk si kecil. Tetapi menurut beliau air putih tidak apa-apa
diberikan kepada bayi, bahkan semestinya begitu untuk membersihkan
mulut sesudah minum susu. Tetapi saya bisa ngotot, dan akhirnya tidak
diberikan air putih.
Saat almarhum mertua saya masuk ICU dan akhirnya meninggal, beliau
menyarankan menambahkan formula. Saya tolak. Saat saya kembali
bekerja, beliau kembali menyarankan untuk menambah ASI dengan formula.
Suami saya menolak karena melihat tekad saya dan tabungan ASI saya
yang cukup banyak. Saat itu, tabungan ASI saya cukup untuk beberapa
Saya sempat sakit panas, beliau bilang ASI-nya dibuang saja. Takut si
kecil ikutan sakit. Walau sudah diterangkan bahwa DSA, it’s okay,
akhirnya untuk yang ini saya menyerah. Toh tabungan ASI saya cukup.
Sekarang si kecil sudah 4 bulan. Beliau meminta saya untuk mulai
memberikan MPASI, bahkan sudah membelikan jeruk baby, biskuit, dsb.
Saya terangkan bahwa menurut WHO lebih baik 6 bulan, dan memberikan
beberapa bacaan yang mendukung. Tetapi beliau bilang bahwa, dia sudah
tahu melalui berita di TV dan di majalah/koran. Dan beliau menerangkan
bahwa enzim di perut bayi harus dirangsang, tidak bisa langsung ada
dan bahwa perkembangan kemampuan si kecil berbeda-beda (ingat beliau
adalah seorang guru biologi, beliau dapat menerangkan dengan
bahasa-bahasa latin, yang tidak saya mengerti). Dan intinya
menerangkan bahwa si kecil sudah mampu diberikan MPASI.
Tolong, dengan apa lagi saya harus menerangkannya? Sejujurnya saya
takut kalau si kecil diberikan MPASI saat saya bekerja…. Bagaimana
Dear Mbak Imelda,
Semoga artikel2 dan juga jurnal2 berikut (termasuk dari WHO ) bisa membantu
mbak utk berdiskusi seimbang dan asik dg sang ibu mertua 🙂
Asik ya kalo blio malah well knowledge spt ibu mertua mbak 🙂
Jika perlu coba buka link aslinay utk diposting utk dicetak.
OK saya yakin mbak imelda moderator diskusi yg amat baik yg bisa
menyampaikan dg cara yg smart tapi jgua bijak 🙂
Btw alm. bapak mertua siapa namanya kalo boleh tau ?!
Jangan2 guru besar saya pas kuliah dulu
Sounds so familiar.
Sumber : http://www.who.int
Information for Health Professionals on Infant Feeding
The World Health Organisation (WHO) revised its guidance in 2001 to
exclusive breastfeeding for the first six months of an infant's life. The UK
resolution at the World Health Assembly. Since its adoption 159 Member
demonstrated their determination to act by preparing or strengthening their
nutrition policies and plans, with France, Australia and Ireland also
recommendations of six months' exclusive breastfeeding.
The UK's Scientific Advisory Committee on Nutrition (SACN) stated in 2001
was sufficient evidence that exclusive breastfeeding for six months is
adequate, but that due to current practices in the UK there should be some
the advice. SACN agreed that the available evidence did not support the
concern that between four to six months breastmilk was inadequate to support
Following WHO's revised guidance, the Department of Health, London issued a
recommendation on breastfeeding last year. Key professional and voluntary
have supported this recommendation, including the Royal College of Midwives,
Community Practitioners and Health Visitors Association and the National
What are the Department's recommendations on feeding infants?
. Breastmilk is the best form of nutrition for infants; it provides all the
nutrients a baby
. Exclusive breastfeeding is recommended for the first six months of an
. Six months is the recommended age for the introduction of solid foods for
breast and formula fed infants.
. Breastfeeding (and/or breastmilk substitutes, if used) should continue
first six months along with appropriate types and amounts of solid foods.
. Mothers who are unable to, or choose not to, follow these recommendations
be supported to optimise their infants' nutrition.
What is the scientific evidence for exclusively breastfeeding for 6 months?
There is extensive scientific evidence to support the consensus that
breastfeeding is the
best way to feed an infant. WHO undertook a systematic review on the Optimal
of Exclusive Breastfeeding. The main objective of the review was to assess
on child health, growth, and development, and on maternal health, of
breastfeeding for six months compared with exclusive breastfeeding for three
months with mixed feeding (introduction of complementary liquid or solid
continued breastfeeding) thereafter through 6 months.
Twenty independent studies were reviewed (nine from developing countries and
from developed countries). The conclusions were:
. Infants who are exclusively breastfed for six months experience less
or respiratory infection.
. No deficits were demonstrated in growth among infants who were exclusively
breastfed for six months.
. No benefits of introducing complementary foods between four and six months
been demonstrated, with the exception of improved iron status in one
. Exclusively breastfeeding for six months is associated with delayed
the menstrual cycle and greater postpartum weight loss in the mother.
Is there any risk associated with the recommendations?
A study by WHO concluded that "while infants must be managed individually,
evidence demonstrated that there was no apparent risk in the recommendation
exclusive breastfeeding for the first six months of life in developed and
Although there is no evidence to suggest that giving a baby solid food
before six months
has any health advantage, it is important to manage infants individually so
deficit in growth development are identified and managed appropriately. All
individuals and will require a flexible approach to optimise their
Mothers should be supported in their choice of infant feeding.
In what ways does exclusive breastfeeding for six months benefit the health
mother and baby?
Although it is recommended that weaning should begin at six months,
should continue to be an important part of babies' diets. Many of the health
gained by the infant and mother are increased the longer breastfeeding
. Breastmilk provides all the nutrients that a baby needs for healthy growth
development for the first 6 months of life.
. Breastfed babies may be less likely to become obese in later childhood.
. Infants who are exclusively breastfed are less likely to experience
/ respiratory infections.
. The risk of developing pre-menopausal breast cancer is reduced the longer
mother continues to breastfeed.
. Mothers who continue exclusive breastfeeding for longer are more likely to
to their pre-pregnancy weight.
. Exclusively breastfeeding for six months is associated with delayed
of the menstrual cycle.
Naylor and Morrow (2001) conducted a review, which concluded that exposure
infant to pathogens that are commonly present in food could result in
The human gut is anatomically and functionally mature at birth in the full
However, immaturity's in digestion, absorption and protective function exist
at birth that
may predispose the infant during the first six months of life to age-related
gastrointestinal disease. They suggested that exclusive breastfeeding
passive and active support of the infant's gut function during the first six
months of life.
This review supported the recommendation that infants should be exclusively
up to six months.
Should infants who are mixed fed on both breastmilk and infant formula milk
just given infant formula milk also introduce solids at six months?
Yes. The Scientific Advisory Committee on Nutrition (SACN) sub group on
Infant Nutrition concluded that there are unlikely to be any risks
delaying weaning to six months in infants who are mixed fed on breast and
formula milk or solely fed on infant formula milk.
Six months is the recommended age to introduce solid foods for all normal
infants whether breastfed or given infant formula milk. Health professionals
consider infants' individual developmental and nutritional needs, whether
mixed fed or given solely infant formula milk before giving advice to
Regardless of whether babies are breastfed or mixed fed on breastmilk and
formula milk, mothers should be supported to optimise their infant's
suitable weaning foods and gradually weaned onto more solid food. Where
choose to introduce solid foods before six months, they should follow
on appropriate types and amounts of first food (COMA, 1994).
What are the risks associated with an early introduction of solid food?
The Introduction of solid food to an infant too early, before sufficient
neuro-muscular co-ordination to allow the infant to eat solid foods or
before the gut and
kidneys have matured to cope with a more diverse diet, can increase the risk
infections and development of allergies.
Early introduction of solids can also reduce the absorption of nutrients
Do babies need to explore tastes and textures before six months to
help with speech development and acceptance of a wide variety of foods?
No. Whilst infants can be offered foods at an earlier age than six months,
anatomy, reflex responses and resulting oral motor function suggest that
Will waiting until six months affect babies' ability to chew?
No. This misconception appears to have arisen from an old paper presenting
studies of children who remained on a liquid diet for 6 -10 months, most of
developmental delays or disabilities (Illingworth and Lister, 1964). A
suggested that 'if children are not given solid foods to chew at a time when
they are first
able to chew, troublesome feeding problems may occur'. This has since been
and inappropriately extended to younger babies with normal development.
Is waiting to introduce solids until six months likely to produce a 'fussy
No. There is no evidence to support the idea that starting solids at around
six months is
more likely to be associated with the baby being a fussy eater. Indeed, a
trial comparing breastfed babies started on solids at either four months or
six months in
Honduras found no difference in appetite or food acceptance as reported by
mothers (Cohen et al, 1995).
What is 'developmental readiness'?
Reviews of the literature on three aspects of the developmental readiness of
solid foods with respect to physiological maturing were published in April
(Wellstart, 2001). These aspects were:
. Development of the baby's immune system.
. Maturation of the gastrointestinal tract.
. Oral development in relation to coping with the transition from a purely
liquid diet to
semi-solid and solid foods.
The expert review team concluded that although there is a great deal that is
known most full term babies are probably ready to start solids near six
perhaps a little beyond.
Is a baby developmentally ready for spoon-feeding before six months?
Active spoon feeding with the upper lip moving down to clean the spoon
emerges at six
months. Refinement of tongue activity during the swallowing of strained
foods is noted
at nine months with up and down tongue movement. Lip closure during
appears at twelve months and resembles mature feeding behaviour. (Stevenson
What are the advantages of waiting until six months?
Infants who are weaned at or near six months can be moved onto a mixed diet
quickly than those weaned earlier. Stopping predominant breastfeeding before
months has been associated with an increase risk of wheezing and lower
tract infections (Oddy WH et al, 2003).
What do mothers believe?
At present 49% of mothers introduce solid foods before 16 weeks (Hamlyn et
This may be for a number of reasons Anderson et al (2001) held focus group
discussions with mothers to try to identify the range of maternal attitudes
that influence the timing of introducing solid foods. Mothers who had
started their babies
on solids believed their babies had shown behaviour indicating readiness.
also aware of the recommendation to wait until four months but did not know
reasoning behind this.
It is common for mothers to believe that giving solid foods will help their
baby to sleep
longer at night. Heinig et al (1993) reported virtually identical sleeping
versus 728 minutes per day).
Many mothers would like their child to be ahead of its peers. Weaning can be
seen as a
developmental milestone and so some mothers may be keen to start weaning as
What should health care facilities do to encourage breastfeeding?
The Department encourages all health facilities to have policies and
protect, promote and support breastfeeding. An example of the required
best practice would be represented by the ten steps to successful
breastfeeding as set
out by the UNICEF UK Baby Friendly Initiative.
Will the baby food manufacturers be persuaded to alter their labelling of
foods from four months to six months?
Weaning foods are currently labelled in accordance with the European Union
The labelling of weaning foods is currently under discussion at CODEX and
the EU. The
UK Government welcomes the introduction of clearer guidance and will work
FSA on this issue.
Will the information for parents be updated so that the advice they are
Leaflets and books such as, 'The Pregnancy Book', 'Birth to Five' and the
leaflet 'Weaning made Easy' will be amended in future publications to
reflect the revised
recommendations. The breastfeeding section of the Health Promotion Agency's
http://www.healthpromotionagency.org.uk/breastfeeding will also be updated.
How should solid foods be introduced?
From six months old, the amount of solid foods given can be gradually
increased so that
solid foods become the main part of the baby's diet, with breast or formula
up the balance. So, by a year old, an infant will be eating a varied diet.
During the first
couple of weeks of weaning, a baby learns that food has a different texture
and that it doesn't come in a continuous flow. All babies are different.
Some start solid
foods earlier, some later. Some are choosy, others seem to like everything.
the baby the more readily a baby will accept a varied diet of texture, taste
The younger the baby the more weaning foods need to be liquid and in smaller
If a mother chooses to wean her baby before the recommended 6 months of age,
which foods should be avoided?
It is recommended that the following foods should be avoided:
. Wheat-based foods and other foods containing gluten, including bread,
breakfast cereals and rusks.
. Nuts and seeds - including peanuts, peanut butter and other nut spread.
peanuts or any type of whole nuts should be avoided for children under five
old as they can cause choking).
. Fish and shellfish
. Citrus fruit and fruit juice such as orange, lemon and lime
Which foods should be avoided from 6 months?
Salt should not be added to any foods given to babies, as their kidneys can't
it. Foods that are high in salt, such as cheese, bacon and sausages should
Processed foods that aren't made specifically for babies such as pasta
breakfast cereals should be avoided as they can be high in salt.
Sugar should not be added to food or drink given to babies as it could
sweet tooth and can lead to tooth decay when the first teeth start to come
Honey should not be given to babies until one year old. Very occasionally,
contain a type of bacteria that can produce toxins in a baby's intestines.
This can cause
serious illness (infant botulism). Honey is also a sugar, and can cause the
There are also certain foods that can cause an allergic reaction in some
babies, so new
foods should be introduced one at a time. Soft cheese (including blue)
introduced after the age of one. Hot spices, such as, black pepper and red
should be avoid until one year of age and thereafter introduced gradually.
such as, coriander, cumin and cinnamon can be used sparingly.
Which drinks are suitable for infants?
Cooled boiled tap water is the best drink for babies if required. Breastfed
need water because each breast provides the baby with watery milk at the
a feed. However, infants fed on infant formula milk can get thirsty.
Some natural mineral waters have a mineral content unsuitable for babies.
there are other bottled waters that are suitable for infant feeding which
'suitable for infant feeding' on their labels. Bottled water like tap water
should be boiled.
Fruit juices are a good source of vitamin C, but this and other drinks may
baby's appetite for milk. Fruit juice should be diluted, one part juice with
ten parts cooled
boiled water in a feeding cup and at mealtimes only. As well as being
acidic, fruit juice
also contains naturally occurring sugars, which can cause tooth decay. For
reasons fruit juice should not be given to babies before 6 months.
Squashes, fizzy drinks, flavoured milk and juice drinks are not suitable for
contain sugars and even when diluted, can cause tooth decay, especially when
a bottle. Babies given these drinks will have a poor appetite, poor weight
gain and, if
they're toddlers, loose stools. Diet drinks and 'no added sugar' drinks are
for babies or toddlers. Tea and coffee are not suitable drinks for babies or
children. Cow, Goat and sheep's milk are not suitable as drinks for babies
under a year
old as they do not contain enough iron and other nutrients to meet their
What about specialised Infant formulas?
Specialised infant formula is not necessary for normal infants. Hydrolysed
formula can be prescribed by the GP if a baby has an allergy to cows' milk.
be better nutritionally than soya-based milks. Babies who are allergic to
cows' milk may
also be allergic to soya. Follow-on infant formula milk is not suitable for
than 6 months.
What is the current advice on Soya milk?
The Committee on Toxicity (COT) has identified a possible risk to long-term
reproductive health of infants arising from the high phytoestrogen content
formulas. SACN has confirmed that there is no particular health benefit
the consumption of soya-based infant formula by healthy infants. It was also
view, that there is no unique clinical condition that particularly requires
the use of soyabased
Therefore, in the light of the potential risk to infants, soya-based infant
not be used as the first choice for the management of infants with proven
sensitivity, lactose intolerance, galaktokinase deficiency and
appropriate hydrolysed protein formulas are available and can be prescribed.
based formulas should only be used or advised in exceptional circumstances
adequate nutrition. For example, for infants of vegan parents or those
infants who do
not accept hydrolysed protein formula.
Anderson, A.S, Guthrie, C, Alder, EM. et al. Rattling the plate - reasons
for early weaning. Health Education Research. August 2001; 16(4):471-9.
Cohen RJ, Rivera LL, Canahuati J, et al. Delaying the introduction of
food until 6 months does not affect appetite or mother's report of food
breast-fed infants from 6 to 12 months in a low income, Honduran population.
1995 Nov; 125(11):2787- 92.
Department of Health. Weaning and the Weaning Diet. Report of the Working
the Weaning Diet of the Committee on Medical Aspects of Food Policy. Report
Health and Social Subjects No 45. 1994 HMSO. London.
Hamlyn B, Brooker S, Oleinikova K, Wands S. Infant Feeding Survey 2000. BMRB
International. 2002. London. The Stationery Office see
Heinig MJ, Nommsen LA, Peerson JM, et al. Intake and growth of breast-fed
formula-fed infants in relation to the timing of introduction of
complementary foods: the
Oddy WH et al, 2003. Breastfeeding and respiratory morbidity in infancy: a
study. Archives of Disease in Childhood. 88:224-228.
Acta Paediatr 1993, Dec; 82(12): 999-1006.Illingworth RS, Lister J. The
sensitive periods, with reference to certain feeding problems in infants and
Pediatr. 1964, 65, 839-848.
Stevenson RD, Allaire JH. The development of normal feeding and swallowing.
[Review] [22 refs]. Pediatric Clinics of North America 1991;
Wellstart. Reviews of the Relevant Literature Concerning Infant
Immunologic, Oral Motor and Maternal Reproductive and Lactational
April 2001. Eds. AJ. Naylor, AL Morrow.
ARTICLE SOURCE :
Sumber : http://www.kellymom.com/nutrition/solids/delay-solids.html
Home > Nutrition for Mom & Baby > Solid Foods and the Breastfed Baby
Why Delay Solids?
· Reasons for delaying solids
· Additional information
Health experts and breastfeeding experts agree that it's best to wait until
your baby is around six months old before offering solid foods. There has
been a large amount of research on this in the recent past, and most health
organizations have updated their recommendations to agree with current
research. Unfortunately, many health care providers are not up to date in
what they're telling parents, and many, many books are not up to date.
The following organizations recommend that all babies be exclusively
breastfed (no cereal, juice or any other foods) for the first 6 months of
life (not the first 4-6 months):
· World Health Organization
· US Department of Health & Human Services
· American Academy of Pediatrics
· American Academy of Family Physicians
· American Dietetic Association
· Australian National Health and Medical Research Council
· Royal Australian College of General Practitioners
· Health Canada
Most babies will become developmentally and physiologically ready to eat
solids by 6-9 months of age. For some babies, delaying solids longer than
six months can be a good thing; for example, some doctors may recommend
delaying solids for 12 months if there is a family history of allergies.
Reasons for delaying solids
Although some of the reasons listed here assume that your baby is breastfed
or fed breastmilk only, experts recommend that solids be delayed for formula
fed babies also.
· Delaying solids gives baby greater protection from illness.
Although babies continue to receive many immunities from breastmilk for as
long as they nurse, the greatest immunity occurs while a baby is exclusively
breastfed. Breastmilk contains 50+ known immune factors, and probably many
more that are still unknown. One study has shown that babies who were
exclusively breastfed for 4+ months had 40% fewer ear infections than
breastfed babies whose diets were supplemented with other foods. The
probability of respiratory illness occurring at any time during childhood is
significantly reduced if the child is fed exclusively breast milk for at
least 15 weeks and no solid foods are introduced during this time. (Wilson,
1998) Many other studies have also linked the degree of exclusivity of
breastfeeding to enhanced health benefits (see Immune factors in human milk
and Risks of Artificial Feeding).
· Delaying solids gives baby's digestive system time to mature.
If solids are started before a baby's system is ready to handle them, they
are poorly digested and may cause unpleasant reactions (digestive upset,
gas, constipation, etc.). Protein digestion is incomplete in infancy.
Gastric acid and pepsin are secreted at birth and increase toward adult
values over the following 3 to 4 months. The pancreatic enzyme amylase does
not reach adequate levels for digestion of starches until around 6 months,
and carbohydrate enzymes such as maltase, isomaltase, and sucrase do not
reach adult levels until around 7 months. Young infants also have low levels
of lipase and bile salts, so fat digestion does not reach adult levels until
· Delaying solids decreases the risk of food allergies.
It is well documented that prolonged exclusive breastfeeding results in a
lower incidence of food allergies (see Allergy References and Risks of
Artificial Feeding). From birth until somewhere between four and six months
of age, babies possess what is often referred to as an "open gut."
This means that the spaces between the cells of the small intestines will
readily allow intact macromolecules, including whole proteins and pathogens,
to pass directly into the bloodstream.This is great for your breastfed baby
as it allows beneficial antibodies in breastmilk to pass more directly into
baby's bloodstream, but it also means that large proteins from other foods
(which may predispose baby to allergies) and disease-causing pathogens can
pass right through, too. During baby's first 4-6 months, while the gut is
still "open," antibodies (sIgA) from breastmilk coat baby's digestive tract
and provide passive immunity, reducing the likelihood of illness and
allergic reactions before gut closure occurs. Baby starts producing these
antibodies on his own at around 6 months, and gut closure should have
occurred by this time also. See How Breast Milk Protects Newborns and The
Case for the Virgin Gut for more on this subject.
· Delaying solids helps to protect baby from iron-deficiency anemia.
The introduction of iron supplements and iron-fortified foods, particularly
during the first six months, reduces the efficiency of baby's iron
absorption. Healthy, full-term infants who are breastfed exclusively for
periods of 6-9 months have been shown to maintain normal hemoglobin values
and normal iron stores. In one study (Pisacane, 1995), the researchers
concluded that babies who were exclusively breastfed for 7 months (and were
not give iron supplements or iron-fortified cereals) had significantly
higher hemoglobin levels at one year than breastfed babies who received
solid foods earlier than seven months. The researchers found no cases of
anemia within the first year in babies breastfed exclusively for seven
months and concluded that breastfeeding exclusively for seven months reduces
the risk of anemia. See Is Iron-Supplementation Necessary? for more
· Delaying solids helps to protect baby from future obesity.
The early introduction of solids is associated with increased body fat and
weight in childhood. (for example, see Wilson, 1998)
· Delaying solids helps mom to maintain her milk supply.
Studies have shown that for a young baby solids replace milk in a baby's
diet - they do not add to baby's total intake. The more solids that baby
eats, the less milk he takes from mom, and less milk taken from mom means
less milk production. Babies who eat lots of solids or who start solids
early tend to wean prematurely.
· Delaying solids helps to space babies.
Breastfeeding is most effective in preventing pregnancy when your baby is
exclusively breastfed and all of his nutritional and sucking needs are
satisfied at the breast.
· Delaying solids makes starting solids easier.
Babies who start solids later can feed themselves and are not as likely to
have allergic reactions to foods.
· Solid Foods and the Breastfed Baby at this website
· Is Iron-Supplementation Necessary? at this website
· When will baby be ready for solid foods? at this website
· Solid Food: Best Delayed by Becky Flora, IBCLC
· Starting Solid Foods by Jeri Carr
· Why Delay Introducing Solids to Your Baby? by Anna Hayward
Supplementation of the Breastfed Baby: "Just One Bottle Won't Hurt"---or
Will It? by Marsha Walker, RN, IBCLC
· The Case for the Virgin Gut: Even the Occasional Bottle of Formula
Has Its Risks by Ann Calandro, RNC, IBCLC
· Additional links on delaying solids from Dr. Jay Gordon
· Breast-Milk: The White Blood by Arlene Jacobs
· WHO Resources on Child Nutrition
WHO: Guiding principles for complementary feeding of the breastfed child
WHO Global strategy for infant and young child feeding (2003)
WHO: Complementary feeding: report of the global consultation, and summary
of guiding principles for complementary feeding of the breastfed child.
WHO: Nutrient adequacy of exclusive breastfeeding for the term infant during
the first six months of life. (2002)
WHO: The Optimal Duration of Exclusive Breastfeeding: A Systematic Review
WHO Resolution WHA54.2 on Infant and young child nutrition (18 May 2001)
WHO Global strategy for infant and young child feeding: the optimal duration
of exclusive breastfeeding A54/INF.DOC./4 (1 May 2001)
Developmental Readiness of Normal Full Term Infants to Progress from
Exclusive Breastfeeding to the Introduction of Complementary Foods: Reviews
of the Relevant Literature Concerning Infant Gastrointestinal, Immunologic,
Oral Motor and Maternal Reproductive and Lactational Development (April
2001), Audrey J. Naylor, MD, DrPH and Ardythe L Morrow, PhD, Editors.
WHO: The Optimal Duration of Exclusive Breastfeeding: Report of an Expert
Consultation WHO/FCH/CAH/01.24 (28-30 March 2001)
· Optimal duration of exclusive breast feeding in low income
countries (editorial). Black RE and Victora CG. BMJ 2002 (30
· Rethinking current recommendations to introduce solid food between
four and six months to exclusively breastfeeding infants. Borresen, HC. J
Hum Lact 1995 Sep;11(3):201-4.
· Breastfeeding: New Discoveries by George Wootan, MD
· How Breast Milk Protects Newborns by Jack Newman, MD
· Protective nutrients and bacterial colonization in the immature
human gut (abstract)
· The Bacterial Flora of Humans by Kenneth Todar, PhD
"At birth the entire intestinal tract is sterile, but bacteria enter with
the first feed. The initial colonizing bacteria vary with the food source of
the infant. In breast-fed infants bifidobacteria account for more than 90%
of the total intestinal bacteria. Enterobacteriaceae and enterococci are
regularly present, but in low proportions, while bacteroides, staphylococci,
lactobacilli and clostridia are practically absent. In bottle-fed infants,
bifidobacteria are not predominant. When breast-fed infants are switched to
a diet of cow's milk or solid food, bifidobacteria are progressively joined
by enterics, bacteroides, enterococci lactobacilli and clostridia.
Apparently, human milk contains a growth factor that enriches for growth of
bifidobacteria, and these bacteria play an important role in preventing
colonization of the infant intestinal tract by non indigenous or pathogenic
· Mohrbacher, N. and Stock, J. BREASTFEEDING ANSWER BOOK. Schaumburg,
Illinois, USA; La Leche League International 1997.
· American Academy of Pediatrics, Work Group on Breastfeeding.
Breastfeeding and the Use of Human Milk. Pediatrics. 1997;100(6):1035
· Pisacane A, et al. Iron status in breast-fed infants. J Pediatr
· Sleisenger & Fordtran. Gastrointestinal and Liver Disease, 6th ed.
W. B. Saunders Company (1998): p. 1495-1497.
Comparisons between different lengths of exclusive breastfeeding:
· Kramer MS, Kakuma R. The optimal duration of exclusive
breastfeeding: a systematic review. Adv Exp Med Biol. 2004;554:63-77.
From the abstract: Infants who are breastfed exclusively for 6 months
experience less morbidity from gastrointestinal tract infection than infants
who were mixed breastfed as of 3 or 4 months of age. No deficits have been
demonstrated in growth among infants from either developing or developed
countries who are exclusively breastfed for 6 months or longer. Moreover,
the mothers of such infants have more prolonged lactational amenorrhea and
faster postpartum weight loss. Based on the results of this review, the
World Health Assembly adopted a resolution to recommend exclusive
breastfeeding for 6 months to its member countries.
· Onayade AA, Abiona TC, Abayomi IO, Makanjuola RO. The first six
month growth and illness of exclusively and non-exclusively breast-fed
infants in Nigeria. East Afr Med J. 2004 Mar;81(3):146-53.
CONCLUSION: It is concluded that exclusive breast-feeding supported adequate
growth during the first six months of life for most of the infants studied.
Early introduction of complementary foods did not provide any advantages in
terms of weight gain in our environment, it was frequently associated with
illness episodes and growth faltering. Many mothers however require support,
encouragement and access to health care providers to breastfeed exclusively
for the first six months of life.
· Kramer MS, et al. Infant growth and health outcomes associated with
3 compared with 6 mo of exclusive breastfeeding. Am J Clin Nutr. 2003
CONCLUSIONS: Exclusive breastfeeding for 6 mo is associated with a lower
risk of gastrointestinal infection and no demonstrable adverse health
effects in the first year of life.
WHO: The optimal duration of exclusive breastfeeding. A systematic review
(compares introduction of solids at 3-4 months vs 6 months)
· Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding.
Cochrane Database Syst Rev. 2002;(1):CD003517.
(compares introduction of solids at 3-4 months vs 6 months)
From the reviewer's conclusions: "Infants who are exclusively breastfed for
six months experience less morbidity from gastrointestinal infection than
those who are mixed breastfed as of three or four months, and no deficits
have been demonstrated in growth among infants from either developing or
developed countries who are exclusively breastfed for six months or longer.
Moreover, the mothers of such infants have more prolonged lactational
· Dewey KG, Cohen RJ, Brown KH, Rivera LL. Effects of exclusive
breastfeeding for four versus six months on maternal nutritional status and
infant motor development: results of two randomized trials in Honduras. J
Nutr. 2001 Feb;131(2):262-7.
· Hop LT, Gross R, Giay T, Sastroamidjojo S, Schultink W, Lang NT.
Premature complementary feeding is associated with poorer growth of
vietnamese children. J Nutr. 2000 Nov;130(11):2683-90.
(mainly compares introduction of solids before/after 3 mo)
· Wilson AC, et al. Relation of infant diet to childhood health:
seven year follow up of cohort of children in Dundee infant feeding study.
BMJ 1998 January;316:21-25. (compares introduction of solids before/after 15
The introduction of solids in relation to asthma and eczema
A Zutavern1, E von Mutius1, J Harris2, P Mills2, S Moffatt2, C White2 and P
1 Dr von Haunersches Kinderspital (University Children's Hospital);
Lindwurmstr. 4, 80337 Munich, Germany
2 Department of Occupational and Environmental Medicine, Imperial College of
Science and Technology (National Heart and Lung Institute), 1b Manresa Road,
London SW3 6LR, UK
Dr Dr A Zutavern
von Haunersches Kinderspital, Lindwurmstr.4, 80337 Muenchen, Germany;
Background: Despite scarce scientific evidence, current feeding guidelines
recommend delayed introduction of solids for the prevention of asthma and
Aims: To explore whether late introduction of solids is protective against
the development of asthma, eczema, and atopy.
Methods: A total of 642 children were recruited before birth and followed to
the age of 5
years. Main outcome measures were: doctor's diagnosis of eczema ever, atopy
according to skin prick test results against inhalant allergens, preschool
wheezing, transient wheezing, all defined at age 5-5
years. Introduction of solids as main exposure measure was assessed
retrospectively at age 1 year.
Results: There was no evidence for a protective effect of late introduction
of solids for the development of preschool wheezing, transient wheezing,
atopy, or eczema. On the contrary, there was a statistically significant
increased risk of eczema in relation to late introduction of egg (aOR 1.6,
95% CI 1.1 to 2.4) and milk (aOR 1.7, 95% CI 1.1 to 2.5). Late introduction
of egg was furthermore associated with a non-significant increased risk of
preschool wheezing (aOR 1.5, 95% CI 0.92 to 2.4). There was no statistical
evidence of feeding practices playing a different role in the development of
asthma and eczema after stratification for parental asthma and atopy status.
Conclusions: Results do not support the recommendations given by present
feeding guidelines stating that a delayed introduction of solids is
protective against the development of asthma and allergy.
SOLID FOOD IN EARLY INFANCY INCREASES RISK OF ECZEMA
Evidence is mounting that consuming solid foods early in infancy puts a
child at increased risk for atopic dermatitis. Fergusson and colleagues in
New Zealand provide convincing data confirming this association. They
followed the diets of 1067 children for the first ten years of their lives;
an estimated 7.5 percent had recurrent or chronic eczema.
No one food type significantly increased the children's risk of chronic
eczema. However, when the researchers analyzed the number of solid food
types consumed in infancy, they found a clear dose-response relation. Babies
given four or more types of solid food by the age of four months were 2.35
times more likely to have chronic or recurrent eczema by the age of ten
years than those not given solids; babies consuming one, two, or three solid
food types had an intermediate risk of eczema. These risks remained after a
proportional-hazards model controlled for confounding variables, such as an
early milk diet and a family history of atopy.
Thus, all children -- not just those considered at high risk for eczema --
should not be given solids until they are at least four months old. If for
any reason a baby is fed solids, only one type should be offered. --RAD
Published in Journal Watch October 16, 1990
Fergusson DM et al Early solid feeding and recurrent childhood eczema: a
10-year longitudinal study Pediatrics 1990 Oct; 86:541-546.[Medline
SOLID FOOD: BEST DELAYED
Recently the American Academy of Pediatrics advised that the healthy,
full-term breastfed baby needs nothing other than mother's milk, including
supplemental formula, water, juice, cereal (spooned or in a bottle), or
other solid food, until he is at least six months old. Breastfeeding experts
have long been advocating that solids be delayed until at least the middle
of the baby's first year. What are the benefits of waiting this long?
· The younger the baby, the more likely it is that any foods other
than human milk will cause food allergies. While solely breastfed, the baby
is protected by components in mother's milk that prevent foreign proteins
from entering the baby's system and causing an allergic reaction. At about
six months of age, the baby begins producing enough antibodies to prevent
such allergic reactions. This benefit is especially important for a baby
whose family has a history of allergies.
· Because a young baby's digestive system is immature, he may not be
able to digest other foods as well, perhaps making spitting up,
constipation, and diarrhea more common. Waiting until the baby is at least
six months old lessens the probability that these unpleasant reactions will
· Solids displace breastmilk in the baby's diet. The more solid food
a baby consumes the less breastmilk he consumes. Early introduction of
solids puts the baby at risk for premature weaning. An inferior food has
been substituted for a superior one, and partial weaning has begun.
· Breastfed babies are rarely obese, but when they are it is most
often related to the early addition of solid foods. This may be because a
younger baby is less able to communicate when he has had enough, perhaps
resulting in overfeeding.
· Breastfeeding provides some degree of birth control. It is most
effective, however, when the baby is exclusively breastfeeding - no formula
or water supplements and no solid foods. The addition of these cuts down on
the amount of time the baby spends at the breast, therefore reducing the
amount of stimulation necessary to inhibit ovulation in the mother.
· A young baby still possesses the tongue-thrust reflex which causes
the food to be pushed out of the mouth rather than swallowed. This coupled
with the fact that most young babies are unable to sit up alone results in
feeding that is messier and more difficult. Once a baby has reached six
months of age the tongue-thrust reflex has faded and baby can take a more
active part in feeding time.
MYTHS CONCERNING THE ADDITION OF OTHER FOODS
"Babies who live in very warm climates need extra water, especially during
summertime, to quench their thirst and avoid dehydration."
Breastmilk is about 80% water. As long as a baby is allowed unlimited and
unrestricted access to his mother's breast, he does not need additional
water at least until he is six months of age and eating solid food and then
only in small amounts to aid with digestion. Giving a baby water may cause
him to feel full, thereby resulting in him demanding to nurse less often and
thus getting less of the milk that he requires for proper nutrition and
growth. Furthermore, some recent studies have indicated that the kidneys of
babies, especially very young ones, are not mature enough to handle large
amounts of water and giving water may actually result in health risks for
the baby. Additionally the mother receives less stimulation when the baby is
given water supplements which may have an adverse effect on her milk supply.
"Adding solid food to a baby's diet will help him go longer between
breastfeedings and perhaps sleep through the night."
There is absolutely no correlation between the presence of solids in a
baby's diet - or the lack of it - and the baby beginning to sleep through
the night. If adding solid food to a young baby's diet results in him going
longer between feedings, it is probably because his digestive system is
having to work overtime due to the strain placed on it by foods he is not
physically mature enough to digest.
"Introducing solids ensures that a baby is not deprived of necessary iron in
Anemia is uncommon in the breastfed baby due to the following reasons: 1) a
healthy, full-term infant has ample iron stores at birth to last him at
least for the first six months of life, 2) although the amount of iron in
breastmilk is small, it is readily absorbed at a rate of 49% compared to 4%
of the iron in formula. This is due to the high levels of lactose and
vitamin C in human milk, which aid in the absorption of iron, and 3)
breastfed babies do not lose iron through their bowels as do formula-fed
infants, whose intestines develop fissures from damage caused by cow's milk.
Written by Becky Flora, BSed, IBCLC
Last revision: April 9, 2001
Source: La Leche League's, "The Breastfeeding Answer Book" (1997) by Nancy
Mohrbacher, IBCLC and Julie Stock, BA, IBCLC
Rethinking current recommendations to introduce solid food between four and
six months to exclusively breastfeeding infants.
The World Health Organization and UNICEF currently recommend to start
weaning between four and six months and no later than six months with the
gradual introduction of solid food. However, some studies show that
voluntary exclusive breastfeeding for about nine months is feasible and can
sustain adequate weight gain and iron status in infants. It is therefore
appropriate to review and evaluate the evidence presently used to set
feeding policy. It appears that the alleged insufficiency of breast milk
volume after four to six months is most likely due to management errors such
as introducing supplements and spacing nursing bouts at wide intervals, both
of which reduce milk yield. Women in developed countries who wish to
breastfeed exclusively beyond four to six months should therefore not be
discouraged from doing so. In developing countries, health authorities and
non-governmental organisations should actively endorse exclusive
breastfeeding for eight to nine months to protect infants against
malnutrition and infections.
· Review, Tutorial
PMID: 7669240 [PubMed - indexed for MEDLINE]
: BMJ. 1993 Jun 12;306(6892):1572-6.Related Articles, Links
· BMJ. 1993 Aug 14;307(6901):444.
· BMJ. 1993 Aug 14;307(6901):444.
Relation between early introduction of solid food to infants and their
weight and illnesses during the first two years of life.
Forsyth JS, Ogston SA, Clark A, Florey CD, Howie PW.
Department of Child Health, Ninewells Hospital and Medical School, Dundee.
OBJECTIVE--To assess the relations between early introduction of solid food
and infant weight, gastrointestinal illness, and allergic illnesses during
the first two years of life. DESIGN--Prospective observational study of
infants followed up for 24 months after birth. SETTING--Community setting in
Dundee. PATIENTS--671 newborn infants, of whom 455 were still available for
study at 2 years of age. MAIN OUTCOME MEASURES--Infants' diet, weight, and
incidence of gastrointestinal illness, respiratory illness, napkin
dermatitis, and eczema at 2 weeks and 2, 3, 4, 6, 9, 12, 15, 18, 21, and 24
months of age. RESULTS--The infants given solid food at an early age (at < 8
weeks or 8-12 weeks) were heavier than those introduced to solids later
(after 12 weeks) at 4, 8, 13, and 26 weeks of age (p < 0.01) but not at 52
and 104 weeks. At their first solid feed those given solids early were
heavier than infants of similar age who had not yet received solids. The
incidence of gastrointestinal illness, wheeze, and nappy dermatitis was not
related to early introduction of solids. There was a significant but less
than twofold increase in respiratory illness at 14-26 weeks of age and
persistent cough at 14-26 and 27-39 weeks of age among the infants given
solids early. The incidence of eczema was increased in the infants who
received solids at 8-12 weeks of age. CONCLUSION--Early introduction of
solid food to infants is less harmful than was previously reported. Longer
follow up is needed, but, meanwhile, a more relaxed approach to early
feeding with solids should be considered.
PMID: 8329916 [PubMed - indexed for MEDLINE]
Early solid feeding and recurrent childhood eczema: a 10-year longitudinal
DM Fergusson, LJ Horwood and FT Shannon
Department of Paediatrics, Christchurch School of Medicine, Christchurch
Hospital, New Zealand.
The relationship between early solid feeding practices and risks of
recurrent or chronic eczema in childhood was examined in a birth cohort of
New Zealand children studied to the age of 10. By the age of 10 years, 7.5%
of children had chronic or recurrent eczema. There were clear and consistent
associations between the diversity of the child's diet during the first 4
months and risks of eczema. Even when due allowance was made for a range of
confounding factors--including parental atopic illness, atopic illness in
siblings, the child's early milk diet, and family social
background--children exposed to four or more different types of solid food
before 4 months had risks of recurrent or chronic eczema that were 2.9 times
those of children who were not exposed to early solid feeding. It is
concluded that early exposure to a diet diverse in potential food antigens
may act to predispose susceptible children to recurrent or chronic childhood
Volume 86, Issue 4, pp. 541-546, 10/01/1990
Copyright © 1990 by The American Academy of Pediatrics