Clinical Review

Breast feeding

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39521.566296.BE (Published 17 April 2008) Cite this as: BMJ 2008;336:881
  1. Pat Hoddinott, senior clinical research fellow and general practitioner 1,
  2. David Tappin, clinical senior lecturer in child health2,
  3. Charlotte Wright, professor of community child health2
  1. 1Centre for Rural Health, University of Aberdeen, Inverness IV2 3BL
  2. 2Paediatric Epidemiology and Community Health Unit, Section of Child Health, University of Glasgow, Royal Hospital for Sick Children, Glasgow G3 8SJ
  1. Correspondence to: P Hoddinott p.hoddinott{at}abdn.ac.uk
  • Accepted 10 March 2008

Clinicians know that breast feeding is crucial to infant health in developing countries, but they may be less aware of the potential longer term health benefits for mothers and babies in developed countries, particularly in relation to obesity, blood pressure, cholesterol, and cancer. The World Health Organization (WHO) recommends exclusive breast feeding (breast milk only, with no water, other fluids, or solids) for six months, with supplemental breast feeding continuing for two years and beyond. Governments in the United Kingdom have adopted this recommendation, but it presents an enormous challenge for countries like the UK and the United States, where breast feeding rates have been low for decades and can seem remarkably resistant to change. In this review, we will focus mainly on developed countries, with reference to the global context. We will summarise the evidence for the beneficial effects of breastfeeding on health, discuss the epidemiology, and provide practical guidance for managing problems associated with breast feeding. We highlight new developments in infant growth charts and current controversies around HIV and donor breast milk.

Sources and selection criteria

We searched several databases—including Medline and Embase—using the keywords “breastfeeding”, “breast-feeding”, “breast feeding”, and “infant feeding”. We also searched Issue 4 2007 of the Cochrane Database of Systematic Reviews, National Institute for Health and Clinical Excellence guidelines, World Health Organization systematic reviews, Clinical Evidence, and personal reference archives.

How does breast milk differ from formula milk?

Formula milk is just a food, whereas breast milk is a complex living nutritional fluid that contains antibodies, enzymes, and hormones, all of which have health benefits. In addition, some methods of delivering formula milk expose the baby to serious risks of infection. Early intake of colostrum, which is rich in antibodies, is especially important in developing countries, and the small volume of colostrum helps to prevent renal overload when the newborn baby is adjusting …

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