Intended for healthcare professionals


Six months of exclusive breast feeding: how good is the evidence?

BMJ 2011; 342 doi: (Published 13 January 2011) Cite this as: BMJ 2011;342:c5955
  1. Mary Fewtrell, reader in childhood nutrition and honorary consultant paediatrician1,
  2. David C Wilson, reader in paediatric gastroenterology and nutrition2,
  3. Ian Booth, Leonard Parsons professor of paediatrics and child health3,
  4. Alan Lucas, director1
  1. 1Childhood Nutrition Research Centre, University College London Institute of Child Health, London WC1N 1EH, UK
  2. 2Child Life and Health, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
  3. 3Institute of Child Health, University of Birmingham, UK
  1. Correspondence to: M Fewtrell m.fewtrell{at}

The recommendation that UK mothers should exclusively breast feed for six months is a controversial area in infant nutrition. Mary Fewtrell and colleagues review the evidence and ask if the time is right for reappraisal of this advice

In 2001, the World Health Organization announced for the consideration of member states its global recommendation that infants should be exclusively breast fed for six months.1 Many Western countries, including 65% of European member states2 and the United States, elected not to follow this recommendation fully, or at all. However, in 2003 the health minister announced that the United Kingdom would comply.3 Substantial evidence indicates that early nutrition has profound implications for long term health, by programming aspects of subsequent cognitive function, obesity, risk of cardiovascular disease, cancer, and atopy.4 However, the evidence base supporting a major, population-wide change in public health policy underwent surprisingly little scrutiny. Indeed, the Department of Health’s Scientific Advisory Committee on Nutrition (SACN) was not asked to formally consider the scientific evidence. A reappraisal of the evidence is timely in view of new data and a recent expert review for the European Food Safety Authority (EFSA), concluding that for infants across the EU complementary foods may be introduced safely between four and six months.5

Basis of the current recommendation

It is important not to confuse the evidence for promoting six months’ exclusive breast feeding with that for breast feeding itself, which is extensive and is not considered here. WHO defines exclusive breast feeding as excluding solids or any other fluids (including infant formulas) except medicines, vitamins, and minerals.6 In the United Kingdom and other countries where early formula feeding is prevalent, the timing of introduction of solid foods in all infants (often called weaning) is useful to consider,7 and evidence on this subject is also …

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