Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

Not so good

The evidence provided by Fewtrell and collaborators to challenge the
WHO 6-month recommendation is no better than the one provided by WHO. It
is in fact slightly worse.

The WHO recommendation is based on two RCTs and
16 observational studies. All the studies published after 2001 on
infection, nutritional adequacy, allergy and coeliac disease, and outcomes
in the longer term that Fewtrell and collaborators cite to question the 6-month policy are observational. The only two RCTs they cite are ongoing
and can not be used to argue against the WHO 6-month policy. Until further
evidence becomes available, I prefer to stand by the WHO recommendations
(and hope the UK and Italian DoH will agree with me).

Incidentally, the
WHO recommendation has never been meant to apply to all infants. It is a
public health recommendation to be used for national and professional
policies and regulations (for example, on labelling of baby foods).
Infants in fact do not wake up the day they reach six months and ask for
solids!!! Readiness to eat the first solids is distributed as any other
biological variable, a Bell shaped curve that in my opinion (because no
research is available to know the real shape) has a mode at six months and
is skewed to the right (i.e. more infants are ready after than before six
months). Why don't we concentrate on physiology and neuromuscular
development to advise mothers on when to start solids, instead of
wandering in search of doubtful evidence?

Finally, I am amazed by the
rapid spread into the popular press and media of the questionable messages
posted by Fewtrell and collaborators in their paper. Less than 24 hours
after publication, newspapers in Italy (and I guess in UK and other
countries; TV will follow suit) are already talking about a "new study"
showing that exclusively breastfeeding infants to six months may be
dangerous. Am I wrong if I ask the authors to make a quick public
statement to transparently say that theirs is not a "new study" but just a
respectable opinion based on shaky grounds?

Competing interests: No competing interests

16 January 2011
Adriano Cattaneo
Institute for Maternal and Child Health, Trieste, Italy