Six months of exclusive breastfeeding recommendation: How applicable is the universal exclusive breastfeeding recommendation policy?

Abstract

Public health organisations, including the World Health Organisation recommend 6 months of exclusive breastfeeding for optimal growth, cognitive development and health. In addition, the provision of nutritionally adequate and safe complementary foods to the infants while breastfeeding continues up until 2 years of age and beyond is also recommended. Exclusive breastfeeding for the first 6 months of life meets the energy and nutrient needs of the infants. The objective of this review therefore, is to assess the appropriateness of a universal 6 months exclusive  breastfeeding recommendation policy in both developed and developing countries. In the last years, recommendations for the optimal duration of exclusive breastfeeding promoted by WHO and UNICEF started to differ. The World Health Organization had recommended exclusive breastfeeding for 4 to 6 months, with the introduction of complementary foods thereafter, whereas UNICEF preferred the wording “for about 6 months”. This led to concerns in larger infant nutrition and public health communities. The American Academy of Pediatrics’ position was also unclear: In two different sections of their Pediatric Nutrition Handbook, recommending human milk “as the exclusive nutrient source for babies during the first 6 months” and “the delayed introduction of solid foods until 4 to 6 months”. Until recently, the only scientific evidence that contributed to the exclusive breastfeeding duration debate was based on observational studies, with well-recognized sources of potential bias. Reverse causality was another potential source of bias, particularly with respect to infectious morbidity and neuro-motor development. Infants who developed a clinically important infection were likely to become anorectic and experienced reduced breast milk intake that led to reduction in milk production and even termination of breastfeeding. The lack of functional and effective food safety standards and policies, safe drinking water, exclusive breastfeeding promoting programs, high infection rates and the broken healthcare systems in the developing countries unlike in the developed countries, are key areas that need further research before the 6 months recommended duration of exclusive breastfeeding can be reduced and/or changed to 4 months, to avoid child morbidity and mortality. It is also important that the 6 months of exclusive breastfeeding are promoted in all developing countries and 4-6 months in all developed countries.

Key words: Exclusive breastfeeding, universal recommendation policy
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