I went away for the weekend and seem to have come back to the world gone mad. Headlines such as “Breast is not best“, “Exclusively breast-feeding for six months ’causes allergies“, and “Mother’s milk”may do more harm than good are all over my RSS feeds.
Now, Analytical Armadillo has written an exemplary article on the ‘facts’ behind this study, and Dispelling Breastfeeding Myths has raised very valid points about the media involvement in the controversy over this. But here are my thoughts on it.
Firstly, three of the four authors of this study “have performed consultancy work and/or received research funding from companies manufacturing infant formulas and baby foods within the past 3 years”. Although it states that no funding was received in connection of this particular document, it does raise serious concerns about the levels of bias in it’s preparation.
That said, here are a few points extracted from the study:
- 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 – in otherwords, they are not disputing the value of breastfeeding, just the duration of exclusive breastfeeding. Not quite the same as saying “breast is not best”.
The study concluded, based on various other studies that exclusive breast feeding for six months, compared with three to four months, was associated with:
- No apparent growth deficits (though flaws in study design were recognised) – in otherwords, exclusively breastfed babies were not lagging behind in any way.
- No apparent relation with the development of allergy – so, that headline was a complete lie.
- Poorer iron status – this is a known fact about breastfeeding. It is also known that it is primarily due to the umbilical cord being clamped too early and that a child whose umbilical cord is left until it stops pulsing will have enough iron for six months. Also, iron from breastfeeding is more easily absorbed than iron in formula milk.
- Delayed return of menses and more rapid postpartum weight loss in mothers – true, but not really relative to this discussion.
US infants who were exclusively breast fed for more than six months had lower risk of pneumonia and recurrent otitis media than those breast fed for four to six months. A Spanish study found risk of hospital admission for all infant infections was decreased with longer exclusive breast feeding; this advantage, however, was seen principally before three months, with little benefit thereafter.
A German study found infants exclusively breast fed for six months, compared with less than four months, had less gastroenteritis. The large representative UK Millennium cohort study suggested 53% of admissions for gastroenteritis and 27% of those for chest infection could be prevented each month by exclusive breast feeding; but, importantly for practice, it was the introduction of infant formula, not solid foods, that predicted increased hospital admission.
While the study raises concerns over iron in infants breastfed exclusively for six months, and suggests further study is necessary, it does NOT say that “mother’s milk does more harm than good”. What it DOES say is that US infants exclusively breast fed for six months, versus four to five months, were more likely to develop anaemia and low serum ferritin, which is of concern given irreversible long term adverse effects on motor, mental, and social development after iron deficiency. I’d like to point out here that the US has a huge c-section rate, and that in c-sections, the umbilical cord is normally cut immediately, therefore not allowing for any transfer of iron.
The study actually mentions this: Such risks might be reduced by improving iron status in pregnancy, delaying umbilical cord clamping, and supplementing infants at risk (for example, those with low birth weight).
Paradoxically, many developed countries have rising rates of food allergy, despite increasing advice to restrict and delay exposure to potentially allergenic foods, including cows’ milk, egg, fish, gluten, peanut, and seeds. Moreover, countries where peanuts are commonly used as weaning foods have low incidences of peanut allergy (Israel, for example)
I found this paragraph especially interesting – when my daughter seemed eternally hungry around six weeks, I was advised off the record to have a tablespoon of peanut butter 20 minutes before every feed, as that would increase the protein in my milk and satisfy her for a little longer. Obviously not advice to follow if you have a peanut allergy, but it definitely made a marked improvement for us.
Oh, and by the way mother’s milk is not cows milk. Your child cannot have lactose intolerance to YOUR milk. YOU may need to cut out dairy at some point, but always remember that your milk is a body fluid, not a dairy product.
This finding suggests that gluten may best be introduced during a critical window of three to six months – which is incredibly convenient finding for people who have ties with people who recommend baby rice from four months.
Analytical Amadillo says: “well it’s an interesting interpretation of the studies. The first they quote (26) has no mention of exclusive breastfeeding and purely examines the introduction of solids. It also (significantly) is studying a group of “at risk” infants. Those introduced to solids in the first 3 months had a five fold risk, and children not exposed to gluten until seven months or later were at a slightly increased risk compared to those who received it at 4-6 months. This difference was only marginally significant, however.”
Whether you’re desperate to start weaning your four month old or not however, the headlines were misleading, inaccurate, and in some cases, plain lies. DBM very accurately stated that the newspapers knew this, too, but went for sensationalist headlines, without caring about the damage it will do to real people, and real babies, and knowing full well that retractions might be required – but it was a risk worth taking, as people remember headlines.
Evidence of the damage, in its earliest stages, can be found in articles like the one in the Guardian, where the author, Barbara Ellen, talks about how the “Breastfeeding Mafia” now have “to take a step back from their strident absolutism, and put choice first.” Which would be a perfectly legitimate opinion or comment, had she not started her article on misinformation and inaccurate journalism – she very obviously did not actually read the report.
Child health experts in the British Medical Journal have advised that, contrary to previous advice, mothers should not exclusively breastfeed for the first six months (no, they didn’t) as this could lead to iron deficiency and coeliac disease (no, not exactly), affect optimal growth and development (um, no, it doesn’t) and put them off certain tastes (yes. If you take them off sweet, warm, lovely breastmilk, and shovel tasteless bland purees down their throats.) I won’t even go in to the value of Baby Led Weaning here, but the Analytical Armadillo did, and it’s worth reading.
How about the damage to mothers who are now so confused, and based on the terrible headlines from news outlets looking to sell papers, how many babies will be forced into solids before they are ready?
And a side note here, sort of in closing, is this:
What is interesting is that the BMJ have distanced themselves from the report via Twitter. This, of course, will not be reported as headline news.
So, NO, Ms Ellen. The Breastfeeding Mafia do NOT have to take a step back from their strident absolutism. In fact, quite the opposite. Now we have to redouble our efforts, start from scratch, try harder, and keep going against the torrent of ignorance that flows from these articles, because sadly, Mothers have ALL the choice, regardless of where they gleaned their knowledge, and their innocent, defenceless, unable-to-communicate-with-anything-other-than-tears, babies, just have to suffer the consequences.