Natalie Wilson asked:

<Does anybody know how the idea of "exclusive breastfeeding" for 6 months came into being? When was it first introduced in research? Policy? Any leads would be very appreciated.>

If you mean, how and when was the concept of exclusive breastfeeding (i.e. the strict rule about giving no other food substances *at all*) introduced, then I don't know, although I'd love to. I'd make an educated guess that it originated with the WHO, who have been the people pushing the idea since then, for fairly obvious reasons (in many of the world's areas, giving any sort of supplementation at all to a breastfed baby can indeed be lethal due to water contamination, not to mention the risk of failure of LAM for a mother who doesn't have any other available method of child spacing) but I couldn't vouch for that one.

If you mean, how did people decide to start advising that exclusivity should continue for 6 months, then that I do know - it was a 2001 paper by Kramer and Kakuma called 'Optimal Duration of Exclusive Breastfeeding' which you can find at http://www.who.int/nutrition/publications/infantfeeding/WHO_NHD_01.08/en/. In brief: Prior to that, it was believed that babies required supplementation with solids from four months onwards in order to meet their nutritional requirements, but concerns existed over whether this increased the risk of infection. This paper reviewed the existing evidence, including several observational studies and two smallish RCTs, and found it supported the idea that breastfeeding would provide sufficient nutrition for the first six months of a child's life for everything except iron, of which supplementation was sometimes needed. Based on this, and one study showing that babies receiving something as well as breastmilk between three and six months were slightly more likely to get diarrhoea than babies exclusively breastfed until six months, they opted for a recommendation for six months as the age to aim for.

Frankly, there is zero evidence to support the idea that we should be drumming it into all mothers' heads to let absolutely nothing else apart from breastmilk cross their babies' lips before the age of six months, and in developed countries we could be a lot more relaxed about the whole thing. But that's just one of my hobbyhorses. Anyway, that's where the 'six months' policy came from, so hope that's of some help.


Best wishes,

Sarah Vaughan

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