Forgot to provide dates:

I finished my Masters in 1985 (when 4-6 months was being debated).

I finished the research for my PhD in 1991, more than a decade before Kramer summarized other's research.  I found my professors at Cornell to be far more thorough in their metaanalyses than Kramer.  Furtheremore, I typically prefer to read the details of the original research not the metaanalyses.  Kay Dewey and Robert Black did quite a bit of research on the timing of supplement introduction.  They grilled the heck out of me about my dissertation results when I presented them because we all recognized how others might misinterpret my results as "yippee, supplementation is good". 

I actually object to the characterization of the WHO "PUSHING" the notion.  My advisor was on the panel that worked on this recommendation. There was zero evidence of harm of waiting to "around" six months to introduce solids.  

I also object to the characterization that a general recommendation of around six months is "drumming into people's head that they should let nothing else other than breast milk pass their baby's lips before the age of six months".  If one reads the Guidelines on the Feeding of Infant and Young Child Feeding there is plenty of room for appropriate modifications based on the individual child.  It is always quite tiresome when people read "recommendations" as "rules" and then blame the "rules" for being rigid with a slew of "in my clinical experience exceptions" when the "rules" don't apply.  Of course a good clinician must adapt for individual case variation.  I for instance, have recommended (gasp!!), pacifiers for infants that were younger than one month because I know the underlying rationale for the recommendation to not use them before one month. 

As I stated before, the jury is still out on the long term health impacts of introducing solids before "around" six months in areas of good sanitation. Just as there is only a small amount of research on the harm of doing so before six month, the flip side -t he safety of doing so - has not yet been "proven". 

You don't need as large a sample size to show that "risk" is probable (in the statistical sense) than you do to show that "safety" is probable.  If you have statistical significance even with a small sample, then you have show that risk is "probable".  And if you find it with a small sample, in all likelihood it is fairly substantial.  On the other hand, if you don't have statistical significance, there are many reasons why you might not have achieved significance.  You can have a risk factor that is fairly rare but physiologically important - for which you would need a larger sample to detect it.  You can have measurement error - which dilutes the probably of detecting a difference.  You can have a relatively "ineffective intervention" such as the Probit study which had a fairly minimal impact on breastfeeding rates.  You might not have waited long enough for the risk factor to develop (as in the case with cancer or metabolic syndromes that appear later in life).  You might not have identified ALL the risk factors.  

Since trials of risk are costly to implement and the present state of politics has become one of withdrawing funding for research that is independent of marketing interests it takes more and more time to get to the bottom of complicated issues such as timing of infant feeding.  I think if we don't decimate funding for scientific research completely, there is hope that research on gut flora and immunology will eventually tease out more evidence about the impact of the important window between four and six months.  Since the biome now is so completely changed due to the overuse of antibiotics globally, I am sure there is a lot more to be discovered about how the lining of the infant gut responds to this changing environment and the age of introduction of substances other than mom's own milk.  

Sincerely, 

Susan E. Burger, MHS, PhD, IBCLC

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