Absolutely spot on, Susan Burger, both posts. Very well said. WHO was quite clear that its population based guidelines were subject to intelligent clinical variation. And around 6 months does mean it can be later as well as earlier. 

Meta-analyses are just as subject to distortion by the assumptions and perspectives people bring to them as any other form of reporting. They may discard studies which have interesting and significant information in them, because they don't meet specific arbitrary criteria set beforehand. So far as I am concerned, if a study suggests there may be harm, industry had better prove that there is none. I do not have to prove that infant formula is hazardous, to varying degrees for varying reasons in varying environments for children with varying genomes and microbiomes. Basic science suggests that arbitrarily-introduced commericially-motivated distortions of any complex physiological norm are unlikely to be of benefit and need to be proven safe.  A 30 billion dollar industry can find the money for research if it has to; it's time for governments to demand that it should. 

And of course the harms of artificial feeding are to mothers as well as infants. This is often completely overlooked, as though, if it's safe for baby to drop off from breastfeeding onto formula or solids or both, that's all we need to know. Duration of breastfeeding is showing up as relevant to just about every western woman's health problems - cancers, CVD and metabolic syndrome, gall bladder problems, you name it. Even if it had been shown that maternal intelligence is more important than nutrition for child outcomes (it hasn't and is highly unlikely ever to be, despite the formula advocates' fond hopes) maximising breastfeeding would be important simply for women's own health and the health of the next generation those women create. 

BTW, that GOLD Speaker someone asked about was almost certainly either me or Carlos Gonzalez, whose book My Child Won't Eat! I get sent direct from Book Depository to every mum of a first baby who wants advice about solids. (No commissions involved; that book should be read more widely.)

I've had a few requests for the footnotes in my previous post so will send the references in a separate post. But there is great value in the long perspective Susan B brings. Few things annoy me more than some naive LC/student saying that only RCTs/meta-analyses/articles less than 5 years old should be cited. There are many forms of evidence, and history is critical to understanding and perspective. If we forget where we came from we'll have to retrace our steps, and I'd prefer us to go forward. 

Maureen Minchin

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