Dear all:

Dr. Gordan's and Lara Hopkins posts made me realize that we are not seeing the forest 
for the trees here and that we probably do not have the population that Lara wants for 
her control.  I don't think it exists ANYWHERE except among small individual outliers.

First, the reason why I don't think we have a large enough population in most of the world 
is that there are no Lactopias where most of the population meets the goal of exclusive 
breastfeeding to six months.  Rachel may be able to comment  on Norway, but the data 
she shared with us while speaking in New York I think was "ever breastfed" not 
"exclusively breastfed".  Step in Rachel if I got this one wrong.  During the 1960s, the 
percentage of six month olds who were still breastfeeding was lower than 25% and then 
climbed back up to 75% by 2000.  Another slide she presented, showed exclusive 
breastfeeding to 4 months at about 40% --- so its unclear how many were exclusively 
breastfeeding to 6 months.  It is possible that Norway may provide some data, but I'm 
still not sure that exclusive breastfeeding survival rates beyond 6 months are going to 
represent enough of the population to draw large-scale conclusions.  Then in developing 
areas of the world, I posted quite a while back how dismal the situation is --- in West 
Africa, the rates of exclusive breastfeeding among infants younger than six months is 
LESS THAN 25%.  Furthermore, in Niger where I visited on and off between 1984 and 
1999, the rates were a dismal 1%.  While some of this may be due to cultural practices 
which exist in almost every culture that I have visit to give ritual "tastes" of food as a rite 
of "survival" when the infant gets to a particular age that usually coincides with the end 
of the neonatal period, more of this is probably due to the worldwide massive destruction 
of normal infant feeding practices.

Outliers should not provide the basis for the larger population because they may be 
different than the overall population.  On the one hand, those lucky babies who are 
exclusively breastfeed to six months may be actually more robust than the average baby. 
These babies may be those who feed less frequently either because they are extremely 
efficient or their mothers have a larger than average milk storage capacity.  They may be 
deemed "good" babies and because they are so healthy, their mothers may not be in any 
rush to introduce solids early to "get them to sleep longer" or "grow faster according to 
the old growth charts".  On the other hand, some babies may not be thriving because 
they have food allergies or digestive challenges that make it difficult for them to tolerate 
anything but breast milk.  These babies may be at much higher risk of adverse 
consequences of early introduction of solids than the typical baby.  Neither of these two 
possibilities should inform our choices about the middle of the population --- it should 
only inform choices about these groups.

What I think is staring us right in the face here is that the FOREST of the vast majority of 
infant feeding is extremely unhealthy.  We are not even coming close to six months of 
exclusive breastfeeding.  This is by far the more important problem on a GLOBAL basis.  
The TREES or outliers SHOULD ALWAYS be evaluated individually on a case by case basis 
and we will always have the examples of those that thrive and do not.  

I did go back to Kathy Dettwyler's website per Dr. Jay Gordon's link and did not find the 
reference to introduction of solids.  I did find many references to the normal duration of 
breastfeeding.  In my own experience, I am not sure my observations really led to the 
conclusions of what is most healthy.  My observations in developing countries and at the 
primate research center at UC Davis (although it was a very large half acre field cage it 
was still an unnatural settiing) lead me to conclude that it is a widespread practice of 
chewing up bits of food and offering little taste tests from mom's finger.  I suspect that 
this never figures into "survey" questionnaires.  And even if it did, many mothers might 
not admit that they offered a bit of chewed up food to their infants.  If I remember 
correctly (again I may be corrected on this one), this was Kay Dewey's speculation (or 
maybe I extrapolated my own perceptions on her talk) on why the need for iron is so high 
so early.  That moms were chewing up the random infrequent bits of meat and offering 
taste tests.  Let me tell you that there are far more forms of meat in the world than the 
standard developed country beef, pork or poultry.  

Once I joked with my neighbors in Zaire about the "mice" that were tormenting our rice 
supplies about eating the mice.  Actually these mice looked like "rats" to me even by New 
York City subway standards.  My neighbors were disgusted, but the friend that was over 
visiting (who was from another tribe), enthusiastically offered to prepare them for us.  I 
don't know what the iron content of insects are, but I did develop a fondness for termites 
and could tolerate caterpillars with a good heavy peanut sauce on top so I didn't have to 
look at them too closely.

In the meantime, I do think we have to consider how to partially COMPENSATE for the 
abnormal feeding practices of the present era with the evidence at hand.  Iron deficiency 
can lead to irreversible cognitive delays long before "anemia" sets in.  This presents us 
with challenges until we return to more normal infant feeding practices.

Best, Susan E. Burger, MHS, PhD, IBCLC.

 

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