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Subject:
From:
Maureen Minchin <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 31 Jan 1997 01:21:42 +1100
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Sarah, thought you might like chapter and verse literally : thank Jim Akre
at WHO Nutrition Unit for this, everyone. I have no idea why his book,
Infant Feeding the Physiological Basis, is so rarely cited by US LCs: it's
required reading in all my courses for healthworkers. It is available from
ILCA and others. (But start at chapter 2, chapter one is off-putting.)

"The World Health Organization's infant-feeding recommendation" (Weekly
Epidemiological Record, No. 17, 1995, pp. 119-120)


>     The World Health Organization's infant-feeding recommendation
>
>     The World Health Organization recommends that infants should be fed
>     exclusively on breast milk from birth to 4 to 6 months of age; that
>     is, they should be given no other liquids or solids than breast milk,
>     not even water (1), during this period.  Given the worldwide variation
>     in growth velocity, an age range is an essential element of this
>     feeding recommendation.  Mean growth Z-scores are indeed observed to
>     begin falling at different points within this 4-to-6-month range in
>     breast-fed infants from different populations worldwide (2).  WHO and
>     its partners are in the process of refining the definition of
>     "optimal" growth, as measured by accepted functional indicators of
>     infant health and well-being.
>
>     After this initial 4-to-6-month period of exclusive breast-feeding,
>     children should continue to be breast-fed for up to 2 years of age or
>     beyond, while receiving nutritionally adequate and safe complementary
>     foods (3-5).  Starting complementary feeding too early or too late are
>     both undesirable (6).  Ideally, the decision when precisely to begin
>     will be made by a mother, in consultation with her health worker,
>     based on her infant's specific growth and development needs.
>
>     WHO's current infant-feeding recommendation was based initially on the
>     technical review and discussion undertaken in 1979 in connection with
>     a joint WHO/UNICEF meeting on infant and young child feeding (7).  The
>     meeting's statement and recommendations were subsequently endorsed in
>     their entirety by the World Health Assembly (8).  Important additional
>     scientific evidence including, most recently in 1995, from the WHO
>     Expert Committee on the use and interpretation of anthropometry
>     (9,10), underscores the reliability of the earlier review.
>
>     Although future scientific information and better understanding of the
>     variable impact of individual and population circumstances may well
>     warrant a change one day, present scientific evidence confirms the
>     suitability of WHO's long-standing infant-feeding recommendation.
>
>     * For more information, contact the Nutrition Unit, Division of Food
>     and Nutrition, WHO, 1211 Geneva 27, Switzerland, fax (41-22) 791-4156,
>     e-mail: <[log in to unmask]>.
>
>     REFERENCES
>
>     1. Forty-fifth World Health Assembly, May 1992, resolution WHA45.34 on
>     infant and young child nutrition and status of implementation of the
>     International Code of Marketing of Breast-milk Substitutes.
>
>     2. WHO Working Group on Infant Growth. An evaluation of infant growth:
>     the use and interpretation of anthropometry. Bulletin of the World
>     Health Organization, 1995, 73(2):165-174.
>
>     3. Innocenti Declaration on the Protection, Promotion and Support of
>     Breastfeeding. Breastfeeding in the 1990s: A Global Initiative.
>     WHO/UNICEF, Florence, Italy, 1990.
>
>     4. Forty-fourth World Health Assembly, May 1991, resolution WHA44.33
>     on the World Summit for Children: follow-up action.
>
>     5. Saadeh R et al. Breast-feeding: the technical basis and
>     recommendations for action. Geneva, World Health Organization
>     (document WHO/NUT/MCH/93.1).
>
>     6. Physiological development of the infant and its implications for
>     complementary feeding. In: Infant feeding: the physiological basis,
>     Akre J (ed.). Supplement to Vol. 67 (1989) of the Bulletin of the
>     World Health Organization. Geneva, World Health Organization, 1990.
>
>     7. Joint WHO/UNICEF Meeting on Infant and Young Child Feeding.
>     Statement and Recommendations. Geneva, World Health Organization, 1979
>     (document WHA33/1980/REC/1, Annex 6).
>
>     8. Thirty-third World Health Assembly, May 1980, resolution WHA33.32
>     on infant and young child feeding.
>
>     9. Physical status: the use and interpretation of anthropometry.
>     Report of a WHO Expert Committee. Geneva, World Health Organization,
>     1995.
>
>     10. WHO Working Group on Infant Growth. An evaluation of infant
>     growth. Geneva, World Health Organization, document WHO/NUT/94.8.


Of course I think that in many cases healthy thriving babies go past 6
months on exclusive breastfeeding, but that's allowed for in this
statement, which given its global audience, seems reasonable enough. There
is of course evidence that in allergic populations 6 months exclusive BF
should be strongly encouraged, and that as Ted Greiner emphasized, we are
weaning on to other foods, not off the breast. But quantitative
malnutrition is as damaging to the immune system as the qualititative
dysnutrition that is artificial feeding. So it is always a case by case
approach in the real world, and dogmatism about ages and sizes can be
dangerous.

Maureen Minchin IBCLC

"All that it takes for evil to win is for good decent folks to do nothing."
(Joan Baez: where is she now?)

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