>most formula fed babies could
not 'last' that long, as we see from observation and also surveys
which show babies on formula tend to start solids quite a bit  sooner
than excl. bf babies.<

Heather, I think we should be careful here.

Starting with who we are talking about:  we will be lumping together never
breastfed babies and babies who started out ebf or mbf and are on
substitutes only by ages of -- under how many months??? -- maybe they all
have identical nutritional needs, maybe not.  Just because the studies have
been lousy on defining breastfeeding, lets not make the reverse mistake with
other forms of feeding -- mbf and nbf (mixed breastfeeding -- term used in
Cochrane review, and never breastfed, an acronym I think I just made up).

Anyway, in terms of studies, this has been poorly researched, and reading
the Kramer and Kakuma Cochrane Review one of the things which struck me most
forcibly is that the difference in what is mixed in the mbf might make huge
differences in health outcomes.  But surely, what we have to be really
really careful is to allow for the possiblity of reverse causality (such a
bedeviling feature of all infant feeding studies).  Are babies who are nbf
or nlbf (no longer breastfed, another term I just made up) given solids
earlier because they 'need' them or because factors -- maybe similar or the
same factors which led to them being nbf or nlbf also lead their
mothers/families to offer other foods at ages before the official
recommendation?

I think we know *so little* about this area -- and I do not know who might
be looking into it an independent way -- as you point out there is scads of
dosh to be made in this field.  I know the Optimal Duration of bf review was
really outside the Cochrane terms of reference, but it was a ssae place to
do it.....dunno where we could expect any decent research to be done for the
deprived nbf and nlbf babies.

The possiblity also exists that, while there is convergence in various
factors for the timing of complementary feeding for ebf babies there will be
no such convergence for nbf babies.  For example, maybe they need nutrients
sooner, but foods other than milks will do some damage to the gut -- I
wonder if anyone has looked at any of this at all, considering how little we
know about physiologically normal children (ebf), I doubt it.

Magda Sachs
Breastfeeding Supporter, BfN, UK

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