Subject: Introducing solids: 
Full Breastfeeding Duration and Associated Decrease in Respiratory Tract
Infection in US Children 
Caroline J. Chantry, MDa, Cynthia R. Howard, MD, MPHb and Peggy Auinger,
MSb,c 

a Department of Pediatrics, University of California Davis Medical Center,
Sacramento, California
b Department of Pediatrics, University of Rochester School of Medicine and
Dentistry, Rochester, New York
c American Academy of Pediatrics Center for Child Health Research,
Rochester, New York 
OBJECTIVE. The American Academy of Pediatrics recommends exclusive
breastfeeding for an infant's first 6 months of life. When compared with
exclusive breastfeeding for 4 months, greater protection against
gastrointestinal infection, but not respiratory tract infection, has been
demonstrated for the 6-month duration. The objective of this study was to
ascertain if full breastfeeding of 6 months compared with 4 to <6 months in
the United States provides greater protection against respiratory tract
infection. 

METHODS. Secondary analysis of data from the National Health and Nutrition
Examination Survey III, a nationally representative cross-sectional home
survey conducted from 1988 to 1994, was performed. Data from 2277 children
aged 6 to <24 months, who were divided into 5 groups according to
breastfeeding status, were compared. Children who required neonatal
intensive care were excluded. SUDAAN software was used to account for the
complex sampling design. Logistic regression adjusted for confounding
factors. Outcome measures included adjusted odds of acquiring pneumonia, 3
episodes of cold/influenza, 3 episodes of otitis media (OM), or wheezing in
the past year or acquiring first OM at <12 months of age. 

RESULTS. In unadjusted analyses, infants who were fully breastfed for 4 to
<6 months (n = 223) were at greater risk for pneumonia than those who were
fully breastfed for 6 months (n = 136) (6.5% vs 1.6%). There were not
statistically significant differences in 3 episodes of cold/influenza (45%
vs 41%), wheezing (23% vs 24%), 3 episodes of OM (27% vs 20%), or first OM
at <12 months of age (49% vs 47%). Adjusting for demographic variables,
childcare, and smoke exposure revealed statistically significant increased
risk for both pneumonia (odds ratio [OR]: 4.27; 95% confidence interval
[CI]: 1.27-14.35) and 3 episodes of OM (OR: 1.95; 95% CI: 1.06-3.59) in
those who were fully breastfed for 4 to <6 months compared with 6 months. 

CONCLUSIONS. This nationally representative study documents increased risk
of respiratory tract infection including pneumonia and recurrent OM in
children who were fully breastfed for 4 vs 6 months. These findings support
current recommendations that infants receive only breast milk for the first
6 months of life. 
Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. 425-432
(doi:10.1542/peds.2004-2283)
http://pediatrics.aappublications.org/cgi/content/full/117/2/425

Comment re solids introduction: I am honestly enjoying the homespun stories,
but this is evidence-based practice.... right?
Marie Farver RN BSN IBCLC RLC

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