Jacquie picked up that a recent media article about the new WHO HIV
and infant feeding guidelines mistakenly suggested that exclusive
breastfeeding should be maintained for 12 months. Christine asks why
we should be surprised at this, when we can't agree on the definition
of exclusive breastfeeding even between ourselves, citing the example
of feeding a baby probiotics. Then she goes on to say, "Exclusive
breastfeeding means that the only things to go into baby's mouth are
mom's breast .... Any giving of a vitamin or supplement means baby is
not exclusively breastfed."
You would think so, wouldn't you? And I happen to agree with
you. But actually WHO gives this definition of exclusive breastfeeding:
"Exclusive breastfeeding means giving a child no other food or drink,
including no water, in addition to breastfeeding with the exception
of medicines, vitamin drops or syrups, and mineral supplements "
(Ref: World Health Organization, Division of Child Health and
Development. Indicators for assessing breastfeeding practices:
reprinted report of an informal meeting 11-12 June, 1991. Geneva:
WHO, 1991. Available at
http://www.who.int/child-adolescent-health/new_publications/NUTRITION/WHO_CDD_SER_91.14.pdf
There's also the possibility that even in research papers when babies
are described as "exclusively breastfed" there may have been a
"lapse", or two or three, in this definition. This is especially
confusing and frustrating in the HIV and infant feeding story, where
exclusive breastfeeding is so important. But "allowable lapses" are
described in a 2004 WHO document entitled, HIV and infant feeding
data analysis, Geneva, 12-14 November 2003, Workshop Report.
So it's as well to read the fine print in the methodology section to
ascertain exactly what the authors mean when they say "exclusive
breastfeeding", and we could all be forgiven for becoming confused,
and perhaps continue to advocate for a tightening up of the definition!
Pamela Morrison IBCLC
Rustington, England
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