Dear friends

Jim Akre sent me the following text from Randa Saadeh at WHO.  Randa 
said it isn't up on the Internet as yet given all the clearances 
required, but she says it can be distributed under her name without 
restriction.  It's certainly good to have such an expert, prompt response.

************
WHO's global public health recommendation is for infants to be 
exclusively breastfed for the first 6 months of life to achieve 
optimal growth, development and health. Thereafter, infants should be 
given nutritious complementary foods and continue breastfeeding up to 
the age of 2 years or beyond.

WHO closely follows new research findings in this area and has a 
process for periodically re-examining recommendations. Systematic 
reviews accompanied by an assessment of the quality of evidence are 
used to review guidelines in a process that is designed to ensure 
that the recommendations are based on the best available evidence and 
free from conflicts of interest.

The paper in this week's BMJ is not the result of a systematic 
review. The latest systematic review on this issue available in the 
Cochrane Library was published in 2009 ("Optimal duration of 
exclusive breastfeeding (Review)", Kramer MS, Kakuma R. The Cochrane 
Library 2009, Issue 4). It included studies in developed and 
developing countries and its findings are supportive of the current 
WHO recommendations. It found that the results of two controlled 
trials and 18 other studies suggest that exclusive breastfeeding 
(which means that the infant should have only breast milk, and no 
other foods or liquids) for 6 months has several advantages over 
exclusive breastfeeding for 3-4 months followed by mixed 
breastfeeding. These advantages include a lower risk of 
gastrointestinal infection for the baby, more rapid maternal weight 
loss after birth, and delayed return of menstrual periods. No reduced 
risks of other infections or of allergic diseases have been 
demonstrated. No adverse effects on growth have been documented with 
exclusive breastfeeding for 6 months, but a reduced level of iron has 
been observed in developing-country settings.

Randa Saadeh
**************

Pamela Morrison IBCLC
Rustington, England

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