Hi Jean and all,

I'm currently a doctoral candidate in pursuit of a PhD in maternal and
child health, and my main research focus has been complementary feeding of
infants. I don't have a definitive answer to your question, because what
I've learned over the last two years of study is that those answers are
still emerging and there are so many facets to them. The study you cited
addressed allergenicity (though to what degree of precision and accuracy
may be debatable -- operationalizing exposure and outcome variables in any
nutritional study but especially in infant feeding is difficult at best,
impossible at worst), but there are, of course, other factors: infant
growth and metabolic programming, maternal health when breastfeeding is
displaced by solid foods prematurely, protection from infections, whether
the solid foods are displacing breastmilk or a substitute ... the list goes
on and on. The most comprehensive resource I've used is the updated
systematic review by Kramer and Kakuma (2012), which drives the WHO
recommendation for 6 months of exclusive breastfeeding. It goes through
each outcome individually and summarizes the literature that was available
at that time (a few years ago now), for both developing and developed
nations. The overall conclusion is that 6 months is the optimal time for
introduction of solid foods, but for many outcomes in certain settings, the
evidence *against* starting between 4 and 6 months isn't necessarily
conclusive, and that seems to be where we need the burden of proof to lay
if we're to enforce the 6-month exclusivity recommendation. Here is the
link to the Kramer and Kakuma review abstract.

http://www.ncbi.nlm.nih.gov/pubmed/22895934

I hope to follow further discussion on this topic as I'm finalizing my
dissertation focus in the next few weeks and I would love to pursue
research questions that our field needs answered -- particularly in this
climate of increased attention to early life nutrition and emergence of
policies that may influence how families feed their infants.

--Diana Cassar-Uhl, MPH, IBCLC (and since I *just* progressed to candidacy
this summer: ABD!)
Cornwall, NY and Hyattsville, MD

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