Hello friends,

Lots to consider when reviewing the literature about complementary feeding. Developed or developing nation? Is the food environment scarce, obedience, or in between? What are the outcomes of interest? Growth of the infant? Maternal health? Prevention of diarrheal illness? 

The comprehensive review the WHO uses to drive its guidance on the timing of complementary feeding is by Kramer & Kakuma. The most recent update was in 2012 and if this is a remotely interesting topic to you, I highly recommend reading the whole review! They evaluated a lot of literature(observational and RCT) for more outcomes than you'll imagine, in both developing and developed nations. 

Interestingly, much of the literature that sought to test hypotheses around 4 vs 6 months of exclusive breastfeeding weren't looking for evidence to extend exclusive breastfeeding -- the investigators were looking for (and largely not finding) evidence of harm in withholding solid food after 4 months of age. 

The evidence to support 6 months of exclusive breastfeeding rather than 4 is unfortunately not absolute; outcome of interest and context are important considerations. Consider also whether displacing human milk comes at a cost of unintended early weaning (full) down the road, and whether what we are displacing human milk with is timely, safe, and appropriate. 

--Diana Cassar-Uhl
MPH, IBCLC
Ph.D. student <----- probably exploring complementary feeding for my dissertation next year :)
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