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Subject:
From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 29 Sep 2014 10:15:45 -0400
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Dear all:

I for one have read filing cabinets work of peer reviewed research on breastfeeding, much of which included articles on risks when breastfeeding wasn't exclusive.  Below is just one of many obituaries on one of my professors at Cornell. Dr. Latham recognized the terrible tragedy of how the marketing of formula in Eastern Africa caused increased deaths due to diarrhea from the marketing that convinced women to use formula.  It has been well established that lack of exclusive breastfeeding increases the risk of diarrhea (as well as many other illnesses) and infant death.  

http://www.washingtonpost.com/local/obituaries/michael-latham-nutritionist-who-advocated-breast-feeding-dies-at-82/2011/04/20/AFL5C7DE_story.html

While I was working on my doctoral dissertation in the early 1990s there was still some global controversy, which was resolved shortly after I completed my doctoral dissertation.  The question of exclusivity to 4 months versus 6 months was extensively reviewed by research scientists for the World Health Organization, which led to the recommendation of 6 months.  One of the members of the committee that worked on the recommendations for the WHO was my dissertation adviser.  His summary was that the evidence was clear that:

*  in areas where water and sanitation are poor, introducing anything other than breastmilk before six months substantially increases risks
*  in areas where water and sanitation are good, introducing anything other than breastmilk before four months increases risks and exclusive breastfeeding to six months does not increase risks

So the global recommendation to exclusively breastfeed to six months is fully supported.

Where he thought the evidence was still murky was whether or not there is a substantial increase in risks in areas where water and sanitation is good from introducing substances other than breastmilk between four and six months.  

Given what we know of the plausible changes to the lining of the infant gut, the emerging research on how intestinal flora influence inflammatory disease it is entirely likely that we will eventually a better understanding of the potential long term impact of introduction of other substances before six months in areas of good water and sanitation.

Since many of us work with breastfeeding problems, many of us are in the position of having to balance the risks of the problem we are assisting breastfeeding families to resolve with the risks of introducing substitutes for mother's own milk.  Such decisions are complex and highly individualized. 

Susan Burger

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