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 (4) "

Ref 4:  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 on web site
http://www.who.int/child-adolescent-health/new_publications/NUTRITION/WHO_CDD_SER_91.14.pdf

Personally, I have a problem with this wide a definition.  Eg it is
likely that medicines such as antibiotics might alter gut flora or
damage the mucosal surface to affect absorption of nutrients and
infective agents, or create artificial differences which would make
an impact on health outcomes.

In addition, I think we need to be aware that in some research
studies, there are "allowable lapses" in the definition of exclusive
breastfeeding.  Lapses are described in a 2004 WHO document entitled,
HIV and infant feeding data analysis, Geneva, 12-14 November 2003,
Workshop Report, "Consistent definitions of feeding patterns should
be used to ensure comparison of findings across studies. It is also
desirable to specify allowable lapses and provide complete
information about how feeding patterns are defined for
analysis.........In addressing the issue of HIV transmission through
breastfeeding, it might be appropriate to use a hierarchical
definition of feeding status with some allowable lapses. For example,
an infant classified as partially breastfed at 6
weeks of age, who has been given formula on more than 3 occasions,
would not be classified as predominantly breastfed at 10 weeks even
if the mother stops giving formula."

Since in the context of HIV exclusive breastfeeding is especially
critical, the issue of lapses is quite frustrating.  For instance,
when you read the small print, it looks as if the ZVITAMBO study
(Iliff 2005) allowed 1 lapse in its definition of EBF (the babies may
have received other foods or liquids on one occasion and still have
been classified as exclusively breastfed) and the transmission rate
of HIV was 1.3% with 3 months EBF.  The transmission rate was
somewhat higher at 4% with 6 months' exclusive breastfeeding in a
South African study (Coovadia 2007) when 3 lapses in EBF were
permitted within the definition.  So it seems to make a difference.

What is frustrating is why vitamins, medications and lapses are
allowed at all within the definition - why not make the entry
criteria into a study examining the effects of exclusive
breastfeeding meticulously stringent and get a "real" result??

Pamela Morrison IBCLC, from beautiful, tropical Penang
(wearing my Co-coordinator WABA BF & HIV Task Force hat)




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