Exclusive breastfeeding should continue to six months

The Canadian Paediatric Society recommends exclusive breastfeeding for the first six months of life for healthy, term infants. Breast milk is the optimal food for infants and breastfeeding may continue for up to two years and beyond.

This recommendation, proposed by the Canadian Paediatric Society Nutrition Committee and adopted by the Board of Directors in March 2005, extends the duration of exclusive breastfeeding from the former range of four to six months (1). It is also consistent with recently published recommendations from Health Canada (2) and the American Academy of Pediatrics Section on Breastfeeding (3). These changes follow the World Health Organization’s 2001 recommendation that exclusive breastfeeding continue for six months (4). The World Health Organization defines exclusive breastfeeding as the practice of feeding only breast milk (including expressed breast milk) to the baby and allows the baby to receive vitamins, minerals or medicine. Water, breast milk substitutes, other liquids and solid foods are excluded (5).

The reasons behind the new recommendation include strong protective effects for infant gastrointestinal infection, and prolonged lactational amenorrhea and increased postpartum weight loss in mothers. There were concerns that this recommendation could result in iron deficiency, other micronutrient deficiencies and growth faltering in susceptible infants. These concerns were directed particularly at populations where maternal nutrition was suspect and infants had high rates of iron, zinc and vitamin A deficiency. However, an 8% global increase in exclusive breastfeeding to six months is estimated to have reduced infant mortality by 1,000,000, decreased fertility by 600,000, and saved countries billions of dollars in breastmilk substitutes (6). While the data for benefit in industrialized countries are limited, they do exist (7,8).

Nutrient-rich complementary foods, with particular attention to iron, should be introduced at six months. Breastfed babies should also receive a daily vitamin D supplement until their diet provides a reliable source or until they reach one year of age (9,10).

The Nutrition Committee recognizes that more research in infant feeding is needed. However, there is no evidence of harm in the new recommendation, and promoting exclusive breastfeeding to six months has the potential to improve health for infants who are economically and socially disadvantaged. We must acknowledge the need to provide adequate social and nutritional support to lactating women.