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Breast-feeding Reduces Risk of Infectious Diseases
Abstract & Commentary
By Hal B. Jenson, MD, FAAP, Professor of Pediatrics, Tufts University School of Medicine, and Chief Academic Officer, Baystate Medical Center, Springfield, MA, is Associate Editor for Infectious Disease Alert.
Dr. Jenson reports no financial relationships relevant to this field of study.
Synopsis: Exclusive breastfeeding until the age of 4 months, and partially thereafter, significantly reduces respiratory and gastrointestinal tract infections in infants.
Source: Duijts L, et al. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics 2010;126:e18-e25.
A prospective, population-based cohort study was conducted from 2002-2006 in the Netherlands of 4,164 children during the first year of life, and included questionnaires and physician-confirmed infections of the upper respiratory tract (URT), lower respiratory tract (LRT), and gastrointestinal tract (GI). Statistical models were adjusted for potential cofounders, including maternal education, ethnicity, smoking, gestational age, birth weight, siblings, and day care attendance. Adjustment for family history of asthma and allergic disease had no impact.
Compared with never-breast-fed infants, those infants who were breast-fed exclusively until the age of 4 months, and partially thereafter, had lower risks, until the age of 6 months, of URT infections (OR: 0.65; 95% CI: 0.51–0.83), LRT infections (OR: 0.50; 95%CI: 0.32–0.79), and GI infections (OR: 0.41; 95% CI: 0.26–0.64). There also was a reduction of LRT infections from the age of 7–12 months (OR: 0.46 95% CI: 0.31–0.69). Neither exclusive breast-feeding for 4 months with no breast-feeding thereafter, nor partial breast-feeding even for 6 months resulted in significantly lower risks of these infections.
The strength of this study is the large cohort size and the prospective design. Breast-feeding exclusively for the first 4 months of life, and partially thereafter, reduced the risk of developing respiratory and gastrointestinal tract infections during the first 6 months of life; for LRT infections, it reduced the risk during their first year of life. In this study, both components were important for protection: exclusive breast-feeding through 4 months but no breast-feeding thereafter and partial breast-feeding for six months were not significantly different from never-breast-fed infants.
Though breast-feeding may not permanently protect against these infections, the importance of breast-feeding in delaying the age of onset cannot be overemphasized. Respiratory and gastrointestinal tract infections are the leading cause of morbidity in children worldwide. The same infectious agent that causes a mild, self-limited respiratory or gastrointestinal tract infection in an older child can cause life-threatening illness in a young infant.
The World Health Organization recommended in 2001 that all children be exclusively breast-fed for the first 6 months of life. The American Academy of Pediatrics recommends exclusive breast-feeding through 6 months of life also, and continued for at least the first year of life and beyond for as long as mutually desired by mother and child, with the introduction of other foods beginning at 6 months of age.
There are two nutritional caveats about breast-feeding. Although human milk contains small amounts of vitamin D, it is not enough to prevent rickets. All breast-fed infants should receive 200 IU of oral vitamin D drops daily, beginning during the first two months of life and continuing until the daily consumption of vitamin D-fortified formula or milk is 500 mL. Fluoride should not be provided during the first 6 months of life, and from 6 months to 3 years of age, the decision whether to provide fluoride supplementation should be based on the fluoride concentration in the water supply (fluoride supplementation generally is not needed unless the concentration in the drinking water is < 0.3 ppm) and in other sources, including toothpaste.