Women who follow NHS guidance and breastfeed their babies exclusively for six months may be putting them at risk of iron deficiency and food allergies, experts have warned.
By Rebecca Smith
The national recommendation must now be changed in light of new evidence that suggests solid food has a health beneift for babies.
Introducing other foods, but not formula, between four and six months of age is advised by numerous baby health groups and many parents simply wean their babies when their child seems to need it, the researchers said.
Britain adopted the World Health Organisation's advice in 2003 but Dr Mary Fewtrell, from the Institute of Child Health and Great Ormond Street, and co-authors specialising in child nutrition, said that few other Western countries did so.
Writing in the British Medical Journal they said the is valid advice for the Third World where there is a greater risk of infection due to lack of clean water and safe foods but in Western countries the evidence for excluding solid foods for six months is less clear.
Less than one per cent of mothers in Britain exclusively breastfed their babies for six months, a survey in 2005 found, although this may be higher now, the authors said.
The WHO recommendation was based on a review of the studies done prior to 2001 and concluded that breastfed babies had fewer infections and no growth problems but many of the trials were conducted in a way that meant researchers could not exclude other reasons for this connection.
Since the WHO advice was issued other studies have suggested that exclusive breastfeeding for six months is associated with iron deficiency which is linked to mental, co-ordination and social development problems. Babies are not routinely screened for iron deficiency which is a 'further concern', the authors said.
Babies not exposed to other tastes, specifically the bitter taste of green leafy vegetables, at an early age may reject these foods later leading to dietary deficiencies, they said.
Also there are concerns that not introducing solid foods before six months may increase the likelihood of allergies.
And a study in Sweden found increased risk of coeliac disease with delayed introduction of gluten suggesting that the best time to introduce gluten containing foods such as wheat flour was between three and six months.
Other studies are ongoing.
Dr Fewtrell wrote: "The critical question is whether the United Kingdom should alter its advice on the introduction of complementary foods while new evidence is assembled.
"At one extreme, it has been suggested that there is insufficient scientific evidence for any lower age for weaning and that "infants should be weaned on demand, which is what most infants and their parents actually do in practice."
"It can be argued that, from a biological perspective, the point when breast milk ceases to be an adequate sole source of nutrition would not be expected to be fixed, but to vary according to the infant’s size, activity, growth rate, and sex, and the quality and volume of the breast milk supply.
"Signalling of hunger by the infant is likely an evolved mechanism that individualises timing of weaning for a mother-infant pair.
"However, others would adopt a more cautious approach, based on data suggesting that the introduction of solid foods before three to four months may be associated with increased fatness and wheeze later in childhood."
She added that a review conducted by the European Food Safety Authority’s panel on dietetic products, nutrition, and allergies concluded that for infants across the EU, complementary foods may be introduced safely between four to six months, and six months of exclusive breast feeding may not always provide sufficient nutrition for optimal growth and development.
The British Dietetic Association Paediatric Group has recently issued similar guidance.
Dr Fewtrell said: "Perhaps the Department of Health might conclude similarly were it to commission an objective, independent review of the evidence that has accumulated since WHO’s review a decade ago."
© The Telegraph Group
London 2011
London 2011
