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.
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.”
Janet Fyle, Professional Policy Advisor at the Royal College of Midwives, said: “I really must challenge the suggestion from the review that the UK should reconsider its current advice on exclusive breastfeeding for six months.
“I believe that this is a retrograde step and plays into the hands of the baby food industry which has failed to support the six month exclusive breastfeeding policy in the UK.
“The argument often advanced that the six months policy is best suited to developing countries is not strictly true. There is evidence that some babies do die in developed countries from inappropriate young child feeding; such as the introduction of solid foods earlier before their swallowing mechanism is mature enough or they have fully developed the capability to cope with solid foods.
“It is also of concern that we are trying to imprint healthy eating habits into children from birth and yet it is being suggested that parents introduce solid foods earlier. In reality, many parents would introduce sugar based solids which could develop the child’s taste for sweet foods and impact on their eating habits later on.
“The RCM remains concerned that parents continue to be given inconsistent and confusing messages on infant feeding.”
A spokesman for the Department of Health said: “Breast milk provides all the nutrients a baby needs up to six months of age and we recommend exclusive breastfeeding for this time. Mothers who wish to introduce solids before six months should always talk to health professionals first.
“The Department of Health will review this research alongside all emerging evidence on infant feeding. We have asked the Scientific Advisory Committee on Nutrition to undertake a review of infant feeding, which is expected to report later this year.”
By Rebecca Smith
Telegraph UK