June 21st, 2010
08:59 AM ET

New study supports exclusive breastfeeding for first six months

By Miriam Falco
CNN Medical Managing Editor

New research provides more evidence that when moms exclusively breastfeed their newborns and infants for the first six months of life, they can signficantly reduce their baby's risk of serious lung and intestinal infections.

Researchers in the Netherlands looked at data from more than 4000 infants. They found that babies who were exclusively breastfed for more than four months had a "significant reduction of respiratory and gastrointestinal diseases in infants."  They also found that being breastfed until six months of age seemed to be even more protective and even appeared to reduce the number of infections for the next six months of the child's life.

The study was published in the journal Pediatrics on Monday.

The benefits of exclusive breastfeeding for the first six months – where a baby is only given breast milk, no formula or solid food or fruit juice or even water – have been known for a while.  In this study, the benefits of breastfeeding come from what's in the breast milk (which can be fed to the baby by nursing or pumping the milk and then bottle-feeding the infant).

Breast milk not only provides all the nutrients a baby needs but moms are also passing along antibodies,which help protect their little ones from infections that cause diarrhea and pneumonia, the two leading causes of child mortality worldwide according to the World Health Organization. More than 1 million child deaths could be avoided each year if more babies were exclusively breastfed during the first six months of life according to the WHO website.

"We've had various evidence for years that infectious diseases are minimized," says the Dr. Ruth Lawrence, chair of the American Academy of Pediatrics Section on Breastfeeding. "But we haven't had as much data in a developed country." Lawrence says this new study confirms what the AAP and WHO already recommend – breastfeed six months exclusively if possible.

In addition to the WHO and AAP, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians and the Centers for Disease Control and Prevention all recommend exclusive breastfeeding of infants until approximately six months of age.

However, according to the CDC's 2009 breastfeeding report card, while nearly three-quarters of babies nationwide start out being breastfed, only one-third of moms were exclusively breastfeeding their babies at three months and only 14 percent were still exclusively breastfeeding at six months.

Pediatricians recognize the challenges new moms face. "It really takes a lot of dedication from the mom's standpoint [to breastfeed] day in and day out for six months," says Dr. Frank Esper, a pediatric infectious disease specialist at Rainbow Babies & Children's Hospital in Cleveland, Ohio.  Esper and Lawrence as well as the CDC and WHO agree more needs to be done to help mothers continue to breastfeed in the United States and worldwide.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

soundoff (250 Responses)
  1. Formula saves lives

    @ Graciegal–

    Pacemakers allow a plethora of adults thrive when they wouldn't have before. Synthetic and processed food for adults allowed many in Haiti survive after that devastating earthquake– many thrived who would have otherwise straved. Medications which are synthetic hormones allow survivors of thyroid cancer and hysterectomies to thrive when they would not otherwise. Should these people be allowed to suffer and possibly die?

    Your idea that the children of those who cannot breastfeed should be left to starve and die is ridiculous, heartless and more than all else lacks intelligence.

    June 22, 2010 at 16:02 | Report abuse | Reply
  2. mommy love

    'So now a plethora of babies have issues because we are allowing them to thrive when they wouldn't have before."

    wow. just wow. that is the most ridiculously horrible thing I have read in a long, long time.

    June 22, 2010 at 21:41 | Report abuse | Reply
  3. Cheryl

    The new healthcare reform law will require what many state laws have already required: that working nursing moms be given breaks to pump and a private clean (not a restroom stall) place to pump for the 1st year after delivery. I am hoping this will help more mothers nurse for longer after going back to work. If you work someplace that you don't think will be compliant with the new law by next year- you should ask your HR person what the plans at your company are to get compliant.

    June 22, 2010 at 21:56 | Report abuse | Reply
  4. Joan Donnaway

    The postings by the 2 Doctors should be highlighted. They do speak with the most wisdom of all. I'm a mother of 3 adult children that I nursed for a total of 5 years (all 3 combined). The 1 nursed the longest appears to have benefited the most. She was born in Scandinavia where women could choose (Way back then!!!) between 10 months maternity leave @ 100% pay or 12 months @ 80% pay. Most chose 12 months. Fathers were also entitled to a year of leave. Few babies had to be in day care before 2 years of age. It's WAY past time for the US to join the civilized world!!!!!

    June 23, 2010 at 01:40 | Report abuse | Reply
  5. mikki

    We need to stop arguing over what's "best" and stop making moms feel bad for needing to use formula. (Similarly, pro-formula parents need to stop lashing out at BF moms and groups since not everyone is militant and mean as some would have you believe). The U.S. needs to focus on how to make breastfeeding possible for many more women, which includes proper support, better maternity leave, better wages for women, and a change in overall attitudes towards childrearing and breastfeeding.

    June 23, 2010 at 09:49 | Report abuse | Reply
  6. mikki

    @MD – "for many of my female friends, the stress of breast feeding has been the biggest contributor to their post partum depression. "

    I would question that to some extent. The difficulty and challenges of new motherhood and breastfeeding I understand. But NOT breastfeeding is actually more likely to contribute to PPD because the breastfeeding hormone (oxytocin) is not released – which helps promote love and bonding in the mother.

    June 23, 2010 at 09:54 | Report abuse | Reply
  7. Meredith

    The percentage of women who actually *CAN'T* bf is TINY. Many women are lead to believe that they can't bf and indeed it is difficult for many women.

    I'm sure no one wants to make women who can't bf feel uncomfortable, but it is important to challenge the notion of "I didn't make enough milk" and a culture that does not support bfing.

    June 23, 2010 at 10:12 | Report abuse | Reply
  8. Meredith

    Before formula, infants did not routinely die from lack of milk. There were wet nurses and most cultures have a standard "formula" of some type of gruel to feed infants.

    June 23, 2010 at 10:21 | Report abuse | Reply
  9. ahm

    I breastfed my baby and had to go back to work when he was four months old. I was able to pump at work but had a male coworker who would "moo" a couple of times into the building-wide intercom whenever he couldn't find me and thought I might be pumping. I'm not sure who was more immature at that point – my infant son, or my 20-ish coworker. It was embarrassing but also funny, and defused some of the awkwardness caused by Americans' inaccurate perceptions of breastfeeding as sexual.

    June 23, 2010 at 10:25 | Report abuse | Reply
  10. mim


    Yes, breastfeeding is THE thing to do. It's proven to boost the immune system for a lifetime of your child, it's the proper fat/protein ratio for a human (as opposed to cow or soy, the proper temperature, no bottles to sterilize and lug along on outings/trips, and it is what a baby needs to develop mentally, provided you are eating well and not abusing yourself by what you put into your mouth. Six months out of your life to effect the life of another is not asking too much, is it?

    June 23, 2010 at 10:33 | Report abuse | Reply
  11. B

    No matter what you think or what your situation is, the fact is that breastmilk is the norm and should be the standard for infant feeding. Its not better then formula- formula is not as good as breastmilk. Thats a pretty important change in words. Formula should be the last resort- and should be available for those babies and mothers who cannot or will not nurse for whatever reason. And there are women who cannot produce milk, babies who have problems with sucking etc. But that doesnt change the facts- to say that breastmilk and artificial food (formula) is the same, is wrong. There has not been any strong success in creating a formula that truly is the same as breastmilk- and unless there is (and you cant expect formula makers to really tell you that), formula should be looked at as a health product that has its own risks. And for every story that you hear about "my child did fine on formula" "I did fine on formula"- well, there are people who do ok on lower nutrionally value foods too and there are many more when you look at the population level instead of the individual level who did not do well. Again, formula was intended as a medical support product, not as a replacement for nursing. The official recommendation btw for infant feeding is nursing, then pumped breastmilk in a bottle, then someone's donated breastmilk and in last place is formula. Formula should be the last option (though I do undertand the EWWW factor for using someone else's milk...)

    As for why more women are not succesful at nursing- in the US we have 2 major issues. One is the lack of support in society for breasttfeeding and the other is lack of support in the workplace. My guess is that if we could tackel the workplace issues- and force companies to have nursing-friendly environments and policies, then we'd see more acceptance by society.

    It should be every baby's right, not privelege, to drink the milk that was made for it- and that milk is made by mom, as a natural part of the childbearing process and NOT by chemicals, additives and milk from other species put together by technicians. And women have the right to know that they CAN choose what to feed thier child but that the standard is breastmilk, and that anything less than that is less nutritious. Formula is fine, its acceptable and ok for your child- but its not the same as breastmilk. Women deserve to be able to make the most informed decision- and the platitudes we read that say that both milk and formula are the same, do no service to any woman.

    June 24, 2010 at 00:15 | Report abuse | Reply
  12. NJ

    Great research, but old news.
    – funny how we have to document stuff we know instinctively.
    -As a maternal-neonatal nurse I'm fully aware that some women 'can't breastfeed /make enough milk.
    -My concern is that some didn't get enough help/education from medical staff.
    -There are lots of things that can help, if only the doctors and nurses would access the info and spend time supporting their patients. It is their responsibility!
    – I always tell my patients:
    1st. give your baby nourishment,
    2nd, breastmilk if possible,
    3rd. from the breast if you can.
    4th. for as long as you are able. [yes, that means beyond 6 months as you wean onto solids]

    June 24, 2010 at 13:51 | Report abuse | Reply
  13. EMama

    I am amazed at how venomous the people representing both sides of this issue are getting. It clearly illustrates just how emotionally loaded this issue is to all moms, regardless of your choices...

    I agree that the percentage of women in American who truly are not physically able to produce enough milk is teeny – around 4%. HOWEVER I don't feel that that statistic takes into account the current "standard" birthing practices being practiced in American hospitals, many of which affect the start and ultimate outcome of a breastfeeding relationship. IVs with steady fluid being pumped into a laboring woman, epidurals, local anesthesia, c-section (currently at a rate of 30+% nationwide and as high as 50% in some major cities) can all contribute to a low supply in the early days. Likewise with a birth that is traumatic to a woman, be it over her perceived pain/fear level, the use of forceps, etc. Once a baby has made their entrance into the world there is another batch of practices that can affect or alter the start of breastfeeding: removing the baby from the mother to clean/weigh/measure/vaccinate, putting antibiotic drops into a newborn's eyes, and of course removal to a nursery (although thankfully that practice seems to be on the way out) .
    all of these things can hinder the start of breastfeeding.

    I'm not trying to make an anti-hospital-birth stance here, but all of the noted items above can negatively affect the start of breastfeeding. There are a whole slew of hormones flowing through the female body at the time of labor and delivery, many of which are in place to aid in the start of breastfeeding. Unnatural births and all of the practices that go along with them can all ultimately interfere with those hormones, making the start of milk production difficult.

    I believe that many women who experience births like the ones listed above (and those are the vast majority in the US), are not aware of their birth choices being a possible factor in their ability to breastfeed down the line. So if they say they tried and didn't have a supply after experiencing a traumatic birth – they are not lying, or not not-putting forth the effort! That was their actual experience.

    Does this mean moms who have a c-section cannot breastfeed? Of course not – it just might take a little more effort. But since the hardest part of starting a breastfeeding relationship is just that – starting it! – shouldn't we try to align as many factors as possible to facilitate that??

    To all moms, moms-to-be – and heck, the dads, too, since so many of them on here seem to be equally judge-y! – EDUCATE YOURSELVES about the pregnancy and birth process in advance, and the entire time you are pregnant! Make whatever choices seem best to you – including breastfeeding or not – but at least know what's happening with your body in advance. Unfortunately you cannot leave these decisions to your doctors, nurses and even most lactation consultants. Doctors and nurses are there to make sure you and your baby do not die. Period. This simultaneously ensures that they will not face a practice-ending lawsuit. Since the mother-infant mortality rates of recent centuries are quite low, there is no reason for all of these medical interventions. This is one area where technology is not helping a field advance. You need to understand what's happening to your own body and be your own advocate!

    So – educate yourself: read Michel Odent, Ina May Gaskin, Jack Newman, 'Breastfeeding Made Simple', anything by Dr. William Sears, see the movie The Business of Being Born. Get support lined up in advance: go to La Leche League, and/or find an INTERNATIONAL BOARD Certified Lactation Consultant (IBCLC – big distinction in the certifications). Make friends with other moms-to-be who have the same breastfeeding goals as you do.

    I agree that better maternity leave policies, as well as better facilities at offices to pump are necessities in this country, however, I think we could make some true changes to the breastfeeding statistics of the US by looking at an even earlier part of the process – BIRTH.

    June 24, 2010 at 15:39 | Report abuse | Reply
  14. NJ

    I totally agree with EMama. When I first taught Prenatal Education in the '60s many women were prepared to work at their birth to the betterment of baby and mum. Unfortunately nowadays by far the majority are uneducated about birth and 'prepared' to let technology take over saying "I'll try to deliver naturally but use whatever I need, without learning any techniques etc. to help. Same goes for breastfeeding "I'll try to breastfeed if I can, the nurses will show me how", without any idea what the normal progression of milk production or learning curve of mother and baby skills. It's no wonder the rate of medical intervention and bottle feeding go up and all of the natural sequelae.

    June 27, 2010 at 17:13 | Report abuse | Reply
  15. RT

    I agree that the number of woman who cannot produce is teeny. I also agree that there is no where NEAR enough support for new mothers. Given the right support many woman could figure out how to nurse. Additionally nursing is NOT easy in the beginning. It takes hard work and a commitment on the part of a mom.

    The American environment that we live in, is also very different from other countries. Many countries live with their extended families, thereby giving a new mother that natural support they need. You don't find that in the US.

    I also think that besides nursing, a lot has to do on the home environment. I wasn't breastfed, and can count on my hand how many times I have gotten sick and needed antibiotic, and I am close to 30. All my siblings are this way.

    I personally choose to breastfeed because a. I can, and I have a tongue tied child, so I don't find that excuse valid. b. I don't work, because daycare would cost more then I would make anyways. C. It is important to me. I want to know that I gave my children the best that I could. Yes, sometimes it has been hard. Yes, sometimes I have had to bring him places. Yes, my boobs are more south of the border then I would like. But it is a worthy sacrifice to make. I even had a surgery after one of my children, and pumped the whole time.

    That being said, so long as you are feeding your baby, I don't care. Yes breast is best, but if it is the difference of your baby being fed or not, feed your baby.

    June 29, 2010 at 12:45 | Report abuse | Reply
  16. Aubrey & Gavin's Mommy

    Look people, this is a news article. It reports the facts. I am sorry if you are offended because you feel guilty or feel as though the article's purpose is to make you feel guilty if you didn't breastfeed. Putting "if possible" is a ridiculous suggestion. The purpose of any news article is to give information, not coddle people. Get over it!!

    June 30, 2010 at 21:01 | Report abuse | Reply
  17. mamaof3

    On a bright note, the new healthcare legislation mandates employers provide a place for moms to pump at work. From an April CNN article:
    Nursing mothers will now get additional support, thanks to page 1239 of the health care bill that President Obama recently signed into law. It requires employers to provide "a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public, which may be used by an employee to express breast milk." Only companies with less than 50 employees can claim it's an undue hardship.

    It is time for the rubber to meet the road. I am a huge breastfeeding advocate. However, I think if we are ever going to see any meaningful change in the numbers, we need to structure things in such a way that moms don't receive the message of "breastfeeding is wonderful. Feel guilty if you don't. But if you do breastfeed, hide at home for the next year because *NO ONE* wants to see you do *that* in public. Most states have laws that protect a mother from being charged with indecency or similar charges; however, there are rarely repercussions for businesses who ask a mother to leave for nursing in public. For those who act as though anyone and everyone should cover, not all babies are cooperative w/ being covered, particularly as they hit 5-6 months and older. If we want more moms to breastfeed, and we want them to nurse longer, then it is time to make sure that they feel secure in their legal protections and public support for breastfeeding. Sending a message that it is great, provided you do it at home and not out in public isn't the way to get women to nurse beyond those first few weeks and months.
    Pumping rooms and breaks, along with public support and better laws protecting breastfeeding mothers would go a long way, as would better breastfeeding education for physicians and other healthcare providers. Too many moms are still getting erroneous advice from docs who insist they are breastfeeding friendly. Then a bump in the road pops up and they suggest formula as a first line of defense when it might not need to be the *first* course of action in a mom who wants to continue nursing.

    July 5, 2010 at 00:11 | Report abuse | Reply
  18. Grandma

    My daughter did not like the sensation of breastfeeding – it caused feelings of depression – so she pumped milk for a year and fed it to her baby in a bottle – while being a full-time college student. Her baby was 18 months old before she had a single sick day. They are completely naturally bonded and the only problem my daughter had with her choice of how to feed her baby was a sense of criticism from nursing mothers and experts that she wasn't doing it 'right.'

    I think more American mothers would breastfeed if they knew pumping milk exclusively was an option and also if they knew how much more quickly they would lose their pregnancy weight. Sadly, the more militant breastfeeding moms and orgs look down on the promotion of 'cosmetic' effects of breastfeeding as well as the practice of pumping exclusively. It's their way or the highway.

    July 12, 2010 at 02:58 | Report abuse | Reply
  19. Ellen

    I was one of those moms who tried very hard to breastfeed her first child, but he wouldn't latch on. I said, "Not everyone can breastfeed." Within five days, I turned to formula.

    I now think that only a VERY SMALL fraction of moms actually can't breastfeed because I had a different attitude with the second baby. Even though he, too, would not latch on I was determined that I would breastfeed my child no matter what. I had the help of family and lactation consultants who called me every single day for two weeks. This, along with a number of medical supplies (a pump, nipple shields, a syringe, feeding my baby pumped breastmilk, etc.) and two weeks of nonstop attempts to breastfeed, my baby finally latched on. I can understand why many women would have said, "I can't breastfeed", and given up, I think that in most cases it is possible. Just try...and try...and try. It's worth it.

    July 12, 2010 at 09:45 | Report abuse | Reply
  20. Belle

    Reading these comments, I can't help but think there's way too much criticism and nowhere near enough acceptance and support going around – everyone comes in for it for one reason or another: breastfeeding mothers, mothers who pump exclusively, mothers who feed formula. BF *is* better for babies and mothers, but no one is helped by shaming, guilt, and heavyhanded tactics. I was horrified at the lactation 'experts' who came into my daughters' hospital rooms and instead of information and support offered with a spirit of respect, used terrible metaphors about formula feeding and acted like they were missionaries try to save the souls of the ignorant natives. Along the way they did encounter some nonjudgmental helpers but shouldn't everyone strive to be respectful?

    No two sets of mothers and babies are alike. Not every mother is fortunate enough to have the time and environment that supports a three-month struggle to successfully breastfeed. Any approach to increasing the number of BF mothers has to respect the mother's autonomy and her response to her particular life situation, and to scrupulously avoid the use of hyperbole and guilt. For some mothers, formula is better than trying to breastfeed. Everyone deserves the right to feel comfortable with her choice – comfortable enough not to judge others in different circumstances.

    July 12, 2010 at 11:46 | Report abuse | Reply
  21. adwoa gyimah

    i had my baby and for the first 4days i wasnt producing breast milk.mind you im not a teen.i switched to formula as a suppliment.i tried breastfeeding along side it but i realised i still wasnt producing enough breastmilk.as my baby grows he gets more hungrier.so then i was left with no option than to continue with the formula and my inadequate breastmilk.exclusive breastfeeding is the best but some of us are left with no option.

    June 21, 2011 at 12:32 | Report abuse | Reply
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