breastfeeding for how many months?

[Zerub]

Does anyone know when the benefits of breastfeeding really start to tail off? The NHS say "at least 6 weeks" and the WHO say "at least two years" and La Leche League would probably say about 5 years. But presumably there is a point when the health benefits to the baby of b'feeding over formula (or cow's milk or lots of yoghurt!) starts to be very small? Does anybody know of any research / statistics / opinion on this? Not that my 5-month-old bottle-refusnik dd looks likely to give up the breast, but you never know...

Another factor, IME, is the placing of the child in the family. My ds1 (f-fed) always had sniffles, tummy bugs, bad ears etc but apart from my next child's severe chronic asthma, each following child had had fewer bugs than the previous. Unless I've got compassion fatigue and just ignore the moans and complaints now!! But when I took dd2 for something minor quite recently the Dr remarked that she had very little in her notes. Perhaps they also get immunity from older siblings? I think I have also developed immunity. I used to get everything ds1 had but now it's very rare indeed that I get their germs.

I think you may have a point about "family immunity" Suedonim. DH and I were unfavourably surprised by how many nasties DS managed to pass on to us in the first year of his life. But all 3 of us are gradually getting better.

Robinw ? hope your mother gets better soon. As you probably know I?ve done a fair bit of breastfeeding research. I wasn?t sure what you meant by poor research. Do you mean all b/f research is badly done? The nutritional/immunological aspects are conclusively known about. I assume you just mean the claims about higher intelligence. As far as I can see most research has tried to take account of social differences, in so far as one can, but of course there are other reasons why women breastfeed or not which may be difficult to measure (family pressure, feelings about your own body, support from midwifes etc etc). It is a difficult topic and I feel most of the research, which is extensive does it well within the many complex parameters. It is a question of what is feasible research.

Terms such as ?breastfeeding makes you smarter? have been used because it sells the idea of breastfeeding. More is the pity that this has to be done. The levels of higher intelligence stated in the literature are actually quite small, just a few points on an intelligence scale and the research will state this. It is more likely that breastfeeding gurus perhaps inflate the idea somewhat. However breastmilk does give you the grounds and the potential to be smart. Breast milk contains long chain fatty acids which aid brain development. I know formula milk has this added to it but something that is artificially made is never going to be as good as the real thing.

This paper states: ?Recent information on breast-milk composition revealed that despite the efforts of formula manufacturers, artificial formulas remain significantly different from breast milk. According to results of animal research and clinical studies, several nutrients and other components present in breast milk could contribute to the enhancement of mental development. Long-chain polyunsaturated fatty acids (LCPUFAs) in human milk have an effect on the chemical composition of the brain and enhance retinal and cortical function.? (American Journal of Clinical Nutrition, Vol. 70, No. 4, 433-434, October 1999 ?Breast is best: human milk is the optimal food for brain development? Ricardo Uauy and Patricio Peirano)

The paper also states:
?The statement that breast-fed children score higher on tests of cognitive function than do formula-fed children is not universally accepted. The main criticism given by skeptics is that observational studies have been interpreted inappropriately and without sufficient adjustment for confounding variables such as socioeconomic status or maternal education. ?

So the very point you have made Robinw is known. They go onto discuss other methods of research, more physiologically than psychologically based.

The research also points out that the act of breastfeeding itself may aid cognitive development due to the mother-child interaction and hormonal response.

Breastfeeding ?mafia?? Rather a strange term to use! I don?t think there is information about low vitamin D levels simply because it is not a problem for the majority. How many children do we know who have Vit D deficiencies due to extended breastfeeding? It is only people with dark skins who may stay indoors a lot (eg for religious reasons) who are at risk and may need supplements. Also sunscreens will interfere with Vit D manufacture. However if you are concerned then I think health clinics provide vitamins at a low cost and you can always eat more Vit D rich food yourself and provide this too your baby.

I?ve provided some examples of research on this below:

Unfounded recommendations for vitamin D supplementation in pregnant and breastfeeding women,
Wiersma TJ, Daemers DO, Steegers EA, Flikweert S.
Ned Tijdschr Geneeskd 2001 Sep 1;145(35):1700-1

In 2000, the Health Council of the Netherlands produced new dietary reference values for the intake of several vitamins, including vitamin D. These stated that pregnant and breast-feeding women without usual exposure to sunlight should consume at least 10 micrograms of vitamin D per day, while for women who were exposed to sunlight 7.5 micrograms daily would be sufficient. Because the mean intake through food is about 3 micrograms daily, the Health Council recommendations imply that all these women should take additional vitamin D. However, the recommendations are not evidence-based. Relevant clinical benefits of vitamin D supplementation in pregnant or breast-feeding women, such as increased bone mass and a reduced fracture risk for mother or child, have never been shown and, given the robust capacity of the skin to produce vitamin D under the influence of ultraviolet light, are rather improbable. Therefore, the intake of extra vitamin D by pregnant and breast-feeding women is unnecessary if they are regularly outside with at least their face and hands uncovered.

Do breastfed infants need supplemental vitamins?

Greer FR. Pediatr Clin North Am 2001 Apr;48(2):415-23

In conclusion, in healthy, breastfed infants of well-nourished mothers, there is little risk for vitamin deficiencies and the need for vitamin supplementation is rare. The exceptions to this are a need for vitamin K in the immediate newborn period and vitamin D in breastfed infants with dark skin or inadequate sunlight exposure.

Infant nutrition and supplements.

Ream S, Murray S, Nath C, Ponte CD. J Obstet Gynecol Neonatal Nurs 1985 Sep-Oct;14(5):371-6

Today, American consumers believe they need more and better nutrients than their diets provide. Consequently, consumers spend approximately three billion dollars each year on vitamin and nutrition products. Vitamin and/or mineral supplements are relatively inexpensive and available without a prescription; therefore, it is understandable that they are used by a substantial portion of the population. However, the last 50 years have witnessed a steadily increasing understanding of vitamins and trace mineral biochemistry and its role in human nutrition and intermediary metabolism. It has not been shown conclusively that normal breastfed infants of well nourished mothers need any specific vitamin and mineral supplements, with the exception of iron and fluoride. The use of vitamin D supplements remains controversial. Preterm infants may require supplements of vitamin E, iron, and folic acid because of their rapid rate of growth and less complete, intestinal absorption.

florenceuk - it takes around 6/7 years for the immune system to to develop fully. Many women don't stop breastfeeding if they return to work. It doesn't mean expressing necessarily as the baby can have mixed feeding or just food during the daytime.

I assume that Iceland reference is a joke

Catt - statistically speaking b/fed babies get fewer infections - this is based on a variety of data such as hospital admissions. If infected the b/fed ones may recover faster or have less severe symptoms. Eg my friend's boy (bottle-fed from birth) had more severe stomach upsets than my ds. If there was a bug going round the playgroup my ds may just go off his food and that would be it whereas other kids would be protectile vomiting from both ends. As far as colds are concerned all babies get them regardless of method of feeding.

Eulalia, thank you!!!!!
I was going to dig out my b/feeding research refs but couldn't muster the energy. Thanks for saying it all so well.

On the immunity (actual examples!) front.
My dd who was exclusively bf to 5 months (then fed to 13 months or so) and who went to a childminder (and mixed with loads of other babies before then) has NEVER been to the doc except for routine checks. Ds has been once as he had an eye infection picked up in the hospital before we went home. He is 9 months old (was exclusively fed to 5 months and is still bf) and has his second cold. Dd has regular colds but as I think the average number of colds a year is over 10, she has never had anything like that, and she goes to playgroup and mixes well with other kids.
Oh, and they both had a high temperature reaction to the 2nd DPT, which they went straight to hospital with , bypassing the GP, as they were both quite ill with it (in hosp overnight) - thought I should say that just for completeness.
The two friends I know who have consistently sick children both bottle feed/fed. One of them is the same age as dd and (me and her Mum counted recently) has had over 20 courses of antibiotics, dd has had none.
I am convinced that the feeding has helped, as dh brings home bug after bug from patients, which he and I get and the children just don't. But I do recognise that my children go to the doc hardly ever as we have one in the house so every time I have a query about a rash etc I just ask dh.

Droile - are you a midwife? I did a bit of research on vitamin supplementation after my HV suggested that I should give my dd supplements. I didn't do this for ds and he is fine. He's always been a healthy eater and had plenty of fresh air and exercise in the sun.

susanmt - yes same here, ds (3) has never been to the doctor for an illness. He had a hernia operation which is totally unrelated to method of feeding. I think I said he's only vomited once and has never had diarrohea. Also despite 3 exposures to chickenpox he's never had that. We both had the flu during the flu epidemic of Winter 99 but we both had a high temperature for only an evening. So in short he's never had a day in bed with illness.

On the whole bottle fed babies thrive fine but they may have more illnesses and of course cow's milk is not always good for things such as a cold which can exacerbate the symptoms.

Eulalia I didnt give my ds the suggested vitamins as no one could tell me the reason why, I even stated a thread here. He is extremely healthy and bf until nearly two. wont be giving them to dd either.

Eulalia, thanks for the info. Actually, now I think about it my ds and dd were both exposed to chicken pox recently. DS who was 2.5 got the bug whereas dd who was only 5 months at the time and had only just had her first bit of formula milk didn't develop chicken pox. Obviously the immunity she got from b/milk kept her safe.

Eulalia, no, I'm a scientist, working in health research at present.
I'll touch wood as I type, but DS1 went to the Dr for the second time ever last month (with impetigo, he's 3) and the GP commented on never having seen him - he was breast fed, but not exclusively. He gets plenty of colds, but not too many. As for DS2, it's too soon to say!

And he's only ever been sick (properly, a la The Exorcist) once, which none of my friends believe. Clearing up copious amounts of vomit is supposed to be par for the course as a mother, but we've been lucky so far.
He'll probably do a bobby-dazzler tonight, now I've said that.

Droile - I used to do research (education and management) and I miss it. Only ever had short term contracts though - not very stable for returning to work.

Yes my ds was never even sick as a baby - just tiny amounts of possit. dd is much the same. I think the tendency to be sick or otherwise is hereditary to some extent. I've only known my ds to be sick once and I've only been sick 'naturally' myself a couple of times (a few more times are drink related!)

Sorry I meant only known dh to be sick once in his life - he's got a stomach like a crocodile!

The research from Dr Dettwyler about breastfeeding was really positive right up to the point where he/she made some whopping great value judgements:
"Breastfed babies still have the "edge" over bottlefed babies, even in a squeaky clean environment with wonderful medical care. They get sick less often, they are smarter, they are happier. Another important consideration for the older child is that they are able to maintain their emotional attachment to a person, rather than being forced to switch to an inanimate object such as a teddy bear or blanket. I think this sets the stage for a life of people-orientation, rather than materialism, and I think that is a good thing."
I provided breastmilk for both my babies to 3 months, expressed for ds and bf dd and I'm all for mums breastfeeding. I think that they should get all the support they need, especially if things aren't going well. However, if people decide to bottlefeed then that is their choice. They are not putting the lives of their baby at risk by doing this and it really peeves when people start suggesting that bf babies are happier, more cuddled, people orientated etc. etc. I also think that although breastmilk provides immune support for a baby, they will also be genetically supported. Neither dh nor I were bf and we are really healthy adults. Likewise I have friends who exclusively bf their babies and those children have had eczema, ear infections etc. So, while I accept that research suggests that overall their are immunity benefits to a bf baby, that still has to be seen in the context of its genetic inheritance, home life etc. Afterall if breast milk was the exlixir of good health, then infant mortality rates would be alot lower in third world countries than they currently are.
Sorry if I'm ranting a bit but the suggestion by Dr Dettwyler that bf babies are happier has really annoyed me.

Just to pick up on infant death rates in the developing world. These are often caused by inadequate formula feeding, with dirty water, over diluted powder etc, not by breastfeeding. In situations where not enough food is available breastfeeding babies may escape the results of lack of food, it's the chldren who are on formula or solids who suffer the most. See Baby Milk Action for lots of info on this issue.

Eulalia, I think you're right about the heredity factor, since I've only been sick twice in my life too (drunken episodes excepted. This is a double edged sword however. I hang on to stomach bugs for ages, as my stomach won't expel them except as a last resort. (you all really wanted to know that, didn't you!)

Bugsy ? why don?t you email Dr Dettywler ? I have done so in the past. I am sure she would be interested to hear your comments. I agree it is simplistic to say that breastfeeding alone makes your baby happier than bottle fed babies. Obviously there are other factors involved in mothering or indeed parenting. However some and I do stress some mothers who don?t breastfeed may spend less time holding their babies. The skin-skin contact in breastfeeding is important in bonding and making baby feel secure. Also breastfed babies tend to feed more often so spend more time in their mother?s arms. As for inanimate objects ? well dummies strike me as being something that some babies become attached to. Breastfed babies tend to become attached to the real thing which of course has a mother attached at the other end! Of course some breastfed babies have dummies too and no doubt some bottle fed babies don?t have dummies - it just seems that many breastfeeding mums complain that their babies are permanently attached to them!

I think ?in ye olden days? perhaps women were closer to their babies and there was less need for comforters such as dummies, blankets, teddies. However women were closer to them because they could take them everywhere with them, in the fields to work and so on. Dr Dettwyler has also done research showing that in countries where women carry their babies in slings to work they never suck their thumbs (another nipple substitute).

I only know my own example ? if you feed your baby/child on demand they do appear to be less interested in a special toy. My ds only asked for his teddy for the first time last night (he is 3 1/4 and he is still breastfeeding a little(not that I really want him to be please note!). We have to balance women having more independence, freedom etc etc against babies having constant access to their mothers (and breasts). Happiness is an extremely difficult thing to measure and it would be hard to show how much of a child's happiness or otherwise is down to the fact that he was breastfed (also how much and for how long etc)

I do think however that it is easy to comfort your child by ?sticking them on the boob? ? you have to make a concerted effort to comfort a child in a different way if you don?t have that. I have a friend who didn?t breastfeed at all her first child and she would put a dummy in and rock him to sleep so I am sure he had plenty of comfort. However she breastfed the 2nd for a few months and she said herself that it was better and she felt that the bond was stronger.

Research has taken into account the variables of genetic inheritance, social class and environmental conditions and once these factors are taken into account breastfed babies are healthier.