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We know that breast feeding is best, but what is the bottom line for nursing mothers? What length of time provides maximum health benefits for infants? The American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least twelve months. But not all women are able or willing to reach the twelve-month goal. According to the International Lactation Consultant Association (ILCA), approximately 70% of women in the United States breastfeed alone or in combination with formula at the time of hospital discharge. The rate drops to about 33% at six months, with even lower rates for low-income and African-American families. Parenting guides and books suggest that breastfeeding longer is better. Doctors tell mothers that breastfeeding for a few weeks is better than not breastfeeding at all.
But how long is long enough? In 2001, the World Health Organization (WHO) changed its recommendation from exclusive breastfeeding for four to six months of age to exclusive breast feeding for at least six months. The term â€œexclusive breast feedingâ€ means exactly that: the infant receives only breastmilk. No supplemental formula, water, other liquids or solid foods are provided.
Of course, vitamins, minerals or necessary medicines are included in this guideline.
Even after the WHO released its recommendation, there was still some lingering debate and confusion regarding the optimal length of breastfeeding. This confusion arose in part from the lack of information about the comparative health gains of different breastfeeding time frames. Most research studies were not specifically designed to clarify whether breastfeeding for three versus four or even six months really mattered.
Breastfeeding Duration Is Important
New findings support growing evidence that the length of time is important. The WHO recommendation is correct six months seems to be the magic number.
Researchers from the University of Califonia-Davis Children’s Hospital, the University of Rochester and the American Academy of Pediatrics Center for Child Health Research studied a nationally representative sample of 2,277 babies.
These scientists compared five groups of infants. The first group included formula-only babies. The other groups of infants were fully breastfed (using formula on a less-than-daily basis) for different lengths of time: less than one month, one to four months, four to less than six months and six months or more. Infants fully breastfed for six months or more were less likely to suffer from pneumonia, ear infections, and colds than infants breastfed for four months. These health gains continued throughout the infants’ second year.
Researchers in 2003 reached similar conclusions regarding breastfeeding duration effects. They compared the benefits of three and six months of exclusive breastfeeding in a sample of 3,483 infants. Babies exclusively breastfed for six months had a lower risk of developing gastrointestinal infections. In addition, exclusive breastfeeding did not cause any negative side effects such as iron deficiency during the first year of life.
These two recent studies complement the large body of evidence indicating that breastfeeding has important benefits for children, mothers, and society. Besides protection from upper respiratory and gastrointestinal effects, the benefits of breastfeeding for infants include:
* Fewer infectious and non-infectious diseases
* Reduced risk for chronic diseases such as diabetes, cancer, allergies and asthma
*Reduced likelihood of becoming overweight and obese children
*Lower incidence of skin disorders
Mothers who breastfeed also experience positive health effects such as less postpartum bleeding, an earlier return to pre-pregnancy weight, and a reduced risk of ovarian and pre-menopausal breast cancers. Families with breastfed infants save thousands of dollars on formula and medical care. Society benefits, too. Fewer trips to physicians and hospitals reduce overall healthcare expenditures. Reduced rates of absenteeism and increased morale can translate into huge savings for large corporations as well as small businesses.
Given the overwhelming amount of research pointing to the benefits of breastfeeding, why do only one-third of American women continue to nurse their infants for six months? Certain characteristics are associated with breastfeeding. Women who fully breastfeed tend to be older and more educated. Mothers who smoke, are single and do not participate in childbirth education classes are less likely to exclusively breastfeed.
The most commonly reported reasons for bottlefeeding are:
* Father’s negative attitude toward breastfeeding
*Uncertainty regarding how much breastmilk is consumed by the nursing infant
* Return to work
Other factors influencing rates of breastfeeding include:
*Negative attitudes of healthcare professionals
* Ready availability of formula
*Nipple pain and irritation
* Time constraints
* Lack of confidence
* Concerns about dietary or health practices
Mothers indicate that receiving more information from prenatal classes, TV, magazines, and books would increase the likelihood of initiating and maintaining breastfeeding. According to lactation specialist Charlotte Burnett, BSN IBCLC from Truman Medical Center Lakewood (Kansas City, MO), much of the educational process targets dispelling common myths about breastfeeding.
For example, many women believe that they are completely unable to eat beans, spicy foods, chocolate, junk food or drink soda while breastfeeding. Other women seem to think they should not even start to breastfeed if they are planning on returning to work or school in six weeks, says Burnett.
Obtaining more family support would also help increase rates of breastfeeding. If a mother or sister didn’t or couldn”t breastfeed, a new mother may have less confidence and desire to breastfeed, reports Burnett. Even if a mother chooses to nurse, detrimental family comments an undermine this decision. Burnett”s clients have heard comments such as, Just give him a little real milk or She wants to breastfeed so much. Are you sure you shouldn”t just give her a bottle?
To complement education and family support, the International Lactation Consultant Association states that supportive, breastfeeding-friendly communities are imperative to increase national rates of breastfeeding.
This may be one of the most difficult hurdles to overcome. A huge barrier is the free formula that companies give away. We are trying to change a culture, reports Patricia Lindsey-Salvo, a lactation specialist who runs the Breastfeeding Center at Beth Israel Medical Center in Manhattan.
In 2001, the Department of Health and Human Services released a Blueprint for Action on Breastfeeding as part of the Healthy People 2010 initiative. This document detailed a comprehensive national breastfeeding policy with a goal of increasing the number of new mothers who breastfeed to 75%. The document also calls for expanding the proportion of women breastfeeding at six months to fifty percent, and twenty-five percent at twelve months.
So What Should a Mother Do?
So what does all of this research and information mean for a mother? Get as much information as you can before deciding to breast or bottle-feed. Discuss problems or concerns that are likely to affect your breastfeeding goals with a lactation consultant or sympathetic pediatrician. Share information with your family and friends, and surround yourself with encouraging and supportive voices. Nurse your infant as long as possible, aiming for at least six months. â€œThe evidence is rolling in every day about the benefits of breastfeeding,â€ reports Lindsey-Salvo.