Four months? Six months? Two years?
There is a risk of allergies and deficiency symptoms if babies are breastfed for too long, assure experts? and reap opposition.
By Anke Brodmerkel
Breast is best, say the English. And mean that breast milk is the ideal food for babies. On the question of how long a baby should be breastfed, however, pediatricians, nutritionists and midwives have not quite so agreed for some time – neither in the United Kingdom nor in this country. Many experts now consider breastfeeding for too long to be dangerous: the mothers risked that their children will suffer more allergies, intolerance and deficiency symptoms.
If you ask the World Health Organization (WHO), however, the recommendation is still clear: a baby should be fully breastfed for six months, i.e. not given any complementary foods or industrially produced infant milk. From the second half of the year, the child will gradually get used to solid food. Until their second birthday, however, they will also receive the breast – longer if mother and child so wish. 1.5 million babies could be saved from death annually, all mothers adhered to this advice, the WHO announced last year.
This recommendation may be suitable for developing countries, wrote British paediatricians working with Mary Fewtrell from the Institute of Child Health at the University of London recently in the medical journal British Medical Journal (BMJ, vol. 341, p. C5955). There, a diet based exclusively on breast milk would offer the best protection against diseases caused by contaminated water or spoiled food. In the industrialized countries, however, scientific studies have now come to different results. Accordingly, mothers in western countries should not wait longer than four months before introducing complementary foods.
Fewtrell and her colleagues provide several reasons for shortening the breastfeeding period. On the one hand, babies who received only breast milk for more than four months are exposed to an increased risk of developing allergies and intolerances, for example to the cereal protein gluten. On the other hand, older, fully breastfed infants suffered from iron deficiency more often than others. And last but not least, a long period of breastfeeding means that the children later find it difficult to get used to new flavors – and then, for example, are reluctant to eat green vegetables.
Three of the four study authors have already worked as consultants for baby food manufacturers or have received research funding from them. Thus, the suspicion could arise that the article in the BMJ may not have been created entirely independently. But it doesn’t seem that simple. “We have been advising mothers against fully breastfeeding their children for six months or more for some time,” says Klaus Vetter, obstetrician at Vivantes Clinic in Berlin and spokesman for the National Breastfeeding Commission. The self-declared aim of the committee, which belongs to the Federal Institute for Risk Assessment, is to promote breastfeeding in Germany.
Time window for unknown foods
“Nobody in this country benefits when mothers wait longer than four months to feed them,” says Vetter. “On the contrary: Children who only receive their first complementary food later have an increased risk of allergies.” Apparently there is a time window that is favorable for the first contact with unknown foods. The recommendation to feed after four months actually only applies to industrialized countries in which the risk of allergies is higher than the risk of infection.
Wolfram Hartmann, President of the Professional Association of Pediatricians (BVKJ), also advocates starting additional feeding after four months. Even the old rule of only introducing new foods very gradually no longer applies. “The more food a baby gets to know while it is still being breastfed, the lower the risk of developing allergies to it,” says Hartmann.
On the subject of intolerance, the German doctors are also of the same opinion with their British colleagues. “It does not seem to make sense to postpone the administration of gluten-containing grains such as wheat or spelled for as long as possible in order to prevent celiac disease,” says Hartmann. According to a recent Swedish study, the risk of developing celiac disease, i.e. an intolerance to the cereal protein gluten, could be reduced by around half if the children were given a fruit and cereal porridge that contained small amounts of wheat at the age of six months .
The additional breastfeeding while introducing new foods seems to have a particularly positive effect on avoiding allergies and intolerances. “But once or twice a day is enough,” says Hartmann. And according to the doctor, a child should be weaned by the first birthday. “After the first year of life, breastfeeding offers no more advantages, but even has a detrimental effect on the child’s development because of the harmful substances in breast milk,” says Hartmann.
The various specialist societies and professional associations, together with the National Breastfeeding Commission and other organizations, already recorded the new findings last year in a consensus paper that was published in the monthly magazine Kinderheilkunde. When drawing up these recommendations for action, the orthodox doctors even managed to get the midwives on board – apparently only after a difficult struggle: The introduction of complementary foods should take place between the fifth and seventh month of life, it is said. The total duration of breastfeeding is not limited backwards, but can be decided jointly by mother and child.
Despite the compromises, most midwives are not happy with the paper. “In Germany we don’t have the problem that mothers breastfeed their children too long, but in most cases far too short,” says the breastfeeding officer of the Lower Saxony Midwives Association, Aleyd von Gartzen from Hanover. “In this respect, I consider the consensus that has been reached to be a step backwards.”
In fact, a study commissioned by the Federal Ministry of Health and based on data from 1997 and 1998 shows that after four months only 33 percent and after six months only ten percent of all infants receive only breast milk. There are no newer figures, but they should not differ significantly from the present ones.
Von Gartzen also admits that, with regard to allergies, it does not seem necessary to fully breastfeed for more than four months. Nevertheless, she says that it is not a must to start complementary food immediately afterwards: “The WHO, Unicef and all breastfeeding associations agree that it is desirable all over the world to have children full for six months and while the introduction of solid foods to continue breastfeeding. ”
A major US analysis also recently concluded that the healthcare system could save $ 13 billion each year if 90 percent of all US infants were given only breast milk in the first half of their life.
Pay attention to signs of maturity
But von Gartzen doesn’t believe in rigid schedules. “It is much more important to pay attention to certain signs of maturity in your child,” she says. Can it already sit with support? Does it show interest in eating the big ones? Has his tongue reflex, which causes solid food to be pushed out of his mouth immediately, gone? “All of this is the case with most babies by six months,” says the midwife. “If the child still signals to their parents that they don’t want to eat the unfamiliar food yet, it is perfectly fine to wait a few days and then offer them another porridge.”
Mathilde Kersting from the Research Institute for Child Nutrition in Dortmund, who was involved in drawing up the consensus paper, has a similar view. “Parents should make the decision as to whether to start additional feeding after four or six months based on their child’s interest in solid foods,” says the nutritionist.
Kersting recommends offering pureed vegetables first, which are supplemented with potatoes after a few days and meat at least five times a week. A teaspoon of rapeseed oil and a small shot of a juice containing vitamin C, which facilitates the absorption of iron from the porridge, round off the recipe.
When it comes to vegetables, parents should be willing to experiment. “In France, babies eat everything – from artichokes to green beans,” says Kersting. This increases the later acceptance of a varied diet and allergies do not develop more often as a result.
Kersting does not want to stipulate until when a child should be weaned. “It is ideal if a baby from the 8th to 10th month of life receives three porridge meals a day, one of which can be made as a milk and cereal porridge with cow’s milk, but the child continues to be breastfed at the same time,” she says.
Thanks for visiting we hope our article Four months? Six months? Two years?
, we invite you to share the article on Facebook, twitter and whatsapp with the hashtag ☑️ #months #months #years ☑️!