Breastfeeding recommendations

What are the official breastfeeding recommendations?

Most organizations like the World Health Organization recommend breastfeeding for at least two years because of the extensive health benefits for babies and their mothers. Families, societies, and the environment also benefit when children are breastfed. Some mothers breastfeed their children well past two years. Extended breastfeeding is normal and offers many benefits. All organizations recommend starting solid foods around six months and some allow for starting as soon as four months, especially if the baby is at a high risk of certain food allergies. Many organizations recommend giving vitamin D to babies.

A) Reasons for recommending breastfeeding

Current guidelines recommend breast milk as the “gold standard” for feeding babies as a large amount of research over the past century has shown that breastfeeding has many benefits for (Kramer 2012):

In particular, breastfeeding can protect babies from chronic diseases, infections, and death. Breastfeeding protects babies from malnutrition by ensuring food security and helps brain and psychological development. Breastfed babies are more likely to have good gut microbes such as bacteria, viruses, and fungi (microbiome). 

There are numerous challenges to doing breastfeeding studies and it is possible that its benefits are over-estimated. Yet even if the actual benefits of breastfeeding are only half or a quarter of the reported ones, breastfeeding still offers many major advantages over infant formula-feeding.

B) The decision to breastfeed

The decision to breastfeed or not is influenced by many factors. While most mothers around the world choose to breastfeed, they may encounter barriers and do not reach their breastfeeding goals. Many of these barriers can be overcome with proper tools and support.

C) The duration of breastfeeding

Because of the many benefits of breastfeeding, most organizations concerned with the health of mothers and babies recommend that babies breastfeed for two or more years.

Some of these organizations are the: 

  • World Health Organization (WHO 2003; WHO 2015)
  • Many countries within the European Union (Koletzko 2020)
  • United Nations Children’s Fund (UNICEF) (WHO 2003)
  • Health Canada (Health Canada 2015) 
  • Canadian Paediatric Society (Abrams 2019)
  • College of Family Physicians of Canada (CFPC 2004)

American institutions such as the American Academy of Pediatrics (Eidelman 2012) differ slightly and recommend breastfeeding for one or more years. The U.K. recommends breastfeeding beyond six months of age but does not give any guidelines on the total length of breastfeeding (RCPCH 2017).

No organization has put a limit on the duration of breastfeeding. Around the world, many women breastfeed past two years of age and well into childhood. This is sometimes called extended breastfeeding and is normal. It offers many benefits to young children.

D) The start of solid foods

The current recommendations are that solid foods are started around six months of age but other considerations can also play a role. These include: 

  • The organization issuing the recommendations
  • Individual factors including:
  • The family’s personal preferences and culture will also 

Please discuss any concerns with your health-care providers

E) Vitamin D

Many organizations recommend giving breastfeeding babies vitamin D by mouth.

References

Abrams E, Hildebrand K, Blair B, et al. Timing of introduction of allergenic solids for infants at high risk. Paediatr Child Health. 2019 Feb;24(1):56-57
  
College of Family Physicians of Canada (CFPC) [Internet]. Toronto: College of Family Physicians of Canada. Infant Policy Feeding Statement; 2004 renewed 2011 [cited October 15, 2019]
 
Eidelman AI, Shandler RJ. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012;129(3)
  
Health Canada; The Infant Feeding Joint Working Group. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months; A joint statement of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada. Ottawa: Health Canada; 18 Aug 2015 [cited October 15, 2019]

Koletzko B, Hirsch NL, Jewell JM, et al. National Recommendations for Infant and Young Child Feeding in the World Health Organization European Region. J Pediatr Gastroenterol Nutr. 2020 Aug 17;71(5):672–8

Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2012;2012(8):CD003517 

Nelson JM, Li R, Perrine CG, et al. Changes in mothers' intended duration of breastfeeding from the prenatal to neonatal periods. Birth. 2017 Nov 17
 
Royal College of Paediatrics and Child Health (RCPCH). Position Statement: Breastfeeding in the UK. London: Royal College of Paediatrics and Child Health; 2017 Nov 20 [cited October 15, 2019]
 
World Health Organization (WHO). Global strategy for infant and young child feeding. Geneva: World Health Organization; 2003
 
World Health Organization (WHO). Breastfeeding Advocacy Initiative. For the best start in life. New York: UNICEF; 2015