Is the "breast is best" mantra an oversimplification?
Recommendations about breastfeeding—absent critical analysis and removed from context—may overvalue its benefit. Here's a look at the evidence.
PRACTICE RECOMMENDATIONS
› Encourage breastfeeding for its potential to reduce the risk of acute otitis media, upper- and lower-respiratory infections, gastrointestinal infection, and dental malocclusion. A
› Promote breastfeeding for its potential to make a small difference in intelligence quotient and the incidence of overweight and obesity—but not for any other significant impact on long-term health. B
› Consider the needs and preferences of the individual when advocating breastfeeding so as to avoid potentially engendering maternal feelings of guilt and inadequacy. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
From The Journal of Family Practice | 2018;67(6):E1-E9.
Sudden infant death syndrome
There is a statistically significant association between sudden infant death syndrome (SIDS) and feeding method. Infants whose cause of death is SIDS are approximately one half as likely to have been breastfed as matched controls.35,37
In 2005, AAP did not recommend breastfeeding as a means to reduce the risk of SIDS because available evidence was mixed, and studies at the time were poorly controlled.38 Since that time, case-control meta-analyses have shed additional light on the association between SIDS and feeding method.35,37
The protective effect exists for any amount of breastfeeding and is stronger for exclusive breastfeeding, suggesting a protective role—not simply an association. Caution should be employed with this conclusion, however, because the studies included in the meta-analysis used univariate analysis primarily and did not control sufficiently for known confounders. In addition, the authors warn that publication bias might overestimate the association.38
Potential mechanisms of a protective role include decreased risk of infection and greater arousability from sleep in breastfed infants. Assuming a protective role, available data suggest that more than 3500 infants need to be breastfed to prevent one case of SIDS.39
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