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.
Shared decision-making is best—for mother and baby
Breastfeeding might prevent certain infections in as many as 50% of infants, but a mother unable to breastfeed can take solace in the fact that >95% of breastfed infants will not realize any benefit from the preventive potential of breastfeeding in regard to hospitalization or allergic disease, and >99% will not realize benefit from either the prevention of SIDS or ALL, or from improvement in long-term health measures (except for, perhaps, a slightly higher IQ). The “breast is best” mantra is likely true at a public-health level; for the individual mother–infant dyad, however, where there is a need to balance personal, social, family, and financial factors, that mantra is an oversimplification.
Regrettably, there is a paucity of data on the risks of breastfeeding promotion—an area that deserves more study. Balancing the abundant, but often limited-quality, data on the benefits of breastfeeding and the sheer lack of data regarding the risks of advocacy represents a clinical and an ethical challenge for physicians. It is a challenge that can only be resolved through individualization of care and shared decision-making, in which the physician is expert on the benefits of breastfeeding, and the mother is expert on the personal circumstances to be weighed against those benefits.
CORRESPONDENCE
Joseph Lane Wilson, MD, ECU Brody School of Medicine, Department of Family Medicine, 101 Heart Drive, Greenville, NC 27834; wilsonjo@ecu.edu.
