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.
Reliable epidemiologic evidence on the incidence of eczema in infants in the United States is limited, but the prevalence in the United States in children younger than 17 years is approximately 10.7% (with wide regional variation). Extrapolating these data generously, the NNT to prevent eczema in the first 2 years of life could be estimated at approximately 36.42
Allergic rhinitis. There is low-grade- and very-low-grade-quality evidence that more breastfeeding, compared to less breastfeeding, is associated with a lower risk of allergic rhinitis in children younger than 5 years (OR=0.79; 95% CI, 0.63-0.98). The association exists regardless of family history and disappears after 5 years of age. The differentiation of allergic rhinitis from rhinovirus infection (for which there is higher-quality evidence of a protective effect with breastfeeding) must be considered when interpreting these data.40
Reliable epidemiologic evidence on allergic rhinitis in children younger than 5 years is lacking, and incidence varies by region. A rough estimate, using data from 6- and 7-year-olds, indicates an NNT of 54 to 70.43
Food allergy. There is no evidence to suggest an association between breastfeeding and food allergy, either as protective or as a risk factor, and studies are limited.40 Interestingly, as data accumulate associating early exposure to foods with protection, some authors have proposed reexamining the recommendation from WHO and US health organizations for exclusive breastfeeding for the first 6 months of life.7,44
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