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.
Dental health
Dental caries. There is consistent evidence that breastfeeding beyond 12 months of age is associated with the development of dental caries of deciduous teeth to 6 years of age (OR=2.90; 95% CI, 2.33-3.60). Many of the studies that showed this association did not control for the introduction of sugary foods and drinks, and there was a trend toward publication bias showing the association.45
Dental malocclusion. There is consistent evidence for approximately a two-thirds reduction in malocclusions in deciduous teeth in breastfed infants (OR=0.32; 95% CI, 0.25-0.40). Although the large majority of these data come from low-income and middle-income countries, the incidence of malocclusion is not thought to be associated with socioeconomic status, as so many other breastfeeding outcomes are.46
Childhood leukemia
In the largest meta-analysis available, a statistically significant inverse relationship between any breastfeeding for >6 months and childhood leukemia is evident in developed countries (OR=0.84; 95% CI, 0.78-0.91), although significant heterogeneity among studies and lack of control for confounding variables are significant limitations. In particular, an association has been demonstrated with acute lymphoblastic leukemia (ALL) but not with acute myelogenous leukemia.47 Given the rarity of childhood ALL, approximately 12,500 infants would need to be breastfed to prevent one case.48
Continue to: Long-term outcomes
