There is no doubt that breast milk is the natural and most physiological nutrition for an infant from the first days of life.
At the same time, the governing documents of different countries often speak not just about breastfeeding, but about exclusive or exclusive breastfeeding, which is recommended as the gold standard for feeding babies up to a certain age. However, not all of these documents contain a decoding of this concept.
the Russian Federation
“The program for optimizing the feeding of children in the first year of life in the Russian Federation: methodological recommendations” from 2019 (hereinafter – the Program of 2019) contains such a decoding. In accordance with this program, “Exclusive breastfeeding” means breastfeeding without supplementation with other food or supplementation, including water (with the exception of drugs or vitamins and mineral supplements; expressed or donated breast milk, including enriched ones, is also allowed).
According to World Health Assembly Resolutions No. 54.2 of May 18, 2002 and No. 59.13 of May 4, 2006, exclusively breastfed children are encouraged to continue breastfeeding for up to 6 months, and therefore to introduce complementary foods from that age. In the 2009 National Program for Optimizing Infant Feeding in the First Year of Life in the Russian Federation, this position was generally supported (more on this here ).
However, some changes have been made to the 2019 Program. In particular, the chapter on the introduction of complementary foods states that, “according to domestic scientists, which coincides with the views of ESPGHAN experts, exclusive breastfeeding until 6 months does not always provide a sufficient level of micronutrient intake, especially iron.” In order to prevent iron deficiency states, the optimal time for introducing complementary foods in healthy children should be the age of 5 months.
Notably, in its guidance document, ESPGHAN (European Society for Pediatric Gastroenterology, Hepatology and Nutrition) recommends exclusive or complete breastfeeding for at least 4 months (17 weeks, beginning of the 5th month of life), and exclusive or predominant breastfeeding for approximately 6 months is considered a desirable target (Fewtrell et al., 2017). Accordingly, ESPGHAN tells us that it is still desirable to maintain exclusive or predominant breastfeeding until 6, and not up to 5 months (as our domestic scientists point out, for some reason referring to ESPGHAN).
The section on the prevention of iron deficiency anemia (IDA) of the 2019 Program states that the natural prevention of IDA in children during the first months of life is exclusive breastfeeding until 4-6 months of life. Further, it is indicated that it is advisable to introduce complementary foods on exclusive breastfeeding – from 5–5.5 months of life, since the introduction of complementary foods after 6 months can contribute to the development of iron deficiency states.
The section on prevention of food allergy (PA) indicates that exclusive breastfeeding up to the age of 4-6 months has a certain preventive effect of PA.
Thus, the 2019 Program recommends complementary feeding between 4 and 6 months. At the same time, on exclusive breastfeeding, the optimal, according to domestic scientists, is the introduction of complementary foods from 5–5.5 months of life, exclusive breastfeeding is allowed up to 6 months of a child’s life.
Position of other countries and international organizations
In terms of international experience, according to the report “Feeding Babies and Children from Birth to 24 Months: A Summary of Existing Guidelines” published in National Academies Press on July 8, 2020, it differs in most cases from the position set out in the Program 2019 of the year.
The report examined the recommendations of 15 guidance documents that reflect the positions of 17 different organizations from Europe, Canada, Australia, United Kingdom, New Zealand, USA, as well as the positions of the Pan American Health Organization and the World Health Organization.
It was found that 13 guidelines recommended exclusive breastfeeding for the first 6 months (Unger et al., 2019; RCPCH, 2019; SACN, 2018; SACN and COT, 2018; Pérez-Escamilla et al., 2017; Health Canada et al., ., 2015; AAFP, 2014; Grueger et al., 2013 (reaffirmed 2018); AAP Section on Breastfeeding, 2012; Ministry of Health, 2012g; NHMRC, 2012h; New Zealand Dental Association, 2008; PAHO / WHO, 2003).
However, there were slight differences in the specific wording. Someone directly points out that “the first 6 months of a child’s life” should be exclusively breastfeeding, or that it should be “up to 6 months.” Someone recommends exclusive breastfeeding “until about 6 months” or “until about 6 months” of a child’s life. In this case, 6 months means the end of 6 months (i.e. 180 days).
Regarding the introduction of complementary foods, the New Zealand Ministry of Health, in its narrative review (Ministry of Health, 2012g), explicitly states that a baby should only be given breastmilk until it is ready for complementary feeding and until it needs it. that will happen at about 6 months of age.
In general, all 13 guiding documents adhere to approximately this position. They prioritize not only the need for additional nutrition, but also the child’s readiness. Because if the child is not ready, this can lead to new problems (for example, we are trying to raise hemoglobin, and we get diarrhea or constipation with the abolition of complementary foods). Read more about the readiness of different body systems here .
Moreover, when the documents refer to the age of “about 6 months”, it is often more likely the age from 5.5 months to 8-9 months, since there are children whose readiness for complementary foods occurs a little later than 6 months (for example, children, prematurely born). At the same time, the introduction of complementary foods after 8-9 months can really lead to a deficiency of certain substances, so it is not worth delaying after this period.
However, in the report cited above, there was one American Heart Association (AHA) guidance document that recommended breastfeeding as an exceptional source of nutrition during the first 4–6 months of life ”(Gidding et al., 2005). And the fifteenth document was the ESPGHAN guiding document, which was already mentioned above (up to 4 months – definitely exclusive breastfeeding, up to 6 months – it is desirable).
Thus, guidelines from different countries and international organizations recommend exclusive breastfeeding up to about 6 months of age. And only 2 documents recommend exclusive breastfeeding for up to 4-6 months, and one of them emphasizes that it is still desirable for up to 6 months.