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Dynamic Chiropractic – January 26, 1998, Vol. 16, Issue 03

Breast Milk Is Best

American Academy of Pediatrics Releases New Guidelines

By Editorial Staff
According to new guidelines1 released by the American Academy of Pediatrics, breast milk is the preferred choice for baby, mother and society in general. The guidelines cite "(e)xtensive research, especially in recent years, documents diverse and compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits."

The paper goes on to state:

"Human milk is uniquely superior for infant feeding and is species-specific; all substitute feeding options differ markedly from it."

According to numerous studies from "developed countries," the benefits of breastfeeding to the baby includes decreased risk for "a large number of acute and chronic diseases." This includes decreases in the incidence and/or severity of:
  • diarrhea2-6
  • lower respiratory infection6-10
  • otitis media4,11-15
  • bacteremia16,17
  • bacterial meningitis16,18
  • botulism19
  • urinary tract infection20
  • necrotizing enterocolitis21,22
And a "possible protective effect" against:
  • sudden infant death syndrome23-25
  • insulin-dependent diabetes mellitus26-28
  • Crohn's disease29,30
  • ulcerative colitis30
  • lymphoma31,32
  • allergic diseases33-35
  • other chronic digestive diseases36-38

Additional studies relate breastfeeding to "possible enhancement of cognitive development."39,40

There appear to be almost as many benefits to the mother who breastfeeds:

  • less postpartum bleeding and more rapid uterine involution41
  • less menstrual blood loss over the months after delivery
  • earlier return to pre-pregnant weight42
  • delayed resumption of ovulation with increased child spacing43-45
  • improved bone remineralization postpartum46
  • reduction in hip fractures in the postmenopausal period47
  • reduced risk of ovarian cancer48
  • reduced risk of premenopausal breast cancer49

The societal benefits are also significant. These include "reduced health care costs reduced employee absenteeism for care attributable to child illness." Among the direct economic benefits to the family is the savings of an estimated $855 for the purchase of formula.

The American Academy of Pediatrics also made some very straight forward recommendations for breastfeeding:

  • Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.50-52

  • Breastfeeding should begin as soon as possible after birth, usually within the first hour.53-55

  • Newborns should be nursed whenever they show signs of hunger, such as increased alertness of activity, mouthing, or rooting.56

  • No supplements (water, glucose water, formula, and so forth) should be given to breastfeeding newborns unless a medical indication exists.57-60

  • Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first six months after birth.61

  • In the first six months, water, juice, and other foods are generally unnecessary for breastfed infants.62,63

  • Should hospitalization of the breastfeeding mother or infant be necessary, every effort should be made to maintain breastfeeding, preferably directly, or by pumping the breasts and feeding expressed breast milk, if necessary.

This is important information for every expectant mother to know, especially with so many "opinions" circulating in the public sector. (Editor's note: A copy of the AAP's policy statement on "Breastfeeding and the Use of Human Milk" can be viewed or downloaded


  1. Breastfeeding and the Use of Human Milk (RE9729). American Academy of Pediatrics. Pediatrics, Dec. 1997;100(6):1035-1039.
  2. Dewey DG, Heinig MJ, Nommsen-Rivers LA. Differences in morbidity between breast-fed and formula-fed infants. Pediatr. 1995:126:696-702.
  3. Howie PW, Forsyth JS, Ogston SA, et al. Protective effect of breast feeding against infection. Br med J. 1990;300:11-16.
  4. Kovar MG, Serdula MK, Marks JS, et al. Review of the epidemiologic evidence for an association between infant feeding and infant health. Pediatrics, 1984;74:S615-S638.
  5. Popkin BM, Adair L, Akin Js, et al. Breast-feeding and diarrheal morbidity. Pediatrics, 1990;86:874-882.
  6. Beaudry M, Dufour R, Marcoux S. Relation between infant feeding and infections during the first six months of life. J Pediatr, 1995;126:191-197.
  7. Frank AL, Taber LH, Glezen WP, et al. Breast-feeding and respiratory virus infection. Pediatrics, 1982;70:239-245.
  8. Wright AI, Holberg CJ, Martinex FD, et al. Breast feeding and lower respiratory tract illness in the first year of life. Br Med J. 1989;299:945-949.
  9. Chen Y. Synergistic effect of passive smoking and artificial feeding on hospitalization for respiratory illness in early childhood. Chest, 1989;95:1004-1007.
  10. Wright AL, Holberg CJ, Taussig LM, et al. Relationship of infant feeding to recurrent wheezing at age 6 years. Arch Pediatr Adolesc Med. 1995;149:758-763.
  11. Saarinen UM. Prolonged breast feeding as prophylaxis for recurrent otitis media. Acta Paediatr Scand, 1982;71:567-571.
  12. Duncan B, Ey J, Holberg CJ, et al. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics, 1993;91:867-872.
  13. Owen MJ, Baldwin CD, Swank PR, et al. Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life. J Pediatr, 1993;123:702-711.
  14. Paradise JL, Elster BA, Tan L. Evidence in infants with cleft palate that breast milk protects against otitis media. Pediatrics, 1994;94:853-860.
  15. Aniansson G, Alm B, Andersson B, et al. A prospective cohort study on breast-feeding and otitis media in Swedish infants. Pediatr Infect Dis J, 1994;13:183-188.
  16. Cochi SL, Fleming DW, Hightower AW, et al. Primary invasive Haemophilus influenzae type b disease: a population-based assessment or fisk factors. J Pediatr, 1986;108:887-896.
  17. Takala AK, Eskola J, Palmgren J, et al. Risk factors of invasive Haemophilus influenzae type b disease among children in Finland. J Pediatr, 1989;115:694-701.
  18. Istre GR, Conner JS, Broome CV, et al. Risk factors for primary invasive Haemophilus influenzae disease: increased risk from day care attendance and school-aged household members. J Pediatr, 1985;106:190-195.
  19. Arnon SS. Breast feeding and toxigenic intestinal infections: missing links in crib death? Rev Invect Dis, 1984;6:S193-S201.
  20. Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. J Pediatr, 1992;120:87-89.
  21. Lucas A. Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet, 1990;336:1519-1523.
  22. Covert RF, Barman N, Domanico RS, et al. Prior enteral nutrition with human milk protects against intestinal perforation in infants who develop necrotizing enterocolitis. Pediatr Res, 1995;37:305A.
  23. Ford RPK, Taylor BJ, Mitchell EA, et al. Breastfeeding and the risk of sudden infant death syndrome. Int J Epidemiol, 1993;22:885-890.
  24. Mitchell EA, Taylor BJ, Ford RPK, et al. Four modifiable and other major risk factors for cot death: the New Zealand study. J Paediatr Child Health, 1992;28:S3-S8.
  25. Scragg LK, Mitchell EA, Tonkin SL, et al. Evaluation of the cot death prevention programme in South Auckland. NZ Med J, 1993;106:8-10.
  26. Mayer EJ, Hamman RF, Gay EC, et al. Reduced risk of IDDM among breast-fed children. Diabetes, 1988;37:1625-1632.
  27. Virtanen SM, Rasanen L, Aro A, et al. Infant feeding in Finnish children <7 yr of age with newly diagnosed IDDM. Diabetes Care, 1991;14:415-417.
  28. Gerstein HC. Cow's milk exposure and type 1 diabetes mellitus. Diabetes Care, 1994;17:13-19.
  29. Koletzko S. Sherman P, Corey M, et al. Role of infant feeding practices in development of Crohn's disease in childhood. Br Med J, 1989;298:1617-1618.
  30. Rigas A, Rigas B, Glassman M, et al. Breast-feeding and maternal smoking in the etiology of Crohn's disease and ulcerative colitis in childhood. Ann Epidemiol, 1993;3:387-392.
  31. Davis MK, Savitz DA, Graubard BI. Infant feeding and childhood cancer. Lancet, 1988;2:365-368.
  32. Shu X-O, Clemens J, Zheng W, et al. Infant breastfeeding and the risk of childhood lymphoma and leukaemia. Int J Epidemiol, 1995;24:27-32.
  33. Lucas A, Brooke OG, Morley R, et al. Early diet of preterm infants and development of allergic or atopic disease: randomised prospective study. Br Med J, 1990;300:837-840.
  34. Halken S, Host A, Hansen LG, et al. Effect of an allergy prevention programme on incidence of atopic symptoms in infancy. Ann Allergy, 1992;47:545-553.
  35. Saarinen UM, Kajosaari M. Breastfeeding as prophylaxis against atopic disease: prospective follow-up study until 17 years old, Lancet, 1995;346:1065-1069.
  36. Udall JN, Dixon M, Newman AP, et al. Liver disease in a1- antitrypsin deficiency: retrospective analysis of the influence of early breast vs bottle feeding. JAMA, 1985;253:2679-2682.
  37. Sveger T. Breast-feeding, a1- antitrypsin deficiency, and liver disease? JAMA, 1985;254:3036. Letter.
  38. Greco L, Auricchio S, Mayer M, et al. Case control study on nutritional risk factors in celiac disease. J Pediatr Gastroenterol Nutr, 1988;7:395-399.
  39. Morrow-Tlucak M, Haude RH, Ernhart CB. Breastfeeding and cognitive development in the first 2 years of life. Soc Sci Med, 1988;26:635-639.
  40. Wang YS, Wu SY. The effect of exclusive breastfeeding on development and incidence of infection in infants. J Hum Lactation, 1996;12:27-30.
  41. Chua S, Arulkumaran S, Lim I, et al. Influence of breastfeeding and nipple stimulation on postpartum uterine activity. Br J Obstet Gynaecol, 1994;101:804-805.
  42. Dewey KG, Heinig MJ, Nommsen LA. maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr, 1993;58:162-166.
  43. Kennedy KI, Visness Cm. Contraceptive efficacy of lactational amenorrhoea. Lancet, 1992;339:227-230.
  44. Gray RH, Campbell OM, Apelo R, et al. Risk of ovulation during lactation. Lancet, 1990;335:25-29.
  45. Lbbock MH, Colie C. Puerperium and breast-feeding. Curr Opin Obstet Gynecol, 1992;4:818-825.
  46. Melton LJ, Bryant SC, Wahner HW, et al. Influence of breastfeeding and other reproductive factors on bone mass later in life. Osteoporos Int., 1993;3:76-83.
  47. Cumming RG, Klineberg RJ. Breastfeeding and other reproductive factors and the risk of hip fractures in elderly woman. Int J Epidemiol, 1993;22:684-691.
  48. Rosenblatt KA, Thomas DB, WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Int J Epidemiol., 1993;22:192-197.
  49. Newcomb PA, Storer BE, Longnecker MP, et al. Lactation and a reduced risk of premenopausal breast cancer. N Engl J Med, 1994;330:81-87.
  50. Gartner LM. Introduction. Gartner LM, ed. Breastfeeding in the hospital. Semin Perinatol, 1994;18:475.
  51. American Academy of Pediatrics, Committee on Nutrition. Nutritional needs of low-birth-weight infants. Pediatrics, 1985;75:976-986.
  52. American Dietetic Association. Position of the American Dietetic Association: promotion of breast feeding. Am Diet Assoc Rep, 1986;86:1580-1585.
  53. Righard L. Alade MO. Effect of delivery room routines on success of first breast-feed. Lancet, 1990;336:1105-1107.
  54. Widstrom AM, Wahlberg V, Metthiesen AS, et al. Short-term effects of early suckling and touch of the nipple on maternal behavior. Early Hum Dev., 1990;21:153-163.
  55. Van Den Bosch CA, Bullough CHW. Effect of early suckling on term neonates' core body temperature. Ann Trop Paediatr, 1990;10:347-353.
  56. Gunther M. Instinct and the nursing couple. Lancet,1955;575-578.
  57. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 3rd ed. Washington, DC: ACOG, AAP; 1992:183.
  58. American Academy of Pediatrics, Committee on Nutrition. Pediatric Nutrition Handbook, 3rd ed. Elk Grove Village, IL: AAP;1993:7.
  59. Shrago L. Glucose water supplementation of the breastfed infant during the first three days of life. J Human Lactation, 1987;3:82-86.
  60. Goldberg NM, Adams E. Supplementary water for breast-fed babies in a hot and dry climate-not really a necessity. Arch Dis Child, 1983;58:73-74.
  61. Ahn CH, MacLean WC. Growth of the exclusively breast-fed infant. Am J Clin Nutr, 1980;33:183-192.
  62. Ashraf RN, Jalil F, Aperia A, et al. Additional water is not needed for healthy breast-fed babies in a hot climate. Acta Paediatr Scand, 1993;82:1007-1011.
  63. Heinig MJ, Nommsen LA, Peerson, JM, et al. Intake and growth of breast-fed infants in relation to the timing of introduction of complementary foods: the Darling study. Acta Paediatr Scand, 1993;82:999-1006.
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