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Optimal duration of exclusive breastfeeding

  1. Michael S Kramer*,
  2. Ritsuko Kakuma

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 29 DEC 2006

DOI: 10.1002/14651858.CD003517

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Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD003517. DOI: 10.1002/14651858.CD003517.

Author Information

  1. McGill University, Faculty of Medicine, Montreal, Quebec, Canada

*Michael S Kramer, Faculty of Medicine, McGill University, 1020 Pine Avenue West, Montreal, Quebec, H3A 1A2, Canada. michael.kramer@mcgill.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Adair 1993a {published data only}
  • Adair L, Popkin BM, Vanderslice J, Akin J, Guilkey D, Black R, et al. Growth dynamics during the first two years of life: a prospective study in the Philippines. European Journal of Clinical Nutrition 1993;47:42-51.
  • Brown K, Dewey K, Allen L. Complementary feeding of young children in developing countries: a review of current scientific knowledge. Geneva: WHO, 1998:30-2.
Ahn 1980 {published data only}
Akeson 1996a {published data only}
  • Akeson PMK, Axelsson IE, Raiha NCR. Growth and nutrient intake in three- to twelve- month-old infants fed human milk or formulas with varying protein concentrations. Journal of Pediatric Gastroenterology and Nutrition 1998;26:1-8.
  • Akeson PMK, Axelsson IE, Raiha NCR. Human milk and standard infant formula together with high quality supplementary foods is sufficient for normal growth during infancy. Pediatric Research 1996;39 Suppl:313A.
  • Akeson PMK, Axelsson IE, Raiha NCR. Protein and amino acid metabolism in three- to twelve-month-old infants fed human milk or formulas with varying protein concentrations. Journal of Pediatric Gastroenterology and Nutrition 1998;26:297-304.
Brown 1991a {published data only}
  • Brown K, Dewey K, Allen L. Complementary feeding of young children in developing countries: a review of current scientific knowledge. Geneva: WHO, 1998:30-2.
  • Brown KH. The relationship between diarrhoeal prevalence and growth of poor infants varies with their age and usual energy intake (abstract). FASEB Journal 1991;5:A1079.
Castillo 1996 {published data only}
  • Castillo C, Atalah E, Riumallo J, Castro R. Breast-feeding and the nutritional status of nursing children in Chile. Bulletin of the Pan American Health Organization 1996;30:125-33.
Cohen 1994a {published and unpublished data}
  • Cohen RJ, Brown KH, Canahuati J, Rivera LL, Dewey KG. Determinants of growth from birth to 12 months among breast-fed Honduran infants in relation to age of introduction of complementary foods. Pediatrics 1995;96:504-10.
  • Cohen RJ, Brown KH, Canahuati J, Rivera LL, Dewey KG. Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras. Lancet 1994;344:288-93.
  • Dewey KG, Cohen RJ, Brown KH, Rivera LL. Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras. Journal of Nutrition 2001;131:262-7.
  • Dewey KG, Cohen RJ, Rivera LL, Brown KH. Effects of age of introduction of complementary foods on iron status of breast-fed infants in Honduras. American Journal of Clinical Nutrition 1998;67:878-84.
  • Dewey KG, Cohen RJ, Rivera LL, Canahuati J, Brown KH. Do exclusively breast-fed infants require extra protein?. Pediatric Research 1996;39:303-7.
  • Dewey KG, Cohen RJ, Rivera LL, Canahuati J, Brown KH. Effects of age at introduction of complementary foods to breast-fed infants on duration of lactational amenorrhea in Honduran women. American Journal of Clinical Nutrition 1997;65:1403-9.
Dewey 1999a {published and unpublished data}
  • Dewey KG, Cohen RJ, Brown KH, Rivera LL. Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants: a randomized intervention study in Honduras. American Journal of Clinical Nutrition 1999;69:679-86.
  • Dewey KG, Cohen RJ, Brown KH, Rivera LL. Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras. Journal of Nutrition 2001;131:262-7.
  • Dewey KG, Cohen RJ, Rivera LL, Brown KH. Effects of age of introduction of complementary foods on micronutrient status of term, low-birthweight, breastfed infants in Honduras. FASEB Journal 1998;12:A648.
Duncan 1993 {published and unpublished data}
  • Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig LM. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics 1993;91:867-72.
Heinig 1993 {published data only}
  • Heinig MJ, Nommsen LA, Peerson JM, Lonnerdal B, Dewey KG. Intake and growth of breast-fed and formula-fed infants in relation to the timing of introduction of complementary foods: the DARLING study. Acta Paediatrica Scandinavica 1993;82:999-1006.
    Direct Link:
Huffman 1987 {published and unpublished data}
Kajosaari 1983 {published data only}
  • Kajosaari M. Atopy prevention in childhood: the role of diet: prospective 5-year follow-up of high-risk infants with six months exclusive breastfeeding and solid food elimination. Pediatric Allergy and Immunology 1994;5(6 Suppl):26-8.
    Direct Link:
  • Kajosaari M. Atopy prophylaxis in high-risk infants. Prospective 5-year follow-up study of children with six months exclusive breastfeeding and solid food elimination. Advances in Experimental Medicine and Biology 1991;310:453-8.
  • Kajosaari M, Saarinen UM. Prophylaxis of atopic disease by six months' total solid food elimination. Evaluation of 135 exclusively breast-fed infants of atopic families. Acta Paediatrica Scandinavica 1983;72:411-4.
    Direct Link:
Khadivzadeh 2004 {published data only}
  • Khadivzadeh T, Parsal S. Effect of exclusive breastfeeding and complementary feeding on infant growth and morbidity. Eastern Mediterranean Health Journal 2004;10(3):289-94.
Khan 1984 {published data only}
Kramer 2000a {published and unpublished data}
  • Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Breastfeeding and infant growth: biology or bias?. Pediatric Research 2000;47:151A.
  • Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of breastfeeding intervention trial (PROBIT): a cluster-randomized trial in the Republic of Belarus. In: Koletzko B, Michaelsen KF, Hernell O editor(s). Short and long term effects of breast feeding on child health. New York: Kluwer Academic/Plenum Publishers, 2000:327-45.
  • Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001;285:413-20.
  • Kramer MS, Guo T, Platt RW, Sevkovskaya Z, Dzikovich I, Collet JP, et al. Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding. American Journal of Clinical Nutrition 2003;78:291-5.
Oddy 1999 {published and unpublished data}
Onayade 2004 {published data only}
  • Onayade AA, Abiona TC, Abayomi IO, Makanjuola ROA. The first six month growth and illness of exclusively and non-exclusively breast-fed infants in Nigeria. East African Medical Journal 2004;81(3):146-53.
Pisacane 1995 {published data only}
Rao 1992 {published data only}
  • Rao S, Kanade AN. Prolonged breast-feeding and malnutrition among rural Indian children below 3 years of age. European Journal of Clinical Nutrition 1992;46:187-95.
Savilahti 1987a {published data only}
  • Heiskanen K, Salmenpera L, Perheentupa J, Siimes MA. Infant vitamin B-6 status changes with age and with formula feeding. American Journal of Clinical Nutrition 1994;60:907-10.
  • Kallio MJ, Salmenpera L, Siimes MA, Perheentupa J, Miettinen TA. Exclusive breast-feeding and weaning: effect on serum cholesterol and lipoprotein concentrations in infants during the first year of life. Pediatrics 1992;89:663-6.
  • Savilahti E, Tainio VM, Salmenpera L, Siimes MA, Perheentupa J. Prolonged exclusive breast feeding and heredity as determinants in infantile atopy. Archives of Disease in Childhood 1987;62:269-73.
Simondon 1997a {published and unpublished data}
  • Simondon KB, Delanay V, Diallo A, Elguero E, Simondon F. Lactational amenorrhea is associated with child age at the time of introduction of complementary food: a prospective cohort study in rural Senegal, West Africa. American Journal of Clinical Nutrition 2003;78:154-61.
  • Simondon KB, Simondon F. Age at introduction of complementary food and physical growth from 2 to 9 months in rural Senegal. European Journal of Clinical Nutrition 1997;51:703-7.
WHO 1994a {published and unpublished data}
  • Brown K, Dewey K, Allen L. Complementary feeding of young children in developing countries: a review of current scientific knowledge. Geneva: WHO, 1998:28-9.
  • Dewey KG, Peerson JM, Brown KH, Krebs NF, Michaelsen KF, Persson LA, et al. Growth of breast-fed infants deviates from current reference data: a pooled analysis of US, Canadian, and European data sets. Pediatrics 1995;96:495-503.
  • WHO Working Group on Infant Growth. An evaluation of infant growth: Document WHO/NUT/94.8. Geneva: WHO, 1994.
  • WHO Working Group on Infant Growth. An evaluation of infant growth: the use and interpretation of anthropometry in infants. Bulletin of the World Health Organization 1995;73:165-74.
WHO 1997 {published and unpublished data}
  • Frongillo EA Jr, de Onis M, Garza C, the World Health Organization Task Force on Methods for the Natural Regulation of Fertility. Effects of timing of complementary foods on post-natal growth. Experimental Biology, New Orleans, April 1997. FASEB Journal 1997;11:A574.
  • WHO Working Group on the Growth Reference Protocol, WHO Task Force on Methods for the Natural Regulation of Fertility. Growth of healthy infants and the timing, type and frequency of complementary foods. American Journal of Clinical Nutrition 2002;76(3):620-7.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Chantry 2006 {published data only}
Ly 2006 {published data only}
  • Ly CT, Diallo A, Simondon F, Simondon KB. Early short-term infant food supplementation, maternal weight loss and duration of breast-feeding: a randomised controlled trial in rural Senegal. European Journal of Clinical Nutrition 2006;60:265-71.
Wang 2005 {published data only}

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Adair 1993b
  • Adair L, Popkin BM, Vanderslice J, Akin J, Guilkey D, Black R, et al. Growth dynamics during the first two years of life: a prospective study in the Philippines. European Journal of Clinical Nutrition 1993;47:42-51.
Akeson 1996b
  • Akeson PMK, Axelsson IE, Raiha NCR. Human milk and standard infant formula together with high quality supplementary foods is sufficient for normal growth during infancy. Pediatric Research 1996;39 Suppl:313A.
Akeson 1998a
  • Akeson PMK, Axelsson IE, Raiha NCR. Growth and nutrient intake in three- to twelve- month-old infants fed human milk or formulas with varying protein concentrations. Journal of Pediatric Gastroenterology and Nutrition 1998;26:1-8.
Akeson 1998b
  • Akeson PMK, Axelsson IE, Raiha NCR. Protein and amino acid metabolism in three- to twelve-month-old infants fed human milk or formulas with varying protein concentrations. Journal of Pediatric Gastroenterology and Nutrition 1998;26:297-304.
Alderman 1986
  • Alderman B, Weiss N, Daling J, Ure CL, Ballard JH. Reproductive history and postmenopausal risk of hip and forearm fracture. American Journal of Epidemiology 1986;124:262-7.
Anandaiah 2000
  • Anandaiah R, Choe M. Are the WHO guidelines on breastfeeding appropriate for India? National Family Health Survey Subject Reports, number 16, May 2000. Mumbai: International Institute for Population Sciences, 2000.
Anderson 1999
Bauchner 1986
Beaudry 1995
Brinton 1995
Brown 1991b
  • Brown KH. The relationship between diarrhoeal prevalence and growth of poor infants varies with their age and usual energy intake (abstract). FASEB Journal 1991;5:A1079.
Brown 1998
  • Brown K, Dewey K, Allen L. Complementary feeding of young children in developing countries: a review of current scientific knowledge. Geneva: WHO, 1998:30-2.
Burgess 2006
Butte 1996
  • Butte N. Energy requirements of infants. European Journal of Clinical Nutrition 1996;50 Suppl 1:24-36.
Chilvers 1993
Cohen 1994b
  • Cohen RJ, Brown KH, Canahuati J, Rivera LL, Dewey KG. Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras. Lancet 1994;344:288-93.
Cohen 1995
  • Cohen RJ, Brown KH, Canahuati J, Rivera LL, Dewey KG. Determinants of growth from birth to 12 months among breast-fed Honduran infants in relation to age of introduction of complementary foods. Pediatrics 1995;96:504-10.
Cummings 1993
Cunningham 1991
Davis 1988
Davis 1998
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De Onis 2006b
  • De Onis M, Onyango AW, Borghi E, Garza C, Yang H, for the WHO Multicentre Growth Reference Study Group. Comparison of the World Health Organization and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes. Public Health Nutrition 2006;9(7):942-7.
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Dewey 1996
Dewey 1997
  • Dewey KG, Cohen RJ, Rivera LL, Canahuati J, Brown KH. Effects of age at introduction of complementary foods to breast-fed infants on duration of lactational amenorrhea in Honduran women. American Journal of Clinical Nutrition 1997;65:1403-9.
Dewey 1998a
  • Dewey KG, Cohen RJ, Rivera LL, Brown KH. Effects of age of introduction of complementary foods on iron status of breast-fed infants in Honduras. American Journal of Clinical Nutrition 1998;67:878-84.
Dewey 1998b
  • Dewey KG, Cohen RJ, Rivera LL, Brown KH. Effects of age of introduction of complementary foods on micronutrient status of term, low-birthweight, breastfed infants in Honduras. FASEB Journal 1998;12:A648.
Dewey 1999b
  • Dewey KG, Cohen RJ, Brown KH, Rivera LL. Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants: a randomized intervention study in Honduras. American Journal of Clinical Nutrition 1999;69:679-86.
Dewey 2001
  • Dewey KG, Cohen RJ, Brown KH, Rivera LL. Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras. Journal of Nutrition 2001;131:262-7.
Enger 1997
FAO/WHO 1973
  • FAO/WHO. Energy and protein requirements. Report of a Joint FAO/WHO Ad Hoc Expert Committee. FAO Food and Nutrition Series No. 7/FAO Nutrition Meetings Report Series No. 52/WHO Technical Report Series No. 522. Geneva: WHO, 1973.
Ford 1993
Frongillo 1997a
  • Frongillo EA Jr, de Onis M, Garza C, the World Health Organization Task Force on Methods for the Natural Regulation of Fertility. Effects of timing of complementary foods on post-natal growth. Experimental Biology, New Orleans, April 1997. FASEB Journal 1997;11:A574.
Frongillo 1997b
Garza 1990
Gdalevich 2001a
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Gerstein 1994
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Heiskanen 1994
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Hide 1981
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  • Kajosaari M. Atopy prophylaxis in high-risk infants. Prospective 5-year follow-up study of children with six months exclusive breastfeeding and solid food elimination. Advances in Experimental Medicine and Biology 1991;310:453-8.
Kajosaari 1994
  • Kajosaari M. Atopy prevention in childhood: the role of diet: prospective 5-year follow-up of high-risk infants with six months exclusive breastfeeding and solid food elimination. Pediatric Allergy and Immunology 1994;5(6 Suppl):26-8.
    Direct Link:
Kallio 1992
  • Kallio MJ, Salmenpera L, Siimes MA, Perheentupa J, Miettinen TA. Exclusive breast-feeding and weaning: effect on serum cholesterol and lipoprotein concentrations in infants during the first year of life. Pediatrics 1992;89:663-6.
Koletzko 1989
Kramer 2000b
  • Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Breastfeeding and infant growth: biology or bias?. Pediatric Research 2000;47:151A.
Kramer 2000c
  • Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, et al. Promotion of breastfeeding intervention trial (PROBIT): a cluster-randomized trial in the Republic of Belarus. In: Koletzko B, Michaelsen KF, Hernell O editor(s). Short and long term effects of breast feeding on child health. New York: Kluwer Academic/Plenum Publishers, 2000:327-45.
Kramer 2001
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Savilahti 1987b
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