Breast Feeding and the Older Infant

The possible benefits and disadvantages to the older infant of breast‐feeding being continued after the introduction of solid foods are reviewed. The limited evidence from industrialised countries suggests that prolonged partial breast‐feeding has little influence on child health and growth. In contrast, in poor areas of the developing world, the continuation of breast‐feeding for 1–2 years after the introduction of other foods appears to have several major benefits. These include the supply of nutrients, the delivery of protective, digestive and trophic agents, and extending the period of infertility in the mother. Partial breast‐feeding after 6 months is associated with reduced severity of infectious diseases particularly in severely malnourished individuals. There is no evidence that partial breast‐feeding plays a causal role in poor growth performance. In poor areas of the developing world, breast‐feeding, together with the provision of adequate amounts of other foods, should be encouraged for the first two years of life. The importance of breast‐feeding in late infancy and early childhood varies considerably between developing and industrialised countries as a result of the wide differences in cultural and socioeconomic backgrounds of mothers who choose to breast‐feed for long periods (Table 2). In industrialised countries prolonged breastfeeding is more common amongst well‐educated, affluent, highly‐motivated mothers who have ready access to good quality weaning foods and health care. The limited evidence currently available suggests that neither child health nor growth are influenced by continuing to receive breast‐milk after 6 months in addition to appropriate amounts of other foods. In this situation, the decision to extend breast‐feeding into late infancy has to be based on family preferences. In contrast, there is a wealth of evidence to suggest that in poor areas of the developing world breast‐feeding after early infancy has a number of major benefits. Breast‐milk is an invaluable source of nutrients when the quality of weaning foods is low and food is in short supply. Breast‐feeding ensures a continuing supply of nutrients during the frequent illnesses experienced by children in these environments and delivers protective, digestive and trophic factors that may be important during the recovery process. In addition, the contraceptive effect of breast‐feeding in underprivileged mothers results in wide birth‐intervals, with the associated beneficial effects on child survival. At present, there is no evidence that prolonged partial breast‐feeding is detrimental to health or growth. On the contrary, the weight of evidence suggests that for children in the developing world breast‐feeding for the first 2 years of life should be actively encouraged.