The recommendations from the American Academy of Pediatrics (AAP), which call for additional breastfeeding until a baby's first birthday or longer, are similar to those from the World Health Organization, which promotes breastfeeding for the benefit of both moms and babies.

"It's a health choice and not just a lifestyle choice, and it's going to protect her baby as well as her," said Dr. Richard Schanler, a neonatologist from North Shore-Long Island Jewish Health System and one of the guideline's co-authors.

"Our problem as pediatricians is we're not getting that message across enough to mothers," he told Reuters Health.

Although the six-month exclusive breastfeeding recommendation is not new, AAP members said that it's a firmer guideline, with more evidence behind it, than in the organization's last breastfeeding statement published in 2005.

Recent studies suggest that only about 13 percent of moms in the U.S. still haven't used any formula or added solid foods at six months.

And many women, especially young, poor mothers, don't ever start breastfeeding, according to the report, published in Pediatrics.

That's worrisome because breastfeeding provides babies with a range of health benefits, including protection against respiratory and ear infections and sudden infant death syndrome.

Later in life, some evidence also suggests that kids and adults who were breastfed are less likely to be obese or have diabetes, and tend to score higher on intelligence tests -- although it's not clear that's because of the breastfeeding.

"It's clear that in order to realize all of those benefits, to ward off all of these adverse health outcomes, you need exclusive breastfeeding," said Dr. Lori Feldman-Winter, a pediatrician at Cooper University Hospital in Camden, New Jersey, and chairperson of the policy committee for the AAP's Section on Breastfeeding.

"Combination feeding, or using infant formula, will undermine" that, she told Reuters Health. "Our recommendation for mothers is not to do any formula feeding."

"Formula has never been shown to be superior to breastfeeding for anything for the mother or the baby," agreed Dr. Michael Kramer, who studies pregnancy and breastfeeding at The Montreal Children's Hospital and wasn't part of the AAP committee.

Still, he pointed out that the health benefit of breastfeeding is "not a guarantee -- it's a relative protection."

For moms themselves, breastfeeding has been linked to less postpartum depression, as well as a lower risk of heart disease and breast and ovarian cancers, according to the new report.

Schanler said that the benefits from breastfeeding come both from the bond that's created between mother and baby through the act itself, and the immune-boosting ingredients in breast milk.

Only moms on certain drugs including chemotherapy treatment, and those with active infections such as untreated tuberculosis, shouldn't breastfeed.

The new guidelines also urge hospitals to promote breastfeeding as early as possible. The AAP recommends that moms first breastfeed their newborns within an hour of giving birth, that moms and babies be kept together in the hospital and that free samples of infant formula not be distributed, as has been common practice (see Reuters Health story of September 26, 2011).

After that, workplaces should make breastfeeding as convenient as possible for women -- which will save companies money in the long run, when moms have to spend fewer days at home.

Schanler said that although breastfeeding shouldn't be stopped at six months, that's the time when babies would benefit from the extra micronutrients, such as zinc and iron, in foods like fortified cereal, meat and fruits and vegetables.

Kramer told Reuters Health that breastfeeding isn't the end-all-be-all for children's health and development, and that reading to your baby and making sure young kids are physically active is also important.

"There are lots of other ways that women can be good mothers if they can't or don't want to breastfeed," he said.

Still, Schanler concluded, "It's going to protect their babies' health, so why not try it?"

SOURCE: bit.ly/yie4ia Pediatrics, online February 27, 2012.

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