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Long-term adequacy of exclusive breast-feeding: how scientific research has led to revised opinions

Published online by Cambridge University Press:  28 February 2007

R. G. Whitehead  and
A. A. Paul
R. G. Whitehead*
Affiliation:
MRC Human Nutrition Research, Downhams Lane, Milton Rd, Cambridge CB4 1XJ, UK
A. A. Paul
Affiliation:
MRC Human Nutrition Research, Downhams Lane, Milton Rd, Cambridge CB4 1XJ, UK
*
*Corresponding Author: Dr R. G. Whitehead, fax +44 (0)1223 291934, email rgwhitehead@compuserve.com
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Abstract

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The present paper reviews the research of the authors and their colleagues over the past 20 years to provide improved nutritional and anthropometric guidelines for the assessment of lactational adequacy and for when the weaning process might be initiated. The nutritional guidelines are based on revised dietary energy requirements. The basic assumption is that since breast milk is a well-balanced food, if energy needs are satisfied so will those for essential nutrients. Energy requirements for young babies have been derived from the application of the doubly-labelled-water technique. This approach indicated that 460 kJ (110 kcal)/kg per d at 1 month and 397 and 355 kJ (95 and 85 kcal)/kg per d at 3 and 6 months respectively would be satisfactory for a nutrient content of high bioavailability. Translated into a breast-milk intake of 850 ml/d the latter would cover the dietary energy needs of the average child growing along the 50th centile until at least 4 months, but the typical child from many developing countries following the 25th centile until 6 months. The importance of revised growth reference values for infancy, equally crucial for assessing lactational adequacy, is also reviewed. In contrast with the shapes of earlier reference patterns, growth trajectories are different when babies are fed in accordance with modern paediatric advice. Mothers and health professionals using the older growth charts to assess the progress of a baby can be misled into assuming that the weaning process needs to be introduced sooner than necessary. Examples of this situation within the context of a developing country are provided.

Keywords

LactationInfantsGrowth
Type
Reproduction and Development Group Symposium on ‘Feeding, nurture and childhood development’
Information
Proceedings of the Nutrition Society , Volume 59 , Issue 1 , February 2000 , pp. 17 - 23
Copyright
Copyright © The Nutrition Society 2000

References

Anderson, MA, Dewey, KG, Frongillo, E, Garza, C, Haschke, F, Kramer, M, Whitehead, RG, Winichagoon, P & de Onis, M (1995) An evaluation of infant growth: the use and interpretation of anthropometry in infants. WHO Working Group on Infant Growth. Bulletin of the World Health Organization 73, 165–174.Google Scholar
Coward, WA, Cole, TJ, Sawyer, MB, Prentice, AM & Orr-Ewing, AK (1982) Breast-milk intake measurements in mixed-fed infants by administration of deuterium oxide. Human Nutrition: Clinical Nutrition 36C, 141–148.Google ScholarPubMed
Department of Health (1991) Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Report on Health and Social Subjects no. 41.London: H.M. Stationery Office.Google Scholar
Department of Health and Social Security (1974) Present Day Practice in Infant Feeding. Report on Health and Social Subjects no. 9.London: H.M. Stationery Office.Google Scholar
Department of Health and Social Security (1988) Present Day Practice in Infant Feeding. Report on Health and Social Subjects no. 32.London: H.M. Stationery Office.Google Scholar
Fomon, SJ, Haschke, F, Ziegler, EE & Nelson, SE (1982) Body composition of children from birth to age 10 years. American Journal of Clinical Nutrition 35, 1169–1175.CrossRefGoogle ScholarPubMed
Freeman, JV, Cole, TJ, Chinn, S, Jones, PRM, White, EM & Preece, MA (1995) Cross sectional stature and weight reference curves for the UK. Archives of Disease in Childhood 73, 17–24.CrossRefGoogle ScholarPubMed
Hamill, PVV, Drizd, TA, Johnson, CL, Reed, RB & Roche, AF (1977) NCHS Growth Curves for Children, Birth to 18 years. US Department of Health, Education and Welfare Publications no. PHD 78–1650. Hyattsville, MD: National Center for Health Statistics.Google Scholar
Paul, AA, Black, AE, Evans, J, Cole, TJ & Whitehead, RG (1988) Breastmilk intake and growth in infants from two to ten months. Journal of Human Nutrition and Dietetics 1, 437–450.CrossRefGoogle Scholar
Paul, AA, Cole, TJ, Ahmed, EA & Whitehead, RG (1998) The need for revised standards for skinfold thickness in infancy. Archives of Disease in Childhood 78, 354–358.CrossRefGoogle ScholarPubMed
Prentice, AM, Lucas, A, Vasquez-Velasquez, L, Davies, PSW & Whitehead, RG (1988) Are current guidelines for young children a prescription for overfeeding? Lancet ii, 1066–1069.CrossRefGoogle Scholar
Ritz, P, Johnson, PG & Coward, WA (1994) Measurements of 2H and 18O in body water: analytical considerations and physiological implications. British Journal of Nutrition 72, 3–12.CrossRefGoogle ScholarPubMed
Rowland, MGM (1985) The ‘why’ and ‘when’ of introducing food to infants: growth in young breastfed infants and some nutritional implications. American Journal of Nutrition 41, 459–463.Google ScholarPubMed
Rowland, MGM, Barrell, RAE & Whitehead, RG (1978) Bacterial contamination in traditional Gambian weaning foods. Lancet i, 136–138.CrossRefGoogle Scholar
Tanner, JM & Whitehouse, RM (1975) Revised standards for triceps and subscapular skin-folds in British children. Archives of Disease in Childhood 50, 142–145.CrossRefGoogle Scholar
Tanner, JM, Whitehouse, RH & Takaishi, M (1966) Standards from birth to maturity for height, weight, height velocity and weight velocity: British children 1965. Archives of Disease in Childhood 41, 613–615.CrossRefGoogle ScholarPubMed
Whitehead, RG (1983) Nutritional aspects of human lactation. Lancet i, 167–169.CrossRefGoogle Scholar
Whitehead, RG (1995) For how long is exclusive breast-feeding adequate to satisfy the dietary energy needs of the average young baby? Pediatric Research 37, 239–243.CrossRefGoogle Scholar
Whitehead, RG & Paul, AA (1981) Infant growth and human milk requirements: a fresh approach. Lancet ii, 161–163.CrossRefGoogle Scholar
Whitehead, RG & Paul, AA (1984) Growth charts and the assessment of infant feeding practices in the western world and in developing countries. Early Human Development 9, 187–207.CrossRefGoogle ScholarPubMed
Whitehead, RG & Paul, AA (1994) Boys Growth Chart and Girls Growth Chart. London: Child Growth Foundation.Google Scholar
Whitehead, RG, Paul, AA & Cole, TJ (1981) A critical analysis of measured food energy intakes during infancy and early childhood in comparison with current international recommendations. Journal of Human Nutrition 35, 339–348.Google ScholarPubMed
Whitehead, RG, Paul, AA & Cole, TJ (1982) How much breast-milk do babies need? Acta Paediatrica Scandinavica 291, 43–50.CrossRefGoogle Scholar
Whitehead, RG, Paul, AA & Cole, TJ (1989) Diet and the growth of healthy infants. Journal of Nutrition and Dietetics 2, 73–84.CrossRefGoogle Scholar
World Health Organization/Food and Agriculture Organization (1973) Energy and Protein Requirements. Technical Report Series no. 522.Geneva: WHO.Google Scholar
World Health Organization/Food and Agriculture Organization/ United Nations University (1985) Energy and Protein Requirements. Technical Report Series no. 724.Geneva: WHO.Google Scholar