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Review
. 2012 Aug 15;2012(8):CD003517.
doi: 10.1002/14651858.CD003517.pub2.

Optimal duration of exclusive breastfeeding

Michael S Kramer  1 , Ritsuko Kakuma
Affiliations
Review

Optimal duration of exclusive breastfeeding

Michael S Kramer et al. Cochrane Database Syst Rev. .

Abstract

Background: Although the health benefits of breastfeeding are widely acknowledged, opinions and recommendations are strongly divided on the optimal duration of exclusive breastfeeding. Since 2001, the World Health Organization has recommended exclusive breastfeeding for six months. Much of the recent debate in developed countries has centred on the micronutrient adequacy, as well as the existence and magnitude of health benefits, of this practice.

Objectives: To assess the effects on child health, growth, and development, and on maternal health, of exclusive breastfeeding for six months versus exclusive breastfeeding for three to four months with mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) thereafter through six months.

Search methods: We searched The Cochrane Library (2011, Issue 6), MEDLINE (1 January 2007 to 14 June 2011), EMBASE (1 January 2007 to 14 June 2011), CINAHL (1 January 2007 to 14 June 2011), BIOSIS (1 January 2007 to 14 June 2011), African Index Medicus (searched 15 June 2011), Index Medicus for the WHO Eastern Mediterranean Region (IMEMR) (searched 15 June 2011), LILACS (Latin American and Caribbean Health Sciences) (searched 15 June 2011). We also contacted experts in the field.The search for the first version of the review in 2000 yielded a total of 2668 unique citations. Contacts with experts in the field yielded additional published and unpublished studies. The updated literature review in December 2006 yielded 835 additional unique citations.

Selection criteria: We selected all internally-controlled clinical trials and observational studies comparing child or maternal health outcomes with exclusive breastfeeding for six or more months versus exclusive breastfeeding for at least three to four months with continued mixed breastfeeding until at least six months. Studies were stratified according to study design (controlled trials versus observational studies), provenance (developing versus developed countries), and timing of compared feeding groups (three to seven months versus later).

Data collection and analysis: We independently assessed study quality and extracted data.

Main results: We identified 23 independent studies meeting the selection criteria: 11 from developing countries (two of which were controlled trials in Honduras) and 12 from developed countries (all observational studies). Definitions of exclusive breastfeeding varied considerably across studies. Neither the trials nor the observational studies suggest that infants who continue to be exclusively breastfed for six months show deficits in weight or length gain, although larger sample sizes would be required to rule out modest differences in risk of undernutrition. In developing-country settings where newborn iron stores may be suboptimal, the evidence suggests that exclusive breastfeeding without iron supplementation through six months may compromise hematologic status. Based on the Belarusian study, six months of exclusive breastfeeding confers no benefit (versus three months of exclusive breastfeeding followed by continued partial breastfeeding through six months) on height, weight, body mass index, dental caries, cognitive ability, or behaviour at 6.5 years of age. Based on studies from Belarus, Iran, and Nigeria, however, infants who continue exclusive breastfeeding for six months or more appear to have a significantly reduced risk of gastrointestinal and (in the Iranian and Nigerian studies) respiratory infection. No significant reduction in risk of atopic eczema, asthma, or other atopic outcomes has been demonstrated in studies from Finland, Australia, and Belarus. Data from the two Honduran trials and from observational studies from Bangladesh and Senegal suggest that exclusive breastfeeding through six months is associated with delayed resumption of menses and, in the Honduran trials, more rapid postpartum weight loss in the mother.

Authors' conclusions: Infants who are exclusively breastfed for six months experience less morbidity from gastrointestinal infection than those who are partially breastfed as of three or four months, and no deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for six months or longer. Moreover, the mothers of such infants have more prolonged lactational amenorrhea. Although infants should still be managed individually so that insufficient growth or other adverse outcomes are not ignored and appropriate interventions are provided, the available evidence demonstrates no apparent risks in recommending, as a general policy, exclusive breastfeeding for the first six months of life in both developing and developed-country settings.

PubMed Disclaimer

Conflict of interest statement

Dr Kramer is the principal investigator of one of the studies (Kramer 2000a) included in this review.

Figures

1.1
1.1. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 1 Monthly weight gain from 4‐6 months (g/mo).
1.2
1.2. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 2 Monthly weight gain from 6‐12 months (g/mo).
1.3
1.3. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 3 Monthly length gain 4‐6 months (cm/mo).
1.4
1.4. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 4 Monthly length gain 6‐12 months (cm/mo).
1.5
1.5. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 5 Weight‐for‐age z‐score at 6 months.
1.6
1.6. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 6 Length‐for‐age z‐score at 6 months.
1.7
1.7. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 7 Weight‐for‐length z‐score at 6 months.
1.8
1.8. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 8 Weight‐for‐age z‐score < ‐2 at 6 months.
1.9
1.9. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 9 Length‐for‐age z‐score < ‐2 at 6 months.
1.10
1.10. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 10 Weight‐for‐length z‐score < ‐2 at 6 months.
1.11
1.11. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 11 Receipt of Fe supplements 6‐9 months.
1.12
1.12. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 12 Hemoglobin concentration (g/L) at 6 months.
1.13
1.13. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 13 Hemoglobin concentration < 110 g/L at 6 months.
1.14
1.14. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 14 Hemoglobin concentration < 103 g/L at 6 months.
1.15
1.15. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 15 Hematocrit (%) at 6 months.
1.16
1.16. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 16 Hematocrit < 33% at 6 months.
1.17
1.17. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 17 Plasma ferritin concentration (mcg/L) at 6 months.
1.18
1.18. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 18 Plasma ferritin concentration < 12 mcg/L at 6 months.
1.19
1.19. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 19 Plasma ferritin concentration < 15 mcg/L at 6 months.
1.20
1.20. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 20 Plasma zinc concentration < 70 mcg/dL at 6 months.
1.21
1.21. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 21 % of days with fever 4‐6 months.
1.22
1.22. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 22 % of days with cough 4‐6 months.
1.23
1.23. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 23 % of days with nasal congestion 4‐6 months.
1.24
1.24. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 24 % of days with nasal discharge 4‐6 months.
1.25
1.25. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 25 % of days with hoarseness 4‐6 months.
1.26
1.26. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 26 % of days with diarrhea 4‐6 months.
1.27
1.27. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 27 % of days with fever 6‐12 months.
1.28
1.28. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 28 % of days with nasal congestion 6‐12 months.
1.29
1.29. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 29 % of days with diarrhea 6‐12 months.
1.30
1.30. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 30 Age first crawled (mo).
1.31
1.31. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 31 Age first sat from lying position (mo).
1.32
1.32. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 32 Did not walk by 12 months.
1.33
1.33. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 33 Maternal postpartum weight loss 4‐6 months (kg).
1.34
1.34. Analysis
Comparison 1 Exclusive breastfeeding for 6 versus 4 months, developing countries, controlled trials, Outcome 34 Maternal resumption of menses 6 months postpartum.
2.1
2.1. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 1 Monthly weight gain 4‐6 months (g/mo).
2.2
2.2. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 2 Monthly weight gain 6‐9 months (g/mo).
2.3
2.3. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 3 Monthly length gain 4‐6 months (cm/mo).
2.4
2.4. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 4 Monthly length gain 6‐9 months (cm/mo).
2.5
2.5. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 5 Weight‐for‐age z‐score at 6‐7 months.
2.6
2.6. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 6 Weight‐for‐age z‐score at 9‐10 months.
2.7
2.7. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 7 Length‐for‐age z‐score at 6‐7 months.
2.8
2.8. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 8 Length‐for‐age z‐score at 9‐10 months.
2.9
2.9. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 9 Weight‐for‐length z‐score at 6‐7 months.
2.10
2.10. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 10 Weight‐for‐length z‐score at 9‐10 months.
2.11
2.11. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 11 Weight‐for‐age z‐score < ‐2 at 6‐7 months.
2.12
2.12. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 12 Weight‐for‐age z‐score < ‐2 at 9‐10 months.
2.13
2.13. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 13 Length‐for‐age z‐score < ‐2 at 6‐7 months.
2.14
2.14. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 14 Length‐for‐age z‐score < ‐2 at 9‐10 months.
2.15
2.15. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 15 Weight‐for‐length z‐score < ‐2 at 6‐7 months.
2.16
2.16. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 16 Weight‐for‐length z‐score < ‐2 at 9‐10 months.
2.17
2.17. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 17 Mid‐upper arm circumference at 6‐7 months (cm).
2.18
2.18. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 18 Mid‐upper arm circumference at 9‐10 months (cm).
2.19
2.19. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 19 One or more episodes of gastrointestinal infection at 4‐6 months.
2.20
2.20. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 20 One or more episodes of respiratory infection at 4‐6 months.
2.21
2.21. Analysis
Comparison 2 Exclusive breastfeeding for 6‐7 versus 3‐4 months, developing countries, observational studies, Outcome 21 Resumption of menses by 6‐7 months postpartum.
3.1
3.1. Analysis
Comparison 3 Exclusive breastfeeding for > 6 months versus 6 months, developing countries, observational studies, Outcome 1 Weight‐for‐age < 75% of reference mean.
4.1
4.1. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 1 Monthly weight gain 3‐8 months (g/mo).
4.2
4.2. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 2 Monthly weight gain 6‐9 months (g/mo).
4.3
4.3. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 3 Monthly weight gain 8‐12 months (g/mo).
4.4
4.4. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 4 Monthly length gain 3‐8 months (cm/mo).
4.5
4.5. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 5 Monthly length gain 6‐9 months (cm/mo).
4.6
4.6. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 6 Monthly length gain 8‐12 months (cm/mo).
4.7
4.7. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 7 Weight‐for‐age z‐score at 6 months.
4.8
4.8. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 8 Weight‐for‐age z‐score at 9 months.
4.9
4.9. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 9 Weight‐for‐age z‐score at 12 months.
4.10
4.10. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 10 Length‐for‐age z‐score at 6 months.
4.11
4.11. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 11 Length‐for‐age z‐score at 9 months.
4.12
4.12. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 12 Length‐for‐age z‐score at 12 months.
4.13
4.13. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 13 Weight‐for‐length z‐score at 6 months.
4.14
4.14. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 14 Weight‐for‐length z‐score at 9 months.
4.15
4.15. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 15 Weight‐for‐length z‐score at 12 months.
4.16
4.16. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 16 Weight‐for‐age z‐score < ‐2 at 6 months.
4.17
4.17. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 17 Weight‐for‐age z‐score < ‐2 at 9 months.
4.18
4.18. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 18 Weight‐for‐age z‐score < ‐2 at 12 months.
4.19
4.19. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 19 Length‐for‐age z‐score < ‐2 at 6 months.
4.20
4.20. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 20 Length‐for‐age z‐score < ‐2 at 9 months.
4.21
4.21. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 21 Length‐for‐age z‐score < ‐2 at 12 months.
4.22
4.22. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 22 Weight‐for‐length z‐score < ‐2 at 6 months.
4.23
4.23. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 23 Weight‐for‐length z‐score < ‐2 at 9 months.
4.24
4.24. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 24 Weight‐for‐length z‐score < ‐2 at 12 months.
4.25
4.25. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 25 Head circumference at 6 months (cm).
4.26
4.26. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 26 Head circumference at 9 months (cm).
4.27
4.27. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 27 Head circumference at 12 months (cm).
4.28
4.28. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 28 Sleeping time at 9 months (min/day).
4.29
4.29. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 29 Total essential amino acid concentration (umol/L) at 6 months.
4.30
4.30. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 30 Total amino acid concentration (umol/L) at 6 months.
4.31
4.31. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 31 Atopic eczema in first 12 months.
4.32
4.32. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 32 Food allergy at 1 year (by history).
4.33
4.33. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 33 Food allergy at 1 year (by double challenge).
4.34
4.34. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 34 Two or more episodes of wheezing in first 12 months.
4.35
4.35. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 35 Hemoglobin concentration (g/L) at 12 months.
4.36
4.36. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 36 Hemoglobin concentration < 110 g/L at 12 months.
4.37
4.37. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 37 Serum ferritin concentration (mcg/L) at 12 months.
4.38
4.38. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 38 Serum ferritin concentration < 10 mcg/L at 12 months.
4.39
4.39. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 39 One or more episodes of gastrointestinal infection in first 12 months.
4.40
4.40. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 40 Hospitalization for gastrointestinal infection in first 12 months.
4.41
4.41. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 41 One or more episodes of upper respiratory tract infection in first 12 months.
4.42
4.42. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 42 Two or more episodes of upper respiratory tract infection in first 12 months.
4.43
4.43. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 43 Four or more episodes of upper respiratory tract infection in first 12 months.
4.44
4.44. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 44 One or more episodes of lower respiratory tract infection in first 12 months.
4.45
4.45. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 45 Two or more episodes of respiratory tract infection (upper or lower) in first 12 months.
4.46
4.46. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 46 Hospitalization for respiratory tract infection in first 12 months.
4.47
4.47. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 47 Number of episodes of otitis media in first 12 months.
4.48
4.48. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 48 One or more episodes of otitis media in first 12 months.
4.49
4.49. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 49 Frequent otitis media in first 12 months.
4.50
4.50. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 50 Death in first 12 months.
4.51
4.51. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 51 Any dental caries (decayed, missing, or filled teeth) at 6 years.
4.52
4.52. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 52 Any incisor caries (decayed, missing, or filled teeth) at 6 years.
4.53
4.53. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 53 Height at 6.5 years.
4.54
4.54. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 54 Leg length at 6.5 years.
4.55
4.55. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 55 Head circumference at 6.5 years.
4.56
4.56. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 56 BMI at 6.5 years.
4.57
4.57. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 57 Triceps skinfold thickness at 6.5 years.
4.58
4.58. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 58 Subscapular skinfold thickness.
4.59
4.59. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 59 Waist circumference at 6.5 years.
4.60
4.60. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 60 Hip circumference at 6.5 years.
4.61
4.61. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 61 Systolic blood pressure at 6.5 years.
4.62
4.62. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 62 Diastolic blood pressure at 6.5 years (mm Hg).
4.63
4.63. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 63 Atopic eczema at 5‐7 years.
4.64
4.64. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 64 Hay fever at 5‐7 years.
4.65
4.65. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 65 Asthma at 5‐7 years.
4.66
4.66. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 66 Food allergy at 5 years.
4.67
4.67. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 67 Allergy to animal dander at 5 years.
4.68
4.68. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 68 Positive skin‐prick test to house dust mite at 6.5 years.
4.69
4.69. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 69 Positive skin‐prick test to cat dander at 6.5 years.
4.70
4.70. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 70 Positive skin‐prick test to birch pollen at 6.5 years.
4.71
4.71. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 71 Positive skin‐prick test to mixed northern grasses at 6.5 years.
4.72
4.72. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 72 Positive skin‐prick test to Alternaria at 6.5 years.
4.73
4.73. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 73 Any positive skin‐prick test at 6‐7 years.
4.74
4.74. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 74 Wechsler cognitive ability test at 6.5 years: vocabulary.
4.75
4.75. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 75 Wechsler cognitive ability test at 6.5 years: similarities.
4.76
4.76. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 76 Wechsler cognitive ability test at 6.5 years: matrices.
4.77
4.77. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 77 Wechsler cognitive ability test at 6.5 years: block designs.
4.78
4.78. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 78 Wechsler cognitive ability test at 6.5 years: verbal IQ.
4.79
4.79. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 79 Wechsler cognitive ability test at 6.5 years: performance IQ.
4.80
4.80. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 80 Wechsler cognitive ability test at 6.5 years: full‐scale IQ.
4.81
4.81. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 81 Teacher's academic rating at 6.5 years: reading.
4.82
4.82. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 82 Teacher's academic rating at 6.5 years: writing.
4.83
4.83. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 83 Teacher's academic rating at 6.5 years: mathematics.
4.84
4.84. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 84 Teacher's academic rating at 6.5 years: other subjects.
4.85
4.85. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 85 Parent's behavior rating at 6.5 years: total difficulties.
4.86
4.86. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 86 Parent's behavior rating at 6.5 years: emotional symptoms.
4.87
4.87. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 87 Parent's behavior rating at 6.5 years: conduct problems.
4.88
4.88. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 88 Parent's behavior rating at 6.5 years: hyperactivity/inattention.
4.89
4.89. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 89 Parent's behavior rating at 6.5 years: peer problems.
4.90
4.90. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 90 Parent's behavior rating at 6.5 years: prosocial behavior.
4.91
4.91. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 91 Teacher's behavior rating at 6.5 years: total difficulties.
4.92
4.92. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 92 Teacher's behavior rating at 6.5 years: emotional symptoms.
4.93
4.93. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 93 Teacher's behavior rating at 6.5 years: conduct problems.
4.94
4.94. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 94 Teacher's behavior rating at 6.5 years: hyperactivity/inattention.
4.95
4.95. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 95 Teacher's behavior rating at 6.5 years: peer problems.
4.96
4.96. Analysis
Comparison 4 Exclusive breastfeeding for 6‐7 months versus 3‐4 months, developed countries, observational studies, Outcome 96 Teacher's behavior rating at 6.5 years: prosocial behavior.
5.1
5.1. Analysis
Comparison 5 Exclusive breastfeeding for > 6 months versus 6 months, developed countries, observational studies, Outcome 1 Very low density lipoprotein concentration (mmol/L) at 9 months.
5.2
5.2. Analysis
Comparison 5 Exclusive breastfeeding for > 6 months versus 6 months, developed countries, observational studies, Outcome 2 Low density lipoproteinconcentration (mmol/L) at 9 months.
5.3
5.3. Analysis
Comparison 5 Exclusive breastfeeding for > 6 months versus 6 months, developed countries, observational studies, Outcome 3 High‐density lipoprotein‐2 concentration (mmol/L) at 9 months.
5.4
5.4. Analysis
Comparison 5 Exclusive breastfeeding for > 6 months versus 6 months, developed countries, observational studies, Outcome 4 High‐density lipoprotein‐3 concentration (mmol/L) at 9 months.
5.5
5.5. Analysis
Comparison 5 Exclusive breastfeeding for > 6 months versus 6 months, developed countries, observational studies, Outcome 5 Apoprotein B concentration (mg/dL) at 9 months.
5.6
5.6. Analysis
Comparison 5 Exclusive breastfeeding for > 6 months versus 6 months, developed countries, observational studies, Outcome 6 Total triglyceride concentration (mmol/L) at 9 months.
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References

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References to other published versions of this review

Kramer 2009
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