Breastfeeding, Complementary Food, and the Risk of Stunting

Abstract

Breastfeeding MedicineVol. 18, No. 5 EditorialFree AccessBreastfeeding, Complementary Food, and the Risk of StuntingArthur I. EidelmanArthur I. Eidelman—Arthur I. Eidelman, MD, FABM, Editor-in-Chief Search for more papers by this authorPublished Online:17 May 2023https://doi.org/10.1089/bfm.2023.29244.editorialAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail My recent travels in war-torn East African countries, who are also suffering from years of severe drought, have only confirmed the conclusion that exclusive breastfeeding serves as the basis for successful infant nutrition, but that it alone cannot meet the vital needs of the growing and developing infant beyond 6 months of age.In these populations, the measure of significant chronic malnutrition is “stunting,” the relationship of height to age, and not the incidence of wasting, that is, the weight for age, or the weight for height relationship.All too often, examining a stunted child can be frequently falsely reassuring as their weight/height ratio is normal (they are proportional) and obvious clinical signs of malnutrition are not present. After a more careful examination and history taking, one realizes that the child being evaluated is not a 2-year-old, but rather a 4-year-old, that is, clearly stunted with a degree of irreversible damage to linear growth and brain development.This situation reflects the inability of mothers to provide adequate quality and quantity of “complementary” food to their infants beyond the first 6 months of exclusive breastfeeding. Simply put, even when mothers successfully continue to breastfeed for ≥2 years, the lack of sufficient protein- and mineral-rich food leads to the stunting inevitability. That 40% or more of children suffer from stunting is a measure of the consequences of a basic relatively nonmodern agricultural economy plus the negative effects of severe chronic drought and civil disturbances.For the past 10 years, I have participated in a nutritional supplemental program that was instituted for a targeted population in Ethiopia. A baseline evaluation of the total population noted a stunting rate of nearly 40%.1–3 Comparable statistics were noted in other areas of Ethiopia, and correlation with infant gender and associated gastrointestinal disease, maternal education, and socioeconomic level was noted.4 Most importantly, the availability of diverse complementary nutritional food was a critical variable in the stunting rate, whereas the frequency of breastfeeding or use of breast milk substitutes was not a variable in the development of stunting.4Simply put, an exclusive breast milk diet is not enough in these populations. As such, policies that focus on food availability, access, and supply are critical both on an individual maternal infant dyad level and as a national priority. What we should remember is that, in the end, it is infant nutrition that drives ultimate national economic success. As the World Bank has stated “ending undernutrition is an issue of equity and saving lives and also of boosting economies and prosperity and the prospect for all people around the world.”5