Abstract
Mixed milk feeding increases the likelihood of breastfeeding cessation, but it is not known if solid feeding (SF) has the same effect. We have identified 10,407 infants breastfed for at least 8–10 weeks from three large U.K. studies (Avon Longitudinal Study of Parents and Children [ALSPAC; born 1990–1991], Southampton Woman's Survey [SWS; 1998–2008], and Infant Feeding Survey 2010 [IFS 2010]) to investigate the associations between early SF and breastfeeding cessation. In the earliest study (ALSPAC), 67% had started SF before the age of 4 months, but in the latest (IFS), only 23% had started before 4 months. Solid food introduction before 4 months was associated with stopping breastfeeding before 6 months in all three cohorts, with little effect of adjustment for maternal sociodemographic characteristics (Poisson regression, adjusted prevalence ratios: ALSPAC 1.55, [95% confidence interval 1.4, 1.8], SWS 1.13 [1.0, 1.3], IFS 1.10 [1.1, 1.3]). Using Cox regression, adjusted hazard ratios for breastfeeding cessation compared with SF after 5 months were 2.07 (1.8, 2.4) for SF before 4 and 1.51 (1.3, 1.8) at 4–5 months for ALSPAC and 1.25 (1.1, 1.5) and 1.15 (1.0, 1.3) for SWS. Earlier introduction of solids was associated with a shorter duration of breastfeeding, particularly in cohorts where earlier introduction of solids was the norm, with a dose–response relationship, which was not explained by background social characteristics. As mothers most commonly introduced solids in the month prior to the then recommended age, continuing to recommend deferring solids to the age of 6 months is important to support sustained breastfeeding.
Highlights
Breastfeeding is important throughout the first year of life, with positive health outcomes in the short (Horta & Victora, 2013) and long term (Kramer et al, 2008)
It is well recognised that intake of breast milk is displaced by use of infant formula milk and that this is an important cause of early breastfeeding cessation, but it is less clear whether early introduction of solid foods has the same effect
After applying the inclusion criteria, there were 10,407 infants with breastfeeding duration of 2 months or more: 6,079 from Avon Longitudinal Study of Parents and Children (ALSPAC), 1,500 from Southampton Woman's Survey (SWS), and 2,828 from Infant Feeding Survey 2010 (IFS); 59%, 52%, and 56% of these were breastfed to the age of 6 months or beyond in ALSPAC, SWS, and IFS, respectively (Table 1)
Summary
Breastfeeding is important throughout the first year of life, with positive health outcomes in the short (Horta & Victora, 2013) and long term (Kramer et al, 2008). These protective effects are most pronounced in low- and middle-income countries but are important in high-income countries (Victora et al, 2016). For this reason, in 2002, the World Health Organisation recommended breastfeeding exclusively for 6 months, followed by continued breastfeeding with complementary feeding up to 2 years or beyond (Kramer & Kakuma, 2002). The review suggested that there was no evidence of harm in developed countries, but did not consider the possible impact of early SF on exposure to breast milk
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