Let us first state what we all agree on: Breast milk is best for the baby in the first place. There is no doubt that breast milk protects against infections, first and foremost against infections of the stomach and intestines. We also find this when we study children who are part of the Norwegian mother, father and child survey, MoBa. One of several reasons why Norwegian children are so healthy is good access to breast milk. Norwegian mothers are at the top of the world, 97 per cent breastfeed at one week of age, and almost 80 per cent still breastfeed at six months. This is reason to be proud of, and no reason to change. But when is the best time to let the baby get other foods in addition to breast milk? The Scandinavian study published in the Lancet in June showed that the incidence of food allergy at the age of three was 60 percent lower if the child received tastings of peanuts, eggs, milk and wheat from 3-4 months of age compared to waiting until six months. This is in line with two other recent studies. In the leadership position in the Lancet, it is commented that the findings are now so solid that there is no reason to wait for more studies before we can establish that additional food in the time window before the age of six months protects against food allergies. In the MoBa study, we have studied several other diseases that could be prevented by prolonged full breastfeeding. We found no differences in the incidence of type 1 diabetes and asthma in children who were fully breastfed for six months compared to four months, and celiac disease was slightly more common among children who started late with porridge. Breastfeeding protected against infections for the first six months. However, the study also showed that the protective effect of breast milk was just as good if the child received the addition of other foods from the age of four months. This is not surprising either, since breast milk contains the same and the additional food is clean and safe. In other words, minor food allergies are the difference that is relevant to Norwegian conditions. The Norwegian Directorate of Health’s guidelines from 2001 to recommend full breastfeeding for six months were controversial, since research data could not support that it made any difference whether other types of food were started at four or six months of age. The revision that came in 2016 landed with a divided attitude after several years of discussions, precisely because many competent professionals did not agree to keep the recommendation from 2001. New Norwegian data (Spedkost 2020) shows that very few wait to provide additional food for six months, as recommended by the Norwegian Directorate of Health. The proportion who breastfeed at 5.5 months of age has fallen from 12 to 5 per cent since 2006. Nevertheless, the proportion who breastfeed at the same age – four out of five mothers – has hardly changed since the first Spedkost survey in 2006. That the national recommendations are followed of a small minority is perhaps just as well, and not entirely surprising. Guidelines that are not perceived as relevant by professionals and by parents have little impact in practice. The Norwegian Directorate of Health states to news that they have no plans to update the guidelines, but are awaiting a new update from the World Health Organization (WHO). This way of thinking presupposes that the optimal infant nutrition is the same regardless of which end of the welfare scale one lives on. Prolonged full breastfeeding is important and can save many children who grow up where infectious diseases are the biggest health threat and alternative food sources can cause infections. Norwegian children have other health challenges, and the food is clean and safe. Recommendations for infant nutrition should be nuanced so that they reach the population to which it applies. Many rich countries therefore have other recommendations than those given by the WHO. The WHO also recommends breastfeeding until the age of 24 months, but the Norwegian Directorate of Health has allowed itself a separate interpretation – at least 12 months. Loyalty to the WHO Council is perhaps still a bit flexible? We who work with children and nutrition on a daily basis in hospitals and in research are not worried about the gap between Norwegian infant parents’ choices and the guideline for infant nutrition. We want good and updated guidelines that are relevant to Norwegian conditions. Therefore, we encourage the Norwegian Directorate of Health to take on new knowledge, and provide guidelines that are in line with good practice.
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Give babies solid food – Expression
