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August 15, 1986, Vol 256, No. 7 >
ARTICLE | August 15, 1986

Studies of Breast-feeding and Infections: Title and subTitle BreakHow Good Is the Evidence? FREE

Howard Bauchner, MD; John M. Leventhal, MD; Eugene D. Shapiro, MD
[+] Author Affiliations

Reprint requests to Child Development Unit, House Officer's Bldg, Room 218, Boston City Hospital, 818 Harrison Ave, Boston, MA 02118 (Dr Bauchner).


JAMA. 1986;256(7):887-892. doi:10.1001/jama.1986.03380070093026
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References

We assessed the extent to which studies of the association between breast-feeding and infection met four important methodological standards that relate to both the scientific validity and the generalizability of the studies. Of the 20 studies (14 cohort, six case-control), only six met three or four of the methodological standards. Four of these six studies found that breast-feeding was not protective against infections and two found that breast-feeding was protective against infections. In the three studies in which statistical adjustments were made for three additional potentially important confounding variables—size of the family, smoking of cigarettes by the mother, and the mother's level of education—the apparent protective effect of breast-feeding against respiratory tract infections disappeared after the adjustments were made. We found that most of the studies have major methodological flaws that may have compromised their conclusions. The studies that met important methodological standards and controlled for confounding variables suggest that breast-feeding has at most a minimal protective effect in industrialized countries.

(JAMA 1986;256:887-892)

REFERENCES

1 +
Martinez GA, Dodd DA: 1981  Milk feeding patterns in the United States during the first 12 months of life . Pediatrics 1983;;71:166-170.
2 +
Jelliffe DB, Jelliffe EF:  'Breast is best' modern meanings . N Engl J Med 1977;;297:912-915.
3 +
American Academy of Pediatrics:  The promotion of breast-feeding . Pediatrics 1982;;69:654-661.
4 +
Welsh JK, May JT:  Anti-infective properties of breast milk . J Pediatr 1979;;94:1-9.
5 +
Glass RI, Svennerholm AM, Stoll BJ, et al:  Protection against cholera in breast-fed children by antibodies in breast milk . N Engl J Med 1983;;308:1389-1392.
6 +
Plank SJ, Milanesi ML:  Infant feeding and infant mortality in rural Chile . Bull WHO 1973;; 48:203-210.
7 +
Mata LH, Urrutia JJ, Gordon JE:  Diarrheal disease in a cohort of Guatemalan village children observed from birth to age 2 years . Trop Geogr Med 1967;;19:247-251.
8 +
Paine R, Coble RJ:  Breast-feeding and infant health in a rural US community . AJDC 1982;; 136:36-38.
9 +
Saarinen UM:  Prolonged breast feeding as prophylaxis for recurrent otitis media . Acta Paediatr Scand 1982;;71:567-571.
10 +
Watkins CJ, Leeder SR, Corkhill RT:  The relationship between breast and bottle feeding and respiratory illness in the first year of life . J Epidemiol Community Health 1979;;33:180-182.
11 +
Chandra RK:  Prospective studies of the effect of breast feeding on incidence of infection and allergy . Acta Paediatr Scand 1979;;68:691-694.
12 +
Cunningham AS:  Morbidity in breast-fed and artificially fed infants: II . J Pediatr 1979;;95:685-689.
13 +
France GL, Marmer DJ, Steele RW:  Breast-feeding and Salmonella infection . AJDC 1980;; 134:147-152.
14 +
Fergusson DM, Horwood JL, Shannon FT, et al:  Breast-feeding, gastrointestinal and lower respiratory illness in the first two years . Aust Paediatr J 1981;;17:191-195.
15 +
Cussen GT:  Breast feeding and neonatal morbidity , in Wharton BA (ed): Topics in Perinatal Medicine . London, Pitman Medical, 1978;, pp 79-87.
16 +
 Research Subcommittee of the South-East England Faculty. The influence of breast-feeding on the incidence of infectious illness during the first year of life . Practitioner 1972;;209:356-362.
17 +
Taylor B, Golding J, Wadsworth J, et al:  Breast-feeding, bronchitis, and admissions for lower-respiratory illness and gastroenteritis during the first five years . Lancet 1982;;1:1227-1229.
18 +
Adebonojo FO:  Artificial vs breast feeding . Clin Pediatr 1972;;11:25-29.
19 +
Frank AL, Taber LH, Glezen WP, et al:  Breast-feeding and respiratory virus infection . Pediatrics 1982;;70:239-245.
20 +
Cushing AH, Anderson L:  Diarrhea in breastfed and non-breast-fed infants . Pediatrics 1982;; 70:921-925.
21 +
Holmes GE, Hassanein K, Miller HC:  Factors associated with infections among breast-fed babies and babies fed proprietary milks . Pediatrics 1983;;72:300-305.
22 +
Downham M. Scott R, Sims DG, et al:  Breast-feeding protects against respiratory syncytial virus infections . Br Med J 1976;;2:274-276.
23 +
Tripp JH, Wilmers MJ, Wharton BA:  Gastroenteritis: A continuing problem of child health in Britain . Lancet 1977;;2:233-236.
24 +
Larsen SA, Homer DR:  Relation of breast versus bottle feeding to hospitalization for gastroenteritis in a middle-class U.S. population . J Pediatr 1978;;78:417-418.
25 +
Fallot ME, Boyd JL, Oski FA:  Breast-feeding reduces incidence of hospital admissions for infection in infants . Pediatrics 1980;;65:1121-1124.
26 +
Pullan CR, Toms GL, Martin AJ, et al:  Breast-feeding and respiratory syncytial virus infection . Br Med J 1980;;281:1034-1036.
27 +
Weinberg RJ, Tipton G, Klish WJ, et al:  Effect of breast-feeding on morbidity in rotavirus gastroenteritis . Pediatrics 1984;;74:250-253.
28 +
Hayden GF, Kramer MS, Horwitz RI:  The case-control study: A practical review for the clinician . JAMA 1982;;247:326-331.
29 +
Dodd C: Report of a Symposium on Clinical Trials Held at the Royal Society of Medicine . London, Pfizer, 1958;.
30 +
Horwitz RI, Feinstein AR:  Methodologic standards and contradictory results in case-control research . Am J Med 1979;;66:556-563.
31 +
Feinstin AR: Clinical Epidemiology: The Architecture of Clinical Research . Philadelphia, WB Saunders Co, 1985;, pp 683-718.
32 +
Dingle JH, Badger GF, Jordan WS: Illness in the Home . Cleveland, Western Reserve University Press, 1964;.
33 +
Sauls HS:  Potential effect of demographic and other variables in studies comparing morbidity of breast-fed and bottle-fed infants . Pediatrics 1979;; 64:523-527.
34 +
Tager IB, Weiss ST, Rosner B, et al:  Effect of parental cigarette smoking on the pulmonary function of children . Am J Epidemiol 1979;;110:15-26.
35 +
Kleinbaum DG, Kupper LL, Morgenstern H: Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif, Lifetime Learning Publications, 1982;, pp 336-337.
36 +
Lee ET: Statistical Methods for Survival Data Analysis . Belmont, Calif, Lifetime Learning Publications, 1980;, p 136.
37 +
Riegelman RK: Studying a Study and Testing a Test . Boston, Little Brown & Co Inc, 1981;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Martinez GA, Dodd DA: 1981  Milk feeding patterns in the United States during the first 12 months of life . Pediatrics 1983;;71:166-170.
2 +
Jelliffe DB, Jelliffe EF:  'Breast is best' modern meanings . N Engl J Med 1977;;297:912-915.
3 +
American Academy of Pediatrics:  The promotion of breast-feeding . Pediatrics 1982;;69:654-661.
4 +
Welsh JK, May JT:  Anti-infective properties of breast milk . J Pediatr 1979;;94:1-9.
5 +
Glass RI, Svennerholm AM, Stoll BJ, et al:  Protection against cholera in breast-fed children by antibodies in breast milk . N Engl J Med 1983;;308:1389-1392.
6 +
Plank SJ, Milanesi ML:  Infant feeding and infant mortality in rural Chile . Bull WHO 1973;; 48:203-210.
7 +
Mata LH, Urrutia JJ, Gordon JE:  Diarrheal disease in a cohort of Guatemalan village children observed from birth to age 2 years . Trop Geogr Med 1967;;19:247-251.
8 +
Paine R, Coble RJ:  Breast-feeding and infant health in a rural US community . AJDC 1982;; 136:36-38.
9 +
Saarinen UM:  Prolonged breast feeding as prophylaxis for recurrent otitis media . Acta Paediatr Scand 1982;;71:567-571.
10 +
Watkins CJ, Leeder SR, Corkhill RT:  The relationship between breast and bottle feeding and respiratory illness in the first year of life . J Epidemiol Community Health 1979;;33:180-182.
11 +
Chandra RK:  Prospective studies of the effect of breast feeding on incidence of infection and allergy . Acta Paediatr Scand 1979;;68:691-694.
12 +
Cunningham AS:  Morbidity in breast-fed and artificially fed infants: II . J Pediatr 1979;;95:685-689.
13 +
France GL, Marmer DJ, Steele RW:  Breast-feeding and Salmonella infection . AJDC 1980;; 134:147-152.
14 +
Fergusson DM, Horwood JL, Shannon FT, et al:  Breast-feeding, gastrointestinal and lower respiratory illness in the first two years . Aust Paediatr J 1981;;17:191-195.
15 +
Cussen GT:  Breast feeding and neonatal morbidity , in Wharton BA (ed): Topics in Perinatal Medicine . London, Pitman Medical, 1978;, pp 79-87.
16 +
 Research Subcommittee of the South-East England Faculty. The influence of breast-feeding on the incidence of infectious illness during the first year of life . Practitioner 1972;;209:356-362.
17 +
Taylor B, Golding J, Wadsworth J, et al:  Breast-feeding, bronchitis, and admissions for lower-respiratory illness and gastroenteritis during the first five years . Lancet 1982;;1:1227-1229.
18 +
Adebonojo FO:  Artificial vs breast feeding . Clin Pediatr 1972;;11:25-29.
19 +
Frank AL, Taber LH, Glezen WP, et al:  Breast-feeding and respiratory virus infection . Pediatrics 1982;;70:239-245.
20 +
Cushing AH, Anderson L:  Diarrhea in breastfed and non-breast-fed infants . Pediatrics 1982;; 70:921-925.
21 +
Holmes GE, Hassanein K, Miller HC:  Factors associated with infections among breast-fed babies and babies fed proprietary milks . Pediatrics 1983;;72:300-305.
22 +
Downham M. Scott R, Sims DG, et al:  Breast-feeding protects against respiratory syncytial virus infections . Br Med J 1976;;2:274-276.
23 +
Tripp JH, Wilmers MJ, Wharton BA:  Gastroenteritis: A continuing problem of child health in Britain . Lancet 1977;;2:233-236.
24 +
Larsen SA, Homer DR:  Relation of breast versus bottle feeding to hospitalization for gastroenteritis in a middle-class U.S. population . J Pediatr 1978;;78:417-418.
25 +
Fallot ME, Boyd JL, Oski FA:  Breast-feeding reduces incidence of hospital admissions for infection in infants . Pediatrics 1980;;65:1121-1124.
26 +
Pullan CR, Toms GL, Martin AJ, et al:  Breast-feeding and respiratory syncytial virus infection . Br Med J 1980;;281:1034-1036.
27 +
Weinberg RJ, Tipton G, Klish WJ, et al:  Effect of breast-feeding on morbidity in rotavirus gastroenteritis . Pediatrics 1984;;74:250-253.
28 +
Hayden GF, Kramer MS, Horwitz RI:  The case-control study: A practical review for the clinician . JAMA 1982;;247:326-331.
29 +
Dodd C: Report of a Symposium on Clinical Trials Held at the Royal Society of Medicine . London, Pfizer, 1958;.
30 +
Horwitz RI, Feinstein AR:  Methodologic standards and contradictory results in case-control research . Am J Med 1979;;66:556-563.
31 +
Feinstin AR: Clinical Epidemiology: The Architecture of Clinical Research . Philadelphia, WB Saunders Co, 1985;, pp 683-718.
32 +
Dingle JH, Badger GF, Jordan WS: Illness in the Home . Cleveland, Western Reserve University Press, 1964;.
33 +
Sauls HS:  Potential effect of demographic and other variables in studies comparing morbidity of breast-fed and bottle-fed infants . Pediatrics 1979;; 64:523-527.
34 +
Tager IB, Weiss ST, Rosner B, et al:  Effect of parental cigarette smoking on the pulmonary function of children . Am J Epidemiol 1979;;110:15-26.
35 +
Kleinbaum DG, Kupper LL, Morgenstern H: Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif, Lifetime Learning Publications, 1982;, pp 336-337.
36 +
Lee ET: Statistical Methods for Survival Data Analysis . Belmont, Calif, Lifetime Learning Publications, 1980;, p 136.
37 +
Riegelman RK: Studying a Study and Testing a Test . Boston, Little Brown & Co Inc, 1981;.

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