PEDIATRICS Vol. 117 No. 2 February 2006, pp. 425-432 (doi:10.1542/peds.2004-2283)
Full Breastfeeding Duration and Associated Decrease in Respiratory Tract Infection in US Children
a Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
b Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
c American Academy of Pediatrics Center for Child Health Research, Rochester, New York
OBJECTIVE. The American Academy of Pediatrics recommends exclusive breastfeeding for an infant's first 6 months of life. When compared with exclusive breastfeeding for 4 months, greater protection against gastrointestinal infection, but not respiratory tract infection, has been demonstrated for the 6-month duration. The objective of this study was to ascertain if full breastfeeding of 
6 months compared with 4 to <6 months in the United States provides greater protection against respiratory tract infection.
METHODS. Secondary analysis of data from the National Health and Nutrition Examination Survey III, a nationally representative cross-sectional home survey conducted from 1988 to 1994, was performed. Data from 2277 children aged 6 to <24 months, who were divided into 5 groups according to breastfeeding status, were compared. Children who required neonatal intensive care were excluded. SUDAAN software was used to account for the complex sampling design. Logistic regression adjusted for confounding factors. Outcome measures included adjusted odds of acquiring pneumonia, 3 episodes of cold/influenza, 3 episodes of otitis media (OM), or wheezing in the past year or acquiring first OM at <12 months of age.
RESULTS. In unadjusted analyses, infants who were fully breastfed for 4 to <6 months (n = 223) were at greater risk for pneumonia than those who were fully breastfed for 6 months (n = 136) (6.5% vs 1.6%). There were not statistically significant differences in 3 episodes of cold/influenza (45% vs 41%), wheezing (23% vs 24%), 3 episodes of OM (27% vs 20%), or first OM at <12 months of age (49% vs 47%). Adjusting for demographic variables, childcare, and smoke exposure revealed statistically significant increased risk for both pneumonia (odds ratio [OR]: 4.27; 95% confidence interval [CI]: 1.27–14.35) and 3 episodes of OM (OR: 1.95; 95% CI: 1.06–3.59) in those who were fully breastfed for 4 to <6 months compared with 6 months.
CONCLUSIONS. This nationally representative study documents increased risk of respiratory tract infection including pneumonia and recurrent OM in children who were fully breastfed for 4 vs 6 months. These findings support current recommendations that infants receive only breast milk for the first 6 months of life.
Key Words: breastfeeding • benefits • respiratory infections • infant feeding • nutrition-infant
Abbreviations: WHO—World Health Organization • URI—upper respiratory infection • OM—otitis media • NHANES—National Health and Nutrition Examination Survey • ROM—recurrent otitis media • OM<12—otitis media at <12 months of age • FullBF<1—fully breastfed for <1 month • FullBF1-3—fully breastfed for 1 to <4 months • FullBF4-5—fully breastfed for 4 to <6 months • FullBF6—fully breastfed for 6 months • OR—odds ratio • CI—confidence interval • no BF—not breastfed
Accepted Jun 3, 2005.
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