John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. It is generally recommended that babies should be exclusively breastfed for the first six months of life, but most are given some additional fluids or foods during this period. In August 2016, Hazel Smith from Our Lady's Children's Hospital in Dublin and Genevieve Becker from BEST services in Galway in Ireland updated the Cochrane Review of the randomised trials and we asked Hazel to tell us about their current findings in this podcast.

Hazel: We examined 11 randomised trials, involving just over 2500 children to investigate if providing breastfed infants with fluids, other than breastmilk, or foods before six months of age is harmful or beneficial to their health. This involved three comparisons, exploring exclusive breastfeeding against the introduction of artificial milk, water or glucose water and food. In summary, we found no evidence that breastfed infants who were given any additional fluids or foods prior to six months had better glucose levels, temperature, weight loss or gain, cough, congestion, nasal discharge and hoarseness, fever or iron deficiency.
Giving infants artificial milk for a few days after birth, in addition to breastfeeding, did not affect the number who were still receiving breastmilk at hospital discharge, but it did slightly increase the likelihood of any breastfeeding at three months of age. Although it should be noted that the studies were graded as having ‘low-quality evidence’. On the other hand, infants were more likely to continue to breastfeed if they were in the exclusive breastfeeding group rather than the group provided with additional water or glucose water in the first few days of life.
Based on a single trial, the use of artificial milk before breastfeeding had a slight protective effect against allergy symptoms at 18 months of age compared to exclusive breastfeeding. However, the trial did not perform diagnostic challenges or other tests to confirm the allergy symptoms noticed and we need to be cautious when interpreting its results. Breastfeeding infants receiving complementary foods at four to six months of age did not show reduced risks of food allergy or eczema.
In conclusion, our review has not found sufficient evidence to disagree with the recommendation of the World Health Organization and other international health bodies that, as a general policy, exclusive breastfeeding without additional foods or fluids, should be recommended for the first six months after birth.

John: Full details of the trials in Hazel’s review, along with more information on exclusive breastfeeding is available in the full version of the review which is available online. Go to Cochrane Library dot com and search ‘early food and fluids’.