Kim Fleischer Michaelsen, Lawrence Weaver, Francesco Branca and Aileen Robertson
WHO Regional Publications, European Series, No. 87
World Health Organization 2000, updated reprint 2003

The guidelines are designed for the WHO European Region, with emphasis on the countries that resulted from the dissolution of the former Soviet Union. Nutrition and feeding practices vary throughout the Region and these recommendations should be applied flexibly and be adapted to local and national needs and circumstances. Despite the wide range of socioeconomic conditions found between and within the Member States of the Region, it is believed that many recommendations can be applied universally. They are especially applicable to the most vulnerable groups of infants and young children living in deprived conditions. These are mainly found in the eastern part of the Region, but are also common in ethnic minorities and children of low-income families in western Europe.

Introduction and Background

This review of the developmental readiness of normal full term infants to progress from exclusive breastfeeding to the introduction of complementary foods has been undertaken as a result of the international debate regarding the best age to introduce complementary (semi-solid and solid) foods into the diet of the breastfed human infant. Since 1979 the World Health Organization has recommended that normal full term infants should be exclusively breastfed for „four to six months.” Over the two decades since this recommendation was established further evidence regarding the benefits of breastmilk and breastfeeding has accumulated. In addition, there have been increasing reports suggesting an association between discontinuing exclusive breastfeeding prior to six months of age and an increase in infant morbidity and mortality. Throughout the world many professionals as well as a number of governments have concluded that there is sufficient evidence to recommend continuing exclusive breastfeeding for „about six months” Even within WHO, UNICEF and other international agencies, some documents continue to recommend exclusive breastfeeding for „four to six months” while others now use „about six months”. There is an urgent need to review this matter and determine whether or not there is sufficient scientific evidence to change in the global recommendation. WHO responded to this need and arranged for a review of the recent studies that relate duration of exclusive breastfeeding („four to six months versus six months”) to infant morbidity and mortality as well as growth and maternal health.