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The World Health Organization, the American Academy of Pediatrics, and all major health organizations recommend that all infants should be exclusively breast-fed for the first 6 months of life, and breast-feeding should be continued while adding weaning foods for the next 6 months and then for as long as mother and child desire (unless there is a medical contraindication).1,2 Human milk has evolved for the human infant and is ideally structured to meet the nutritional needs for infant growth and development. It provides a variety of bioactive components that protect from infection and promote normal development.3 These include hormones (oxytocin, thyroid-stimulating hormone, growth hormone, thyroxine, cortisol insulin), growth factors (epidermal growth factor, nerve growth factors, somatomedin-C, insulinlike growth factors), neuropeptides (somatostatin, neurotensin, vasoactive peptides), inflammatory and immunomodulatory agents (cytokines), and pheromones, which stimulate suckling behavior.4-6 The relative composition of milk and its bioactive agents differ from one mother to the next depending on her past experience, her genetic makeup, her diet, and the gestational age of her infant. The composition of the mother’s milk changes over time following birth and over the course of the feeding.

The beneficial effects of providing species-specific nutrition in the early months may extend far past the time of weaning and have been described as “nutritional programming.” Human milk significantly influences growth, neurocognitive development,7 and cardiovascular disease.6-9 Advantages of breast milk also are observed in the preterm or small-for-gestational-age infants, especially in the prevention of necrotizing enterocolitis,10 but supplementation with specific nutrients may be required to assure optimal growth and neurocognitive development.11

The concept of nutritional programming implies that a stimulus or insult during a critical or sensitive period of development can have long-term or lifetime effects. A beneficial effect of human milk on long-term development of a healthful childhood and adult intestinal microbiome has been proposed but is not yet established.12 Colostrum, with its host of bioactive factors, is the infant’s first immunization and likely begins the interaction between breast milk and intestinal mucosal factors that control the development of the intestinal microbiome. Factors known to interfere with the normal establishment of a beneficial flora include delayed feedings, antibiotics, cesarian section delivery, and formula feeding.9,12 Human milk supports the prevalence of beneficial microflora (bifidobacteria and lactobacillus) and potentially inhibits the establishment of pathogenic microbes.6 Exclusive breast-feeding for at least 4 months is also associated with a reduction in atopic disease, indicating that later immunologic responses are possibly programmed during infancy.13

Breast-feeding appears to establish a more healthful feeding pattern throughout life that influences growth parameters. The physiologic weight loss in the first several days and subsequent growth pattern of the breast-fed infant differs from that of formula-fed infants.14 Some studies suggest that breast-fed infants may have lower rates of obesity compared to formula-fed infants.15,16 This finding has led to the establishment of ...

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