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Running head: OUTCOMES OF BREASTFED INFANTS 1
Outcomes of Breastfed Infants Compared to Alternative Feeding Methods
Michelle Russell
University of South Florida – College of Nursing
NUR 4165
12-9-12
Word Count: 4,301
OUTCOMES OF BREAST-FED INFANTS 2
Outcomes of Breastfed Infants Compared to Alternative Feeding Methods
Introduction
There has been controversy, especially among mothers and pregnant women, about
which feeding method is more beneficial for infants – breastfeeding, formula fed, or even a
combination of both. This synthesized literature review focuses on the benefits of breastfeeding
and what makes it stand apart from other infant feeding alternatives. The American Association
of Pediatrics (AAP) (2012) has established recommendations such as exclusive breastfeeding
within the first six months of an infant’s life, iron-rich formula for those infants formula fed
(since the nutrition is not equivalent to that of breast feeding), no cow’s milk during the first year
of life, and recommends the introduction of jarred baby food at 6 months of life. The World
Health Organization (WHO) (2012) also agrees with the AAP on exclusive breastfeeding during
the first 6 months of life. Five unique and reliable peer reviewed articles, written within the last
five years, were reviewed and critiqued to address this controversy. Despite these authoritative
recommendations, only 20% of the women population who mother an infant in the United States,
exclusively breastfeed (Center for Disease Control and Prevention (CDC), 2009). Healthy
People 2020 (2012) has a goal for 60.6% of all infants to be breastfed at 6 months by year 2020.
All five articles reviewed here are unique in that they each address various aspects of
breastfeeding such as: nutritional benefit, prevention of illness, the long term affect on brain
function, mental health, and overall health outcomes amongst minority populations. The articles
utilized are titled the following: (1) “Breastfeeding Protects against Current Asthma up to 6
Years of Age” (Silvers et al., 2011), (2) “The Long-Term Effects of Breastfeeding on Child and
Adolescent Mental Health: A Pregnancy Cohort Study Followed for 14 Years” (Oddy et al.,
2010), (3) “ Breast-Fed Infants Process Speech Differently From Bottle-Fed Infants: Evidence
From Neuroelectrophysiology,” (Ferguson and Molfese, 2007), (4) “Associations Among
OUTCOMES OF BREAST-FED INFANTS 3
Feeding Behaviors During Infancy and Child Illness at Two Years,” (Philipsen, Razza, Malone,
and Brooks-Gunn, 2008) and (5) “Breastfeeding and Health Outcomes among Citizen Infants of
Immigrant Mothers” (Neault et al., 2007). The articles were purposefully reviewed in this order
to synthesize from narrow studies to broader in terms of the benefits associated with
breastfeeding.
Reliable databases were used to search for these articles including ‘MDConsult,’
‘Medline,’ and “CINAHL.’ both funded by the Shimberg Library to provide the full article for
review. Search terms used to obtain the articles include ‘breastfeeding benefits formula fed’ and
other variations of that phrase to obtain articles that can provide a comparison of both feeding
methods. Articles not chosen were those not peer-reviewed, not recent within five years, reviews
of studies, meta-analysis, if the study was not reliable or credible, or if the study failed to address
the clinical problem entirely.
Synthesized Literature Review
Silvers et al., (2011) conducted a research study to investigate the effects of breastfeeding
on children between ages 2 to 6 who are currently suffering with asthma. The sample included
1105 infants; they were categorized in a prospective birth cohort in New Zealand. Expectant
mothers were recruited by their midwives before their child’s birth, and consent was provided.
Methods to collect information consisted of questionnaires given to mothers at their child’s birth,
and at 3, 6, and 15 months. Questionnaires asked the participants questions to provide detailed
information on breastfeeding. There were two ways in which breastfeeding was assessed through
the questionnaire- the duration of ‘exclusive’ breastfeeding and the duration of ‘any’
breastfeeding. ‘Exclusive’ breastfeeding questions contained components such as the age when
infant formula, food or drinks were introduced. While mothers who fell into the ‘any’
OUTCOMES OF BREAST-FED INFANTS 4
breastfeeding category were asked to provide information regarding the age when the
breastfeeding ceased. Based off the responses, questionnaires were compiled to determine the
durations of exclusive breastfeeding and partial breastfeeding. There was a total of 1105 infants
enrolled in the study before birth, and questionnaires were completed for 1064 children at 3
months, 1011 at 15 months, 1011 at 2 years, 1007 at 3 years, 986 at 4 years, 990 at 5 years, and
920 at 6 years. Secondly, information about any wheezing or current asthma at 2, 3, 4, 5, and 6
years was collected amongst children as a secondary measure. The article defined asthma as:
ever having a diagnosis, any wheeze in the last 12 months, or use of inhaler within the last 12
months.
A table was included to provide a breakdown of participant demographics including
gender, age when breastfeeding began and/ or ended, and compiled other variables such as
smoking during pregnancy or in the household, atopy, parental history of allergic diseases,
maternal history of asthma (Silvers et al., 2011). The ‘Exclusive’ breastfeeding category was
further broken down by age when infant formula, food or drinks were introduced. Whereas the
‘any’ breastfeeding group was broken down to the age when the breastfeeding ceased. Based on
the results, of the 987 of the infants who were exclusively breastfed, 337 began ingesting infant
formula, food, or drinks within or equal to the first week of life. Furthermore, of the 1011 infants
who fell into the ‘any’ breastfeeding category, 335 stopped breastfeeding between 6-12 months.
The outcomes for current children with asthma and current children who are wheezing
from ages 2 through 6, were compared to the number of the individuals who fell into that age
group to the number of individuals who were diagnosed with asthma or presented with wheezing
(Silvers et al., 2011). Further analysis of the results and table demonstrate that for each month of
exclusive breastfeeding, asthma was reduced by 17% for children 2 years old, 12% for 3 years,
OUTCOMES OF BREAST-FED INFANTS 5
11% by 4 years, 12% by 5 years and 9% by 6 years. Atopic children were also factored in-
exclusive breastfeeding for ages greater than 3 months reduced asthma in atopic children by 63%
by 4 years, 56% by 5 years of age, and 59% by 6 years.
The purpose of the study conducted by Oddy et al. (2010), was to determine if
breastfeeding independently affected child and adolescent mental health. A longitudinal study
was conducted in Australia on a total of 2900 recruited pregnant women who were then followed
for 14 years. The participant’s criteria for enrollment included gestational age between 16 and 20
weeks, proficiency in English, expectation to deliver at a hospital, and plan to remain in Western
Australia for long term follow-up. Demographic data from each expecting mother including
family, social, economic, and obstetric history were compiled during the enrollment process.
Once each mother delivered their child, the new born was examined by a pediatrician. By using a
Child Behavior Checklist (CBCL), mental status assessments were achieved at ages 2, 6, 8, 10,
and 14 years. According to the California Evidence Based Clearinghouse (CEBC), the CBCL is a
reliable scale which obtains report from parents, or guardians about their child’s competencies or
behaviors (Achenbach, 2009). A total of 20 competencies were assessed by the caregiver at all
age intervals including the child’s activities, social relations, and school performance; as well as
118 behavior and emotional problems based off a likert scale (Oddy et al., 2010). In addition to
the CBCL, a questionnaire, structured interview and clinical examination were completed on all
available children at ages 2, 6, 8, 10, and 14 years as well. The questionnaires were sent by mail
to be completed before the interview and assessments, and contained information regarding the
general health and well-being of the family and child.
After statistical analysis of the results through T-scores was established, it was
determined that breastfeeding less than 6 months was correlated with increased child behavioral
OUTCOMES OF BREAST-FED INFANTS 6
problems; whereas breastfeeding for longer than 6 months was associated with less occurrence of
mental health problems amongst children (Oddy et al., 2010). There were 28% of infant’s
breastfed between 6 and 12 months, and 24% were breastfed for 12 months of longer. Of the
infant’s breastfed at least 6 months or more, there was a significantly lower CBCL scores across
all domains; the lower score is indicative of decreased mental health problems. Variables such as
smoking during pregnancy, low family income, young mothers (usually without college
education), stressful events, and absence of the biological father were correlated with mothers
who breastfed less than 6 months, as well as a higher CBCL score.
A study conducted by Ferguson and Molfese, from the department of psychological and
brain sciences at the University of Louisville, examined how breast-fed infants process speech
differently from bottle-fed infants (2007). This study identified that polyunsaturated fatty acids
(PUFAs) in breast milk are correlated with increasing nutritional benefits, and are thought to
have an impact on brain and cognitive development. Although, there is PUFA enriched formula
on the market as well, which claims to have the same effects on the brain and cognitive
development as breast milk. The purpose of this study was to analyze the differences on brain
function between breast milk and PUFA containing formula.
A total of 12 infants participated in this study between ages 5 months and 7 months
(Ferguson and Molfese, 2007). Two different phases of testing took place: (1) a behavioral
assessment session which evaluated the infant’s developmental level and (2) an Event Related
Potential (ERP) portion which evaluated wavelengths of brain responses to auditory speech. Two
groups were established for participants: exclusive breastfeeding and exclusive bottle fed
(PUFA) formula. Each group contained 3 males and 3 females, and both had a mean age of 6
months. Much of the other demographic information was the same between both groups such as
OUTCOMES OF BREAST-FED INFANTS 7
birth weight, apgar scores, maternal age, and maternal education level (majority of the mothers
had college education). A Mental Development Index (MDI) was first administered to assess
each infant’s development level; there were no significant differences of development level
between each infant group. The next portion of the study consisted of auditory stimuli which
contained 6 consonant- vowel syllables. Efforts were implemented to improve the ‘naturalness’
of the sounds by using a Klatt synthesizer to model the amplitude and frequency of natural
speech. The stimulus was centered midline over each infant’s head and the stimulus intervals
varied to reduce expectation and habituation effects. Immediately following the auditory
simulation, the infants head circumference was measured to determine an appropriate size 128-
electrode net; this was then used to record auditory ERPs. Electrophysiological data was
recorded with Net Station 3.0, and the infants were continuously monitored with the EEG.
Infants were awake during the entire procedure, and testing was temporarily suspended if there
was motor or state change.
Statistical analysis supported the original hypothesis that breast-fed infants were
advantaged for later cognitive development and was more sensitive to speech stimuli (Ferguson
and Molfese, 2007). Furthermore, infants who received the exclusive PUFA enriched formula
did not generate similar brain activity in comparison to the breast-fed infants. Based on the
results, it is assumed that breast-fed infants are more advantaged specifically in linguistic and
cognitive development.
The purpose of the study conducted by Hetzer et al. (2008) was to examine different
feeding combinations, and the effects each one has with toddlerhood child illness such as asthma,
respiratory, gastrointestinal infections, and ear infections. Participants were excluded from the
study if: (1) the infant was fed cow milk during the first 6 months of life, (2) the biological
OUTCOMES OF BREAST-FED INFANTS 8
mother was not still the caregiver of the child at 9 months and 2 years mark, (3) if the child was
less younger than 23.4 months by the time of the second data collection, (4) children with long
term disabilities (i.e. spinal bifida), (5) if there was not complete parents interviews at the child’s
9 months and 2 year age, or (6) if there was missing data on the child’s feeding or illness. This
left the study with a final sample of approximately 7,900 children. Three distinct parts of the
study was collected: (1) demographic, background information, (2) feeding methods/
combinations that occurred during the first 6 months of life, (3) the occurrence of childhood
illness by 2 years of age.
Background/ demographic information were collected at the 9 months mark (Hetzer et
al., 2008). More specifically, this information included the infant’s demographics such as race/
ethnicity, sex, birth weight. Family demographics was also collected including the mothers age,
marital status, education level, health status, body mass index (BMI), maternal depression,
income (and if they were receiving WIC – a nutritional program for children). Information was
further collected about the pregnancy to account for variables about neonatal nutrition (including
vitamin intake), alcohol or tobacco use, number of visits to the obstetrician, or any other habits
or nutritional intake that could influence the child’s health outcome. Further information was
also collected about the home environment including other children present in the household,
food insecurity, or if the child received any non-parental care before 6 months of age. The
mother-child relationship was also assessed using the Nursing Child Assessment Teaching Scale
(NCATS), which measured 73 behaviors of the mother’s cognitive and social growth fostering,
responsiveness, sensitivity, and the child’s reactivity. This portion took 9 months to assess and
mother-infants were categorized in low engagement, average engagement, or high engagement
categories.
OUTCOMES OF BREAST-FED INFANTS 9
The second portion of information collection consisted of infant feeding practices;
whether exclusive formula, exclusive breast feeding, a combination of both or other feeding
methods and combinations during the infants first 6 months of life (Hetzer et al., 2008). (The
final portion of the study assessed the health and illness of infants at both the 9 months interview
and at the 2 year mark. There were four illnesses reported on: (1) Asthma, (2) respiratory
infection, (3) gastrointestinal infection, and (4) ear infection. Mothers were asked to report if
their child experienced any of these four illnesses or had symptoms of by the time of the 2 year
interview. The multiple variables were analyzed and were examined separately to assess whether
they had an impact on the health outcomes of the children during this study.
The results concluded that nearly 70% of feeding practices during the infants first 6
months of life consisted of breastfeeding (Hetzer et al., 2008). Of the 70% who were fed some
breast milk, 78% were also fed formula at some point during the 6 months (typically starting at 2
months), 74% were fed solid food (i.e. babyfood), and 15% were fed some sort of finger food
(i.e. Cheerios). Only 8% of the infants were exclusively breast fed during the first 6 months of
life – which followed the AAP’s recommendation.
There were two models created in this study- model 1, which specifically examined the
association of breastfeeding and combinations feeding methods with childhood illness, and
model 2, which controls for variables in the family-child background and demographics (Hetzer
et al., 2008).. Children were breast fed exclusively for 6 months had the lowest occurrence of
respiratory and ear infections when specifically looking at feeding combinations. In regards to
asthma, model 1 showed that children who were exclusively breastfed had lower rates of asthma
compared to other feeding combinations. However, when model 2 was analyzed to control the
variables, there was no statistical difference in children who were exclusively breastfed versus
OUTCOMES OF BREAST-FED INFANTS 10
those who had a combination in acquiring asthma. Model 1 also found that exclusively breast-fed
infants had lower rates of respiratory infections as well. Once the variables were accounted for in
model 2, infants exclusively breast-fed still had lower rates of respiratory infection and were
statistically different compared to other feeding combination groups, except for the breast milk
and formula group. Model 1 also suggested that there is no significant predictor of
gastrointestinal infections when analyzing feeding methods alone. However, model 2 determined
that when variables were controlled, exclusively breast-fed infants were no different in the
likelihood of contracting a gastrointestinal infection in comparison to the other feeding
combination groups. In regard to likelihood of acquiring ear infections, infants who were
exclusively breast fed had significantly less odds of acquiring the infection compared to the other
groups. Model 2 supported model 1 with the variables accounted for.
The study conducted by Neault et al. (2007), was broader in that its purpose was to
examine the effects of breastfeeding’s health outcomes on infants on a specific population –
immigrant mothers with food insecurity. Investigation is needed to analyze why immigrant
mothers are more likely to breast-feed and yet their children are at higher risk for poor health and
nutrition compared to their United States born peers. The participants were recruited from 5
regions throughout the Unites States at urban pediatric health care sites. To qualify for the study,
mothers must be immigrants with food insecurity, and the children must be less than 1 year of
age. A total of 3,592 immigrant mothers and 5,208 U.S. born mothers participated in this study.
Participants were excluded if they could not speak English, Spanish or Somali, unknowledgeable
about their demographics or child household, if the household lives in a different state than
where the interview is taking place, if the child was critically ill or if they refused consent. A
total of 21,564 caregivers were interviewed, however due to participants not meeting the
OUTCOMES OF BREAST-FED INFANTS 11
requirements, refusal to sign the consent form, or incompletion of the interview, there was a
result of 3,592 infants of immigrant mothers and 5,208 infants of U.S. born mothers.
The participating mothers were interviewed in private in the clinic, after consenting to the
study, and were surveyed by the Children’s Sentinel Nutrition Assessment Program (Neault et
al., 2007). Children aged 0-3 were interviewed in private settings during the waiting periods at
the clinics/ emergency department. Measurements such as weight and length were also recorded.
The initial interview contained topics of breastfeeding initiation (feeding combinations) and
duration, child’s current health status and past medical history, household sociodemographic
information, use of any federal assistance aid program and food security. Infants were
categorized based on if they have ever been fed breast milk, and for how long. However,
exclusive breast feeding was not recorded. Background and demographics of the infants and
mothers were compiled in a chart for comparison. T tests were used to determine statistical
significance between demographic information, breastfeeding status, and overall child health and
growth.
The results of this study concluded that of the U.S. mothers who were interviewed, they
breast-fed their infants less frequently (typically less than 1 month) compared to immigrant
mothers (Neault et al. 2007). There was also no significant health decline in infants who were
born to U.S. born mothers, which corresponds with the food insecurity associated with
immigrant mothers. Majority of the immigrant mothers were from Mexico, and others were from
Africa, other parts of Central America, Caribbean Islands, South America, Asia/ Pacific, and a
small amount from other regions. Of the infants from immigrant mothers, 83% of them were
breast-fed with a mean duration of about 3 months.
OUTCOMES OF BREAST-FED INFANTS 12
The first table provided, compares demographic information among both groups and
really associates the differences among breast feeding status (Neault et al. 2007).. There was also
a correlation amongst the immigrant mothers between breastfeeding, federal aid benefits, lower
income and food insecurity. Table 2 was un-adjusted (did not include variables) to analyze the
health outcomes associated breast fed infants to immigrant mothers. This table showed that the
breast-fed infants alone were associated with lower rates of poor health and also were correlated
with faster growth (weighing more and were longer for age). Table 3 was adjusted to control for
the background and demographic variables, and even still it was consistent with table 2 that
breast-fed infants were less likely to endure poor health despite the adjustment. Table 4 used z-
scores to include the food insecurity variable in the immigrant population and found that of the
children who were born to immigrant mothers with food insecurity and were breast fed were still
less likely than the non-breast-fed group to acquire illness and poor health; however, this
difference was not significant. The same was for those infants born to immigrant mothers with
food insecurity who were breast-fed – they still weighed more and were longer than the other
infant counterparts who had the same demographic information but were not breast-fed.
Discussion
All of the studies were similar in that they all focused on the benefits of breastfeeding but
contrasted since they all focused on different aspects of breastfeeding benefits (Silvers et al.,
2011; Oddy et al., 2010; Ferguson and Molfese, 2007; Philipsen et al., 2008; Neault et al., 2007).
While the first three studies analyzed focused on more specific breast feeding benefits (asthma,
mental health, and intellectual outcomes), the last couple focused on broader topics (illnesses and
immigrant mothers). All the studies contrasted in design, methods, and sample characteristics;
however, even with these variations, they all supported exclusive breastfeeding to other methods.
OUTCOMES OF BREAST-FED INFANTS 13
Majority of the studies also accounted for major confounding variables, which could have altered
the results.
The strength of the study conducted by Silvers et al. (2011) was that the definition of
breastfeeding was specific, data collection was prospective, and there was a wide range of
breastfeeding duration. The study also examined other similar studies with similar birth cohorts
to analyze why there were differences – this is beneficial to analyze the necessity of further
research and validity of the results. A disadvantage was some of the variables which were not
taken into account that could have altered the results, including the exclusion of infant formula,
food and drinks containing potential allergic components.
The major strength of the study conducted by Oddy et al. (2010) was that it was
longitudinal and majority of the participants followed through with the study. The study was also
able to produce evidence of the association between breast-fed infants and mental health
outcomes in relation to social, biological, and demographic factors. The analysis of all of these
different mental health domains allowed the study to account for multiple variables that could
have influenced the studies outcomes. However, accuracy and reliability could have further been
achieved if there was biochemical analysis of breast milk samples. Other possible explanation
that needs to further be explored are factors such as maternal contact and positive stress response
in infants that is associated with breast feeding and if those aspects contribute to positive health
outcomes.
In the study conducted by Ferguson and Molfese (2007), there was a positive outcome
with the study that there was statistical significance in electrophysiology between breast fed
infants and those infants who received PUFA enriched formula. Another strength of this study
was that the study supported all three hypothesis: (1) breast-fed infants are advantaged in later
OUTCOMES OF BREAST-FED INFANTS 14
cognitive development, (2) infants fed with PUFA enriched formula only generated activity on
one brain hemisphere (whereas breast-fed infants were stimulated on both hemispheres), and (3)
breast-fed infants would have wavelength variation and PUFA formula fed infants would be
more restricted. Another benefit of this study was the ability to measure the part of the brain
being stimulated. Breast-fed infants had more stimulation in the frontal and temporal lobe and
PUFA enriched formula fed infants experienced stimulation among more of the parietal and
occipital lobes. This suggested that breast-fed infants are advantaged in linguistic and cognitive
development. However, it would be interesting to see a longitudinal study conducted to measure
the proposed breast-fed versus PUFA enriched formula fed infants to further examine the results
and improve accuracy.
The study conducted by philipsen et al. (2009) was interesting in that is examined the 4
major childhood illnesses and the effects feeding methods have on them. It took into account all
feeding methods, exclusive breast feeding or formula, and combinations which improved
accuracy of results. It further analyzed family demographics and backgrounds to control other
variables that might influence childhood health. This study was very thorough and careful in its
analysis; it was able to account for other possible explanations in the results. A limitation to this
study was that with particular feeding combinations, duration and age of initiation was not fully
addressed. Furthermore, diagnosis of the illnesses examined in the study may not always be
diagnosed or found in toddlerhood – there might not have been enough variation in the sample to
detect the differences.
One major benefit of the study conducted by Neault et al. (2007), was that it was
consistent with other similar studies which improved the credibility and reliability of the results.
There was also a large sample size which improves the outcome of results. This study further
OUTCOMES OF BREAST-FED INFANTS 15
carefully examined the demographics and background of the participants. There were also some
limitations to this study – the Children’s Sentinel Nutrition Assessment Program study excluded
immigrants who were excluded for language purposes, and this assessment does not ask about
exclusive breastfeeding. Because of those missing components, not all immigrants who could
have contributed to the study were accounted for, and there was no way to know which
immigrants exclusively breast-fed or breast-fed along with formula.
Conclusion
All of the research articles synthesized were unique in they each focused on different
benefits of breast feeding and supported breastfeeding benefits on all different domains. It can be
determined that breastfeeding specifically improves infants health outcomes on illnesses and
mental health – despite socioeconomic and household variables, or immigration status. However
researchers need to continue to explore the question of why there continues to be a low
percentage of mothers who do not exclusively breastfeed despite the positive outcomes and
current authoritative recommendations. That major topic can be further broken down to analyze
limitations to exclusive breastfeeding such as maternal or infant illnesses and disabilities, social
and familial factors that may contribute, and even lack of education about the benefits amongst
pregnant women and current mothers. Healthcare professionals need to further educate their
patients more about breastfeeding and the positivity that is associated with the infant’s health. If
parents understand how beneficial natural breast feeding is for the child and themselves, mothers
may be more receptive to the method in the future.
OUTCOMES OF BREAST-FED INFANTS 16
References
AAP. (2012). American academy of pediatrics. Retrieved from
http://www2.aap.org/breastfeeding/faqsbreastfeeding.html
Achenbach, T. (2009). Child behavior checklist for ages 6-18 (cbcl/6-18). Retrieved from
http://www.cebc4cw.org/assessment-tool/child-behavior-checklist-for-ages-6-18/
CDC. (2012). Retrieved from Department of Health and Human Services website:
http://www.cdc.gov/breastfeeding/data/reportcard.htm
Ferguson, M., & Molfese, P. J. (2007). Breast-fed infants process speech differently from bottle-fed
infants: Evidence from neuroelectrophysiology. Developmental Neuropsychology, 31(3), 337-
347.
Healthy People 2020. (2012, October 30). Healthypeople.gov. Retrieved from
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26
Neault, N. B., Frank, D. A., Merewood, A., Philipp, B., Levenson, S., Cook, J., Meyers, A. F., & Casey, P. H.
(2007). Breastfeeding and health outcomes among citizen infants of immigrant mothers. Journal
of the American Dietetic Association, 107(12), 2077-2086.
Oddy, W. H., Kendall, G. E., Li, J., Jacoby, P., Robinson, M., De Klerk, N. H., Silburn, S. R., & Zubrick, S. R.
(2009). The long- term effects of breastfeeding on child and adolesvent mental health: A
pregnancy cohort study followed for 14 years. The Journal of Pediatrics, 156(4), 568-573.
Philipsen Hetzner, N. M., Razza, R. A., Malone, L. M., Brooks-Gunn, J., & , (2008). Associations among
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Silvers, K. M., Frampton, C. M., Wickens, K., Pattemore, P. K., Ingham, T., Fishwick, D., Crane, J., & Town,
I. (2011). Breastfeeding protects against current asthma up to 6 years of age. The Journal of
Pediatrics, 160(6), 991-996.
OUTCOMES OF BREAST-FED INFANTS 17
World Health Organization. (2012). World health organization. Retrieved from
http://www.who.int/topics/breastfeeding/en/
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