Is the "breast is best" mantra an oversimplification?

Sudden infant death syndrome

There is a statistically significant association between sudden infant death syndrome (SIDS) and feeding method. Infants whose cause of death is SIDS are approximately one half as likely to have been breastfed as matched controls.^35,37

In 2005, AAP did not recommend breastfeeding as a means to reduce the risk of SIDS because available evidence was mixed, and studies at the time were poorly controlled.³⁸ Since that time, case-control meta-analyses have shed additional light on the association between SIDS and feeding method.^35,37

The protective effect exists for any amount of breastfeeding and is stronger for exclusive breastfeeding, suggesting a protective role—not simply an association. Caution should be employed with this conclusion, however, because the studies included in the meta-analysis used univariate analysis primarily and did not control sufficiently for known confounders. In addition, the authors warn that publication bias might overestimate the association.³⁸

Exclusive breastfeeding is likely the single greatest risk factor for hospital readmission in newborns.

Potential mechanisms of a protective role include decreased risk of infection and greater arousability from sleep in breastfed infants. Assuming a protective role, available data suggest that more than 3500 infants need to be breastfed to prevent one case of SIDS.³⁹

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