The evidence for public health recommendations on infant feeding

Public health recommendations should be based on the best available scientific evidence, and this necessitates careful appraisal of the available data and management of scientific uncertainty. This paper discusses the difficulties in collecting and interpreting scientific data on infant feeding, in particular the fact that since it is not feasible to randomise healthy infants to be breast or formula-fed, the majority of available data come from observational studies with associated methodological limitations. The scientific evidence available to underpin recommendations for breastfeeding and for 6 months exclusive breastfeeding are presented in the context of these limitations, noting disagreement between expert groups considering the same scientific data. Finally, the use of science to formulate infant feeding recommendations, and communication of information, including scientific uncertainty, to parents are discussed.