We are fully aware of the breast-feeding recommendations presented by the CPS and the AAP. In fact, these recommendations provided in large measure the impetus for our breast-feeding peer support trial.1 Clearly, exclusive breast-feeding is preferred over formula feeding for the initial 6 months postpartum.
Notwithstanding our agreement on this point, the sentence referenced was intended to express the equally important point that in North America we are not even close to achieving these breast-feeding recommendations: most Canadian and American mothers do not breast-feed at 6 months postpartum, much less exclusively. Furthermore, practising physicians should understand that most mothers discontinue breast-feeding prematurely because of practical difficulties, not because they choose to do so based on recommendations for optimal breast-feeding duration.2 We hope that by conducting a methodologically rigorous trial we have aided physicians in their ability to provide evidence-based care. We also hope they will counsel their patients about options for overcoming breast-feeding difficulties to achieve infant-feeding goals, goals which are often developed before the mother becomes pregnant and enters the formal health care system.2
Cindy-Lee Dennis Assistant Professor University of Toronto Toronto, Ont.