Weaning breastfed baby before 6 months

[srisky]

Don't get me wrong, I am pro-breast feeding and think this would be great for both mother and baby if it all goes well. All mothers should be encouraged to breast feed, be given the opportunity to breast feed with early skin-skin contact and should be provided support in the community. Society also needs to adapt so that breast feeding in public is the norm. We are lucky that we live in an area that has several sources of support for breastfeeding. Mothers that attend the breastfeeding workshop are those that are most motivated to breastfeed, so there is a huge selection bias there.

My issue is more with the way in which information has been provided to me. I am fortunate enough to have the knowledge, confidence and social support with regards to breastfeeding. However, my concern is for those mothers who do not have this and leave the breastfeeding workshop with the idea that if they do not manage to successfully breast feed then they have somehow failed their child.

I can only speak for myself when I say that the issue(s) I had with the breast feeding workshop was the very one-sided/biased information provided. I left feeling that if I did not or could not breast feed then my baby, and possibly the generations that followed, would suffer from allergies, recurrent repsiratory tract infections, malalignment of the jaw requiring removal of teeth etc. That was inspite of knowing already that this was not true.

I feel that it would have been far better for them to stick to topics such as: how to breast feed; common problems the mother and baby may encounter; how to solve them; and where to seek help from. An appropriate balance to the breastfeeding advice that the workshop should have provided would be to say that if breast feeding doesn't work despite seeking help from various health professionals, then formula would be a safe alternative for your baby. I found the various pointless stories, including Ms Kedves description of how she has suffered life long eczema after being given formula milk at hospital as a baby, the most insulting to our intelligence.

There is as much scaremongering and misinformation/bias from the heavily pro-breastfeeding groups as there is from formula/baby food industry. Neither extremes are helpful and are likely to be detrimental.

[Belle]

This issue makes me very sad, as well as angry, and I won't repeat points I've made in the past (I hope).

I think someone mentioned the apparently common cases of newborn babies who end up dehydrated or jaundiced through early feeding issues - I personally know of about four of five, including one whose baby was in hospital with a lumbar puncture. Only then did she start giving formula (having been told sternly not to by HVs etc), and subsequently managed to breastfeed for well over a year. What I do believe, with regret, is that if only I'd broken out of the myopic 'must be breastmilk' haze I was in during the first week, and given my son some formula, he'd have thrived and so would I, and perhaps breastfeeding would have been achievable as a result. The irony.

I know there are women out there who have tried and tried through blood, sweat, tears, and near continuous expressing, and made it work, but not all of us are perhaps emotionally equipped for that struggle in those tough early days. I think generally on this forum we do manage to strike a balance of expressing our differing and strongly held view; and not judging others. Never is this more important than on such an emotive topic.

[sophiechristophy]

Belle - there must be flexibility and balance with all things.

[srisky]

Belle - it saddens me to read your post. I mentioned the cases of babies being admitted for iv rehydration after their mothers depserately tried to persevere with breast feeding and it is heart breaking.

Breast may be best but not at all costs. A sick baby and a desperate mother does not make a happy situation.

Breast feeding may be natural but it is damn hard and like many natural things it sometimes does not work.

Health professionals should encourage and support breast feeding but it should be emphasised that you have not failed as a mother if it does not work for you and your baby. You should not be left with the impression that your child will suffer as a result. Motherhood is full of enough guilt about whether you are doing the right thing for your child.

[helena handbasket]

I think that's exactly what she's trying to say.

Yet for every mother that sadly tells the story of her breast feeding struggles, there's always someone more than happy to jump in with "yes but.........." and the result is a the constant feeling that you are not being heard.

Sorry, edited to add that was a response to sophie

[Lue Lue]

Why the rush of weaning earlier than 6 months..? There's so many studies that breast milk (especially) excludingly is the best option for a baby the 6 first month. Not to talk about the mess and work you need to put behind weaning a child!

Once I spoke with a woman who said she gave baby rice to her 2 month old daughter who was just crying all the time (no wonder, her little immature tummy probably was hurting really bad!!). Baby tummies cant digest and gain all the nutritions from solids in a very young age..

[Fuschia]

helena handbasket Wrote:

-------------------------------------------------------

> Fuschia Wrote:

> --------------------------------------------------

> -----

> > It is true though that the first feed of

> formula

> > does affect the "virgin gut"

> >

> >

> http://www.health-e-learning.com/articles/JustOneB

>

> > ottle.pdf

>

> But see this is part of the problem. My son was

> just not latching on at all and my milk was

> nowhere to be seen. He was losing weight and

> turning a bit yellow and I knew he needed to eat

> and eliminate to get his system working. But how?

> What do you do when you are a new mother and

> watching your tiny baby needing to eat and

> rejecting your breast full stop? I knew about the

> first formula, knew it was a risk, didn't want to

> do it but seriously what on earth is a new mom in

> full panic supposed to do? I knew if I persisted

> it might work, but might not so how long do you

> sit and watch your newborn go downhill until you

> make a stand as a mother and say "to hell with all

> the judgement and rhetoric, I'm feeding my child!"

> It's not necessarily rational but it's certainly

> some surge of maternal instinct to get your new

> baby fed.

>

> THIS is what drives women crazy, this presumption

> that if only you knew better or were stronger in

> your convictions or something.

>

> Ah Fuschia, you and I have sparred on this plenty,

> you can tell I'm taking out my frustration on the

> wrong victim

> hey?:)) Now if only I could find Gwen the breast

> feeding Nazi who should be the target for my

> grrrrrrr.

I do understand how you feel as twin II didn't latch for 11 days, and latest baby has a tongue tie and didn't latch on at all from 6 days old. I was lucky I could express so fed them ebm via syringe (twin II and bottle (syringe wasn't enough) for the latest. I knew offering a bottle wouldn't help his latch (this was before I knew he had TT)

So I know how it feels... I was lucky I was prepared with a pump, syringe etc, just in case. I do advise others to get this stuff in for the early days...

[Countjc]

I can totally relate to so many of these posts and the high level of confusion out there. I am a Biologist and so do have a good understanding of the science but at the same time have been swept up in all the mixed advice out there and what is 'the right thing to do'.

One thing to point out, and a few other posters have done this, is that so many of these diseases are multifactoral which means that it is very difficult to blame the illness on one thing. The genetic profile of a person plays a huge part of what diseases they are susceptible to and then whether or not the environment they come into contact with will lead to them getting that disease.

On my part I was worried about asthma and eczema as my brother, husband and brothers in law all suffer from them. I've gone into my breast feeding issues in the past so wont again in detail but gave my son only expressed breast milk for 12 weeks. the whole time I kept looking at an NHS poster that quoted the different illnesses that your child would be less likely to get if you breastfed for this length of time. In the end expressing caused me even more damage so I stopped but really beat myself up about it. My husband is a mathematician and looked at the statistics behind these timeframes and found them to be based on v. small sample studies and without taking account into all the other factors. Both asthma and eczema are hereditary on the male line and (without dumbing down the science too much) are caused by quite 'strong' or dominant genetic factors. My husband, brother and brothers in law were all exclusively breast fed for a year (with solids introduced at 4-6 months) and all still got asthma and eczema, in fact from 5 months they had it. So far my son has not, at 9 months but I bet if he had i would be blaming myself for giving him formula.

On the coeliac front I have had to research this quite heavily too as my mother and uncle have it and I have been tested for it quite regularly. There is a lot of confusion out there- my HV said to wait for a year to give gluten, GP no idea. I am lucky that I have a GP and paediatrician in the family but even they were not sure. On speaking to the coeliac society, their view on the latest reseach was to introduce at 6 months and to monitor. They had research to show that delaying till a year could be more damaging- can try and dig out this piece if anyone interested. (but also felt more research was required).

So what I am trying to say, whilst giving my family medical history(!) is to agree that there is so much conflicting advice out there but also to remember that so many other factors play a part in these diseases. Agree with so many of you in 'doing what feels right'. Sometimes a little knowledge is too much info and we end up feeling guilty for not following the correct advice.

Had wanted to word this more clearly but my little boy is ill at the mo and my brain not feeling like it used to!

[Fuschia]

Had to break off to deal with a fight... to add that despite being readmitted on day 3 due to my high blood pressure, and daily MW visits for almost a month, only one of the NHS staff really tried to help when i described my problems. Most of the others seemed to assume I would just be giving formula. I didn't get much encouragement, let alone pressure, to stick with the bf. And having fed 3 children previously, inc twins, you would have thought they would have suspected something like TT was the cause

The MW who did help was fantastic, and so were my independent MWs. Clare Kedves is also very dedicated I hear, in fact she phoned me last night (!) and I a going to see her today re newborn's continuing problems

[katielou]

Totally agree that there is too much conflicting advice out there - I breastfed for 6 months - but ended up topping up with bottles towards the end as my little man was soooo hungry - was trying to hold off weaning till 6 months because of the latest advice. I haven't read all the posts on this topic - there are quite a few pages - so this article might have been mentioned before

http://www.bbc.co.uk/news/health-12180052

Noone really knows do they?! And I agree with everyone that mums put far too much pressure on themselves (I had an awful meeting with a hv who told me I should never ever ever give my baby finger foods as he might choke - the next hv I saw advised me to give him finger foods - who knows?!) - at the end of the day - looking at all my friends, I would have no idea who was breastfed / bottle fed / weaned early or later - and they are all healthy, happy adults now!

[Saila]

my son was in special care cos of dehydration and the nurse in there said that *half* the babies were in for the same reason

anyway - we weren't together for 7 of his first 10 days due to him being in SC and I had an amazing bfding councillor who massively helped me with pumping and syringe feeding. I agree with you Fuschia - the MWs were very unsupportive of me bfding in hospital and wouldn't let me syringe feed. after i said i didn't want to formula feed my son, They reluctantly insisted on beaker feeding and i cried watching my milk just getting spilt everywhere! it was soul destroying. I took it upon myself to secretly syringe feed. I even sneaked into SC and took some syringes cos i wasn't allowed to do it downstairs in teh ward.... crazy

I then got double thrush (i was on antibiotics for 15 days) which then morphed into double mastitis all with continued failure to latch on.

This meant i was sterilising/pumping/syringe feeding for 6 weeks. I slept for 1 hour intervals, with often no help as my partner was doing night shifts. Doign this with a fever from the mastitis took me to breaking point and i dotn even think it was safe for me to be looking after a young baby in that state - plus i had a traumatic birth and was exhausted and shocked from that too

my mother bf all three of us and was really surpised (as was i) with the problems i had. I just assumed it'd happen. But it didn'nt and i massively beat myself up about it. As do many vulnerable women at that time. Just look at the 'what would i do differently' thread and you'll see how much women tried everythign to make it work. We all want to be able to do it but the pressure, not just from some MWs, but NCT groups (not mine mind but i've heard some shocking stories) and comments from things like this forum make it emtionally very tough indeed.... but there comes a time when enough's enough and you need to move forward. But it's the mother's decision and she should be respected for that

anyway - sorry if i'm repeating too.

edit to say: and then what really upset me was half the 'benefits' that were explained to me turned out to be based on very flaky evidence and most of the benefit was at the very beginning of bfing. it seems to me the most proven benefit is the reduction in breast cancer risk for the mum. fingers xed it works out next time cos it's apparently proportional to how long you bf. as for the other stuff. most things i read contradict.

[KatsuQueen]

Belle Wrote:

-------------------------------------------------------

> This issue makes me very sad, as well as angry,

> and I won't repeat points I've made in the past (I

> hope).

>

> I think someone mentioned the apparently common

> cases of newborn babies who end up dehydrated or

> jaundiced through early feeding issues - I

> personally know of about four of five, including

> one whose baby was in hospital with a lumbar

> puncture. Only then did she start giving formula

> (having been told sternly not to by HVs etc), and

> subsequently managed to breastfeed for well over a

> year. What I do believe, with regret, is that if

> only I'd broken out of the myopic 'must be

> breastmilk' haze I was in during the first week,

> and given my son some formula, he'd have thrived

> and so would I, and perhaps breastfeeding would

> have been achievable as a result. The irony.

>

> I know there are women out there who have tried

> and tried through blood, sweat, tears, and near

> continuous expressing, and made it work, but not

> all of us are perhaps emotionally equipped for

> that struggle in those tough early days. I think

> generally on this forum we do manage to strike a

> balance of expressing our differing and strongly

> held view; and not judging others. Never is this

> more important than on such an emotive topic.

Belle, I totally agree. (Belle and I were next to each other on KCH wards with our sons for a good week, and wow it was a struggle) Not just the presure to breastfeed but also not to bottle-feed, as if with one bottle, that was it, your child would be a delinquent with all the allergies under the sun, and wouldn't be able to bond with you for the rest of your life no matter what you did.

The best decision I ever made was when MiniKatsu was 2 days old and crying from hunger, I phoned my husband and told him to bring two packets of Aptamil for me. He was really confused because he knew that I wanted to breastfeed. But just a few bottles in those early days got us through, and most importantly gave me confidence that yes, my baby was hungry (there was nothing else wrong with him), he could suck strongly and once my milk "came in" it would be OK.

After that he was "exclusively" breastfed for 4 months.

Maybe it's just my own feelings of inadequacy but sometimes, I got the feeling that "exclusive breastfeeding" was pushed so hard - as if you were giving your baby a bottle of poison instead of milk. Which is totally nuts.

Sorry if I have gone off topic, it is about weaning after 6 months, sorry.

[Fuschia]

The intestinal flora thing gets reversed once you switch to breastmilk from formula. I think the only irreversible problem can be cows milk protein allergy. I actually had that as a baby/child... so it makes me very cautious about formula. I think if you don't have that family history, there is much less need to be paranoid.

[Belle]

That's so funny - I did the same thing, a bit later after I'd been moved away to another bed I think, but didn't get as far as opening the carton as my community midwife advised in deeply sorrowful tones that 'it would be a terrible mistake now to put that baby on formula' - so I carried on with the expressing hell and begging for donor milk at King's till we got home from hospital. I remember the utter relief of giving a bottle as opposed to a cup, and looking at the cartons knowing we had enough food for our baby, instead of thinking he might get ill again if I didn't pull of bfing.

it's really interesting that those who wanted to bf didn't always get the support, and those who wanted to use formula didn't either, just shows there's as much diversity in the opinions of the professionals as there is among us mums.

[buggie]

Find others experiences v interesting. Bugglet was full term but tiny (still below the 0.4th centile) and at birth couldn't latch on and spat syringes of milk out, so while attempting to get her to latch on at every feed I would end up giving formula via a bottle (which she took really well) and both of which were provided by the hospital.

Even on seeing the Joanne (Claire's colleague) and being shown to hand express colostrum it was agreed to con't offering the breast but then topping up with formula until my own milk came in/I discovered nipple shields!

I never felt pressure not to use a bottle (cup feeding was suggested, but on a 3hr feeding schedule with it taking 1/2hr to hand express 1ml I didn't see that as a viable option) but wonder if this was due to them knowing I was a paediatric nurse and so being perceived to be better informed into the risks/benefits... as it was I hadn't read/researched that widely and just went with my instincts.

As it is at 16wks old I have a v happy (tiny) baby who loves br/feeding but is also happy to take EBM/formula via a bottle (thus if anything ever happened to me I'd know she wouldn't starve/have to stress about her trying bottle for first time).

It is amazing seeing the amount of pressure Mums put on themselves - in Paeds ED have seen so many babies that have come in dehydrated/jaundiced due to br/feeding not getting off to the best start and stress themselves out even further over giving even one formula feed to raise the babies blood sugar (which then wakes them up a bit/give them energy) to enable them to have a better attempt at latching on and thus stimulating supply - a sleepy baby who's unable to latch isn't going to stimulate supply as well.

[Fuschia]

I think one thing that's not well put across is that "demand feeding" a slightly older bf baby doesn't mean you only feed a newborn when it asks. Several of mine have been jaundiced/sleepy and needed to be woken every 2-3h to be fed (by syringe in one case and even then she lost 10% of her birthweight)

I think what's missing from the info (going on leaflets and HV advice, i never went to any workshops) is the reality of bf a baby... how frequently you need to feed, for eg. I am on baby no 4 and it's only due to recent acquaintance via Mr Google after the tongue tie/expressing trauma that I now know a new baby takes 2-3oz at a time, digests it in 90 mins, will feed something like 12 times in 24h, and from 1m old will consume pretty close to 25oz in 24h (with the amount not increasing as the baby grows) You would have thought 4 children in I would have known some of that... OTOH as bf went well, overall, with nos 1-2 (if not so smoothly for no 3) i just fed as often as it was asked for, and didn't worry too much about the frequency/amount...

[Fuschia]

From comments on the BMJ site:

Adriano Cattaneo, Epidemiologist

Institute for Maternal and Child Health, Trieste, Italy

"The evidence provided by Fewtrell and collaborators to challenge the WHO 6-month recommendation is no better than the one provided by WHO. It is in fact slightly worse.

The WHO recommendation is based on two RCTs and 16 observational studies. All the studies published after 2001 on infection, nutritional adequacy, allergy and coeliac disease, and outcomes in the longer term that Fewtrell and collaborators cite to question the 6-month policy are observational. The only two RCTs they cite are ongoing and can not be used to argue against the WHO 6-month policy. Until further evidence becomes available, I prefer to stand by the WHO recommendations (and hope the UK and Italian DoH will agree with me).

Incidentally, the WHO recommendation has never been meant to apply to all infants. It is a public health recommendation to be used for national and professional policies and regulations (for example, on labelling of baby foods). Infants in fact do not wake up the day they reach six months and ask for solids!!! Readiness to eat the first solids is distributed as any other biological variable, a Bell shaped curve that in my opinion (because no research is available to know the real shape) has a mode at six months and is skewed to the right (i.e. more infants are ready after than before six months). Why don?t we concentrate on physiology and neuromuscular development to advise mothers on when to start solids, instead of wandering in search of doubtful evidence?

Finally, I am amazed by the rapid spread into the popular press and media of the questionable messages posted by Fewtrell and collaborators in their paper. Less than 24 hours after publication, newspapers in Italy (and I guess in UK and other countries; TV will follow suit) are already talking about a ?new study? showing that exclusively breastfeeding infants to six months may be dangerous. Am I wrong if I ask the authors to make a quick public statement to transparently say that theirs is not a ?new study? but just a respectable opinion based on shaky grounds?"

http://www.bmj.com/content/342/bmj.c5955/reply

[Saila]

Article from The Times last week:

A proper debate on the best way to feed a baby in the first six months is being stifled by an ?almost religious evangelism? for women exclusively breastfeeding, the lead scientist behind a new study said.

Mary Fewtrell, a paediatrician from University College London?s Institute of Child Health, said that she could not understand why questioning the policy, which is current government guidance, provoked such ?outpourings of vitriol? from its supporters.

Dr Fewtrell was speaking to The Times after the publication of an analysis in the British Medical Journal yesterday that suggested that the recommendation be reexamined.

The researchers agree that breastfeeding is the healthiest option, but concluded that babies could suffer iron deficiency and may be more prone to allergies if they receive only breast milk. A review of 33 studies found ?no compelling evidence? for not introducing solids at four to six months.

The report does recommend, however, that in developing countries waiting until six months can be beneficial, because of concerns over hygiene and nutrition.

Current guidelines in Britain are for women to breastfeed for six months before introducing solids. The Department of Health said the latest paper would be included in a review of infant feeding policies, but its guidance remained unchanged.

A spokesman said: ?The totality of the evidence supports a protective role of exclusively breastfeeding for the first six months of an infant?s life.?

The BMJ study was attacked by the Royal College of Midwives and baby nutrition organisations. Spokespeople questioned the scientists? links to the baby-food industry, which they said was an obvious beneficiary from a change in guidance.

Dr Fewtrell rejected the allegations, which she described as insulting and upsetting, and a smokescreen ?because they can?t rebut the science?.

She said that the scientists had acknowledged in their study that they had provided advice for the baby-food industry, and they carried out their research as independent authors. ?If you are doing work in infant nutrition you cannot not have links to the industry,? she said. ?Part of our responsibility as paediatricians and scientists working in the field is to advise industry. We want to ensure that the evidence is appraised and the best advice gets to mothers for their babies? health.?

Janet Fyle, professional policy adviser at the Royal College of Midwives, challenged the findings of the review as a ?retrograde step that plays into the hands of the baby-food industry?. Other organisations, such as Baby Milk Action, issued even stronger rebuttals describing it as ?an attack from industry-funded scientists?.

Dr Fewtrell said she could have predicted the reaction, which like previous such stances undermined sensible appraisal. She and others were not trying to formulate policy, but present evidence. ?We have worked in this area for a very long time. This [reaction] is partly what stifles any scientific debate in this field. People feel intimidated. If you stick your head above the parapet you get this vitriol. I don?t undertsand where this evangelism comes from. It?s like some sort of religious belief. It?s personally upsetting but we have to press on with this because its the science.?

She added that ?lots of people? shared the views held by her and her fellow researchers ?but are quite intimidated because they know if they express something like this its seen almost as if its blasphemous?.

The Scientific Advisory Committee on Nutrition is to meet next week to set out the parameters for a review of guidance on infant feeding, taking in all the latest evidence.

Britain changed its advice in 2003, two years after the World Health Organisation recommended that all infants should be exclusively breastfed for six months.

Health chiefs said yesterday that the BMJ analysis would be included. ?We recognise the emerging evidence in this area and the need to review current policy on infant feeding, to ensure that the recommendations are based on the best available evidence,? a Department of Health spokesperson said.

?The paper in this week?s BMJ is not a new research study nor is it a systematic review of all available evidence, but it merely calls for a review of the evidence on which the original recommendations on exclusive breastfeeding for about six months and introduction of solids at around six months were based.?

[sophiechristophy]

"Why don?t we concentrate on physiology and neuromuscular development to advise mothers on when to start solids, instead of wandering in search of doubtful evidence?" - such a good point!

[helena handbasket]

Saila I think that Times article is compelling because it's a bit of a cry to restore sanity......... they are not claiming to absolutely have any answers but are asking rightly "Why can't we at least examine? Consider?".

Funny enough I came across a piece by accident today that discussed a variation on the topic; the American Pediatric Association is examining iron deficiencies in 4-6 month old infants, but no mention of adding solids. Their recommendation was to add an iron supplement. Is this a case of one outcome, two very different interpretations and paths? I follow both American and British media quite closely and am often amazed at how different the approaches are to the same story. Makes me weary to believe most of it to be honest.

Can't remember the periodical (it was a link from something else) but might take another look.

[Saila]

American's seem to be more keen to take a tablet for something than us brits. But i think that's changing? you'll know more than me on this.

Fuschia was absolutely right though in that the reporting of this 'story' was inaccurate. I heard it as a study on radio4. I'm not sure that's the doctor's fault though and it doesn't surprise me as things are often spun to get more of a story out of it.

what really really shocks and upsets me is the accusations and what to me looks like a blatant smear campaign by the RCM against these doctors. It's deeply worrying that people are being put off doing studies for fear of being intimidated like that.

There is a real deep set skepticism in this country against science and doctors which i fear is only going to get worse once the Conservatives implement a profit driven NHS (but that's a whole new thread) controlled by GPs....

[sophiechristophy]

What benefit would the RCM have in a smear campaign?

[Saila]

because they somehow think it's against breastfeeding... when it isn't.

[helena handbasket]

The supplement would be liquid drops, just like those used for vitamin D supplementation in breast fed babies. I assume that is done in sun deprived Britain? My vit. D levels were extremely low when I left the UK..........

It seems like a rational way to address the issue; it looks like there is evidence that there is the potential for iron deficiencies in these babies, there is as yet no consensus n the effect of solids on a 4-6 month old tummy so logically top up the iron in the mean time and keep doing the research.

Instead, everyone can point fingers, misinterpret, re-interpret, embellish and distort until nobody even knows what the original issue was. As much as I adore the British press, this is something that they do well and it goes nowhere.

AS a Canadian we spend the bulk of our time convincing ourselves we are not American and feeling smug, but generally the British perceptions of the average American were so far off I found myself defending them. Odd. We don't want to be them, but we are more than happy to benefit from their brilliant research in the health sciences and I never quite understood the British hobby of dismissing things as "too American".

This is off topic but anyway...... for a year I went to my GP complaining of stomach and chest pain. Every couple of weeks I would sit in her office crying over the stress of it. So? She said it was stress (!) and offered me anti-depressants or counseling. I didn't want to get stuck on the meds so chose counseling and spent 10 weeks being told to stop feeling negative about the pain because it was causing the pain. (?) Got back to Canada, went to my old doctor (who is English) who said it sounded like reflux, gave me some medicine and in two weeks I was better. A year of HELL and all I need was a little pill here and there.

Um, I had a brilliant insight but it's nowhere to be seen on my post and I've lost the plot. Sorry!:))

[Fuschia]

helena handbasket Wrote:

-------------------------------------------------------

>

> it looks like there is evidence that there is the

> potential for iron deficiencies in these babies,

Not really..

from AnalyticalArmadillo, linked above

"Insufficient Iron

From the paper:

More recent data from 2007 raise further concerns on whether six months? exclusive breast feeding would reliably meet iron requirements. US infants exclusively breastfed for six months, versus four to five months, were more likely to develop anaemia and low serum ferritin, which is of concern given irreversible long term adverse effects on motor, mental, and social development after iron deficiency.(20) (21) (22) Such risks might be reduced by improving iron status in pregnancy, delaying umbilical cord clamping, and supplementing infants at risk (for example, those with low birth weight).

So I dug out the studies they quoted

Only one examines iron levels and infant feeding (20) The others are about the effects of severe anaemia. The study examines 2268 infants, which sounds pretty impressing - until you discover only 136 were breastfed exclusively for six months. Furthermore it's 6 months or more, so some may have been exclusively fed longer than 6 months which is often advised at the moment for high risk infants. They found solids at 4-6 months instead of 6 months + reduced the risk of anaemia, low serum ferritin but not low hemoglobin and concluded:

Young children in the United States fully breastfed for 6 months may be at increased risk of iron deficiency. Adequate iron may not be provided by typical complementary infant foods.

It adjusted for birth weight and demographic, but no mention of other factors ie prematurity

This small study also contradicts the finding of numerous other studies. For example a 2008 study found:

Full-term babies who are exclusively breastfed are not at heightened risk of low iron stores by the age of 6 months, even if their mothers were iron-deficient during pregnancy

Breast milk is low in iron, but infants can absorb it much more easily than they absorb the iron in fortified formula. Healthy full-term infants are also born with enough iron stores to make deficiency unlikely in the first 6 months.

"