The quality of evidence is downgraded by inconsistency (unexplained variability in results)
The recommendation is strong because the intervention has potential benefits without any harms.
Several studies have shown that short-lasting breastfeeding or none at all predispose to otitis media «Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis 1989 Jul;160(1):83-94. »1, «Alho OP, Koivu M, Sorri M, Rantakallio P. Risk factors for recurrent acute otitis media and respiratory infection in infancy. Int J Pediatr Otorhinolaryngol 1990 Jun;19(2):151-61. »2, «Pukander J, Luotonen J, Timonen M, Karma P. Risk factors affecting the occurrence of acute otitis media among 2-3-year-old urban children. Acta Otolaryngol 1985 Sep-Oct;100(3-4):260-5. »3, «Owen MJ, Baldwin CD, Swank PR, Pannu AK, Johnson DL, Howie VM. Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effus»4, «Kero P, Piekkala P. Factors affecting the occurrence of acute otitis media during the first year of life. Acta Paediatr Scand 1987 Jul;76(4):618-23. »5, «Chandra RK. Prospective studies of the effect of breast feeding on incidence of infection and allergy. Acta Paediatr Scand 1979 Sep;68(5):691-4. »6, «Saarinen UM. Prolonged breast feeding as prophylaxis for recurrent otitis media. Acta Paediatr Scand 1982 Jul;71(4):567-71. »7 but this relationship could not be shown in all studies «Fleming DW, Cochi SL, Hightower AW, Broome CV. Childhood upper respiratory tract infections: to what degree is incidence affected by day-care attendance? Pediatrics 1987 Jan;79(1):55-60. »8, «Tainio VM, Savilahti E, Salmenperä L, Arjomaa P, Siimes MA, Perheentupa J. Risk factors for infantile recurrent otitis media: atopy but not type of feeding. Pediatr Res 1988 May;23(5):509-12. »9, «Rubin DH, Leventhal JM, Krasilnikoff PA, Kuo HS, Jekel JF, Weile B, Levee A, Kurzon M, Berget A. Relationship between infant feeding and infectious illness: a prospective study of infants during the f»10. A meta-analysis by Uhari et al «Uhari M, Mäntysaari K, Niemelä M. A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis 1996 Jun;22(6):1079-83. »11 showed that breastfeeding for at least three months reduced the risk of acute otitis media (risk ratio 0.87; 95% CI 0.79 - 0.95). Paradise et al «Paradise JL, Elster BA, Tan L. Evidence in infants with cleft palate that breast milk protects against otitis media. Pediatrics 1994 Dec;94(6 Pt 1):853-60. »12 reported that children with a cleft palate who had been given breast milk had middle-ear effusion for a shorter time than children who had received milk substitute.
Duncan et al «Duncan B, Ey J, Holberg CJ, Wright AL, Martinez FD, Taussig LM. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics 1993 May;91(5):867-72. »13 report that children who received only breast milk for at least four months had fewer episodes of otitis media during their first year of life compared with those who had received no breast milk at all or were only partly breast-fed. Correspondingly, Aniansson et al «Aniansson G, Alm B, Andersson B, Håkansson A, Larsson P, Nylén O, Peterson H, Rignér P, Svanborg M, Sabharwal H. A prospective cohort study on breast-feeding and otitis media in Swedish infants. Pedia»14 concluded that children who had been breast-fed exclusively during their first year of life had fewer episodes of otitis, partly breast-fed children had slightly more and weaned children had the most episodes of acute otitis.
An U.S. based study «Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics 2006;117(2):425-32. »15 included infants who were fully breastfed for 4 to < 6 months (n = 223) and infants who were fully breastfed for > or = 6 months (n = 136). Adjusting for demographic variables, childcare, and smoke exposure revealed statistically significant increased risk for both pneumonia (OR 4.27; 95% CI 1.27 to14.35) and > or = 3 episodes of OM (OR 1.95; 95% CI 1.06 to 3.59) in those who were fully breastfed for 4 to < 6 months compared with > or = 6 months.
An U.S. based randomized study «Bonuck KA, Freeman K, Trombley M. Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use. Arch Pediatr Adolesc Med 2006;160(9):953-60. »16 included 338 low-income, mother-infant dyads (n = 163 for the intervention group and n = 175 for the control group). The women were randomized to a prenatal and postpartum lactation support intervention vs. usual care. End-points included otitis media-, respiratory tract-, or gastrointestinal-related visits. The mothers and infants were followed until the child was 12 months old. Only the number of otitis media visits was reduced in the intervention group. Other endpoints did not differ by treatment group. At 2 weeks, 87% of the mothers in intervention group were breastfeeding vs. 66% of controls. At 5 months, responding numbers were 53% vs. 39%. In intervention group, 39.4% of infants had at least one period of AOM vs. 47.1% in the control group (P</=.03).