An Editor's Perspective on Breastfeeding Terminology

Rasmussen et al.’s provocative article, suggesting a new lexicon for our use of the term “breastfeeding,” poses no less a challenge to those of us with editorial responsibility as it does for clinical researchers and survey takers. Clearly, as she so eloquently details, the generic term “breastfeeding” needs to be expanded into a description of what actually is happening in the real world of infant feeding, both as to what is the source of the human milk and what is the mechanics of the feeding process. Surely, it should be self-evident, that equating bottle feeding of pasteurized, frozen, and thawed donor human milk to the feeding of fresh milk by an infant who is sucking at his or her biologic mother's breast can no longer be accepted. It is not just a matter of terminology and the need for language specificity but also, clearly, as we now know, scientifically it is not the same!

As such, it seems to me, as Editors that we need to require that the Methodology Section of every future submission to Breastfeeding Medicine of an article wherein “breastfeeding” is the subject that the authors utilize terminology comparable to what Rasmussen proposes. I suspect that the suggestions of Rasmussen et al. are not the last word on the subject, but that they will serve as a basis for serious discussion and ultimately a consensus of proper new terminology. In fact I hope that the Academy of Breastfeeding Medicine (ABM) in its role as “the premier global organization for education of all physicians on breastfeeding and human lactation and a trusted source of authoritative clinical and scientific information to guide professional and societal practices” ¹ will take the lead and convene an appropriate multidisciplinary medical group to formulate specific recommendations as to a consensus for a desired new and functional terminology.

In addressing this issue, I would suggest that there is an additional and possibly controversial issue that should also be addressed. To date, exclusive breastfeeding is defined as the ingestion of human milk to the exclusion of all other fluids and solid foods. As we know, the recommendations of ABM, World Health Organization, American Academy of Pediatrics, and others ² are that infants exclusively breastfed for 6 months and the rate of exclusivity in any given population have become a measure of the success or failure of its local healthcare system. However, recently, there are increasing recommendations for introducing nonbovine milk products such as peanuts as early as the fourth month as a technique for allergy prevention particularly for high-risk infants. ³ Ingestion of such products per current definition would have the infants labeled as no longer exclusively breastfeeding even though the source of milk protein remains solely human milk. Our current terminology does not distinguish nonexclusive breastfeeding based on introduction of “formula” (a breast milk substitute) and those who introduce noncow milk food products. Even the feeding of water by current terminology defines the infant as a nonexclusive breast feeder. Although this may be technically correct, there is no evidence that such feeding of water per se alters the benefits of human milk when it continues to the sole source of nutrition. Thus, in my opinion, the issue of how to redefine exclusivity has to be addressed in the development of any new terminology.