Breastfeeding Recommendations: Torn Between Evidence and Emotions—A Commentary

The recently published German evidence-based guideline on “Breastfeeding Duration” recommends that infants in Germany should be exclusively or predominantly breastfed for 6 months, with a total breastfeeding duration of 12 months. These recommendations rely exclusively on low- and very low-certainty evidence, and fall short of what would be expected for an evidence-based guideline. The guideline has been criticized by a large number of eight professional organizations, which is very unusual. As delegates or deputy delegates of our respective medical-scientific societies participating in the six-year guideline development process, we disagree with the published guideline recommendations and present here our key methodological and content-related concerns. In our view, there is no sufficient evidence that would demonstrate superiority of the proposed recommendation with respect to benefits and harms compared to the long-standing recommendation of exclusive breastfeeding for 4–6 months and continued breastfeeding for as long as mother and child desire for healthy populations in Germany and Western Europe.