Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis.
OBJECTIVE
To synthesise the evidence on the association between duration and exclusivity of breastfeeding and the risk of acute otitis media (AOM).


METHODS
Systematic review and meta-analysis following searching of PubMed, CINAHL and EMBASE electronic databases.


RESULTS
Twenty-four studies, all from the USA or Europe, met the inclusion criteria. In the pooled analyses, any form of breastfeeding was found to be protective for AOM in the first 2 years of life. Exclusive breastfeeding for the first 6 months was associated with the greatest protection (OR 0.57 95% CI 0.44, 0.75), followed by 'more vs less' breastfeeding (OR 0.67; 0.59, 0.76) and 'ever vs never' breastfeeding (OR 0.67; 0.56, 0.80).


CONCLUSIONS
This systematic review and meta-analysis provides evidence that breastfeeding protects against AOM until 2 years of age, but protection is greater for exclusive breastfeeding and breastfeeding of longer duration. Exclusive breastfeeding during the first 6 months was associated with around a 43% reduction in ever having AOM in the first 2 years of life. After 2 years of age, there is no evidence that breastfeeding protects against AOM; however, there were few studies and the evidence quality was low.
Allergy and Lung Health Unit, Centre of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia.
G
G
Bowatte
Allergy and Lung Health Unit, Centre of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia.
R
R
Tham
Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics, Royal Children's Hospital, Parkville, Vic., Australia.|Institute of Inflammation and Repair, University of Manchester, Manchester, UK.
K J
KJ
Allen
Allergy and Lung Health Unit, Centre of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia.|NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, TAS, Australia.
D J
DJ
Tan
Allergy and Lung Health Unit, Centre of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia.
Mxz
M
Lau
Allergy and Lung Health Unit, Centre of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia.
X
X
Dai
Allergy and Lung Health Unit, Centre of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Carlton, Vic., Australia.|Murdoch Childrens Research Institute and University of Melbourne Department of Paediatrics, Royal Children's Hospital, Parkville, Vic., Australia.
C J
CJ
Lodge
D000208:Acute Disease; D001942:Breast Feeding; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010033:Otitis Media / Q000453:epidemiology*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
Breastfeeding; Child; Formula feeding; Otitis media