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To the Editor: Dr Paradise¹ stated that "less salient risk factors for OM include . . . formula feeding in early infancy." The reference cited was his own 1997 study² in which "infants were considered breastfed if their diet at the time included any breast milk" and which demonstrated only a small difference in OM rates between breastfed and formula-fed infants.

However, clearer definitions of breastfeeding better illuminate its benefits. For example, Duncan et al,³ controlling for low socioeconomic status, older siblings, and day care attendance, found significantly higher rates of single and recurrent episodes of OM in infants who received anything but breast milk before 4 months of age. They also noted a dose-response effect in that those who were exclusively breastfed for 6 months or more had less than half the rate of recurrent OM of those who were breastfed for fewer than 4 months.

The US Department . . . [Full Text of this Article]

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