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The Effect of Breastfeeding on Childhood Otitis Media

Current Allergy and Asthma Reports volume 17, Article number: 45 (2017) Cite this article

Abstract

Purpose of Review

The purpose of this review is to summarize the literature regarding the association between breastfeeding and childhood otitis media (OM), with focus on the literature published within the past 5 years. The review comprises original articles and recent reviews.

Recent Findings

The effect of a protective effect of breastfeeding on the risk of OM is still being discussed. Within the past 5 years, 6 reviews and 15 original articles have been published. No randomized controlled trials have been published, and the diversity of exposure and outcome measures in the studies was significant. Also, we provide a summary of the recent literature on cost-benefit of breastfeeding and believed mechanism of protection against OM.

Summary

Breastfeeding for more than 6 months seems to protect against OM during the first 6 years of life. Exclusive breastfeeding may have a more protective effect than non-exclusive breastfeeding. Introduction of formula feeding before the age of 6 months increased the risk of OM.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Stevens EE, Patrick TE, Pickler R. A history of infant feeding. J Perinat Educ. 2009;18:32–9.

    Article  PubMed  PubMed Central  Google Scholar 

  2. • Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387:475–90. A comprehensive review of the effect of breastfeeding on mother and child health status and a general description of the breastfeeding rates worldwide.

    Article  PubMed  Google Scholar 

  3. Kørvel-Hanquist A, Koch A, Niclasen J, Dammeye J, Lous J, Olsen SF, Homøe P. Risk factors of early otitis Media in the Danish National Birth Cohort. PLoS One. 2016;11:e0166465.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Liese JG, Silfverdal SA, Giaquinto C, et al. Incidence and clinical presentation of acute otitis media in children aged <6 years in European medical practices. Epidemiol Infect. 2014;142:1778–88.

    CAS  Article  PubMed  Google Scholar 

  5. Sarpong EM, Miller GE. Narrow- and broad-Spectrum antibiotic use among U.S. children. Health Serv Res. 2015;50:830–46.

    Article  PubMed  Google Scholar 

  6. Otters HBM. Trends in prescribing antibiotics for children in Dutch general practice. J Antimicrob Chemother. 2004;53:361–6.

    CAS  Article  PubMed  Google Scholar 

  7. Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, Grasso D, Barbiero C, Tamburlini G. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One. 2012;7:e36226.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Bartick MC, Schwarz EB, Green BD, Jegier BJ, Reinhold AG, Colaizy TT, Bogen DL, Schaefer AJ, Stuebe AM. Suboptimal breastfeeding in the United States: maternal and pediatric health outcomes and costs: suboptimal breastfeeding in the United States. Matern Child Nutr. 2017;13:e12366.

    Article  Google Scholar 

  9. Pokhrel S, Quigley MA, Fox-Rushby J, McCormick F, Williams A, Trueman P, Dodds R, Renfrew MJ. Potential economic impacts from improving breastfeeding rates in the UK. Arch Dis Child. 2015;100:334–40.

    CAS  Article  PubMed  Google Scholar 

  10. Colchero MA, Contreras-Loya D, Lopez-Gatell H, Gonzalez de Cosio T. The costs of inadequate breastfeeding of infants in Mexico. Am J Clin Nutr. 2015;101:579–86.

    CAS  Article  PubMed  Google Scholar 

  11. •• Palmeira P, Carneiro-Sampaio M. Immunology of breast milk. Rev Assoc Méd Bras. 2016;62:584–93. A general description of the immunological roll of breast milk on the immune system of the newborn child.

    Article  PubMed  Google Scholar 

  12. Brandtzaeg P. The mucosal immune system and its integration with the mammary glands. J Pediatr. 2010;156:S8–S15.

    CAS  Article  PubMed  Google Scholar 

  13. Stenfors LE. Non-specific and specific immunity to bacterial invasion of the middle ear cavity. Int J Pediatr Otorhinolaryngol. 1999;49(Suppl 1):S223–6.

    Article  PubMed  Google Scholar 

  14. Björck L, Rosén C, Marshall V, Reiter B. Antibacterial activity of the lactoperoxidase system in milk against pseudomonads and other gram-negative bacteria. Appl Microbiol. 1975;30:199–204.

    PubMed  PubMed Central  Google Scholar 

  15. Biesbroek G, Bosch AATM, Wang X, Keijser BJF, Veenhoven RH, Sanders EA., Bogaert D (2014) The Impact of Breastfeeding on Nasopharyngeal Microbial Communities in Infants. Am J Respir Crit Care Med 140612135546007.

  16. Hilty M, Qi W, Brugger SD, Frei L, Agyeman P, Frey PM, Aebi S, Mühlemann K. Nasopharyngeal microbiota in infants with acute otitis media. J Infect Dis. 2012;205:1048–55.

    CAS  Article  PubMed  Google Scholar 

  17. Maldonado J, Cañabate F, Sempere L, Vela F, Sánchez AR, Narbona E, López-Huertas E, Geerlings A, Valero AD, Olivares M, et al. Human milk probiotic lactobacillus fermentum CECT5716 reduces the incidence of gastrointestinal and upper respiratory tract infections in infants. J Pediatr Gastroenterol Nutr. 2012;54:55–61.

    Article  PubMed  Google Scholar 

  18. Patel JA, Alvarez-Fernandez P, Jennings K, Loeffelholz M, McCormick D, Chonmaitree T. Factors affecting Staphylococcus aureus colonization of the nasopharynx in the first 6 months of life. Pediatr Infect Dis J. 2015;34:826–30.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Claycombe KJ, Brissette CA, Ghribi O. Epigenetics of inflammation, maternal infection, and nutrition. J Nutr. 2015;145:1109S–15S.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  20. Wiertsema SP, Veenhoven RH, Sanders EA, Rijkers GT. Immunologic screening of children with recurrent otitis media. Curr Allergy Asthma Rep. 2005;5:302–7.

    CAS  Article  PubMed  Google Scholar 

  21. Chapman DJ, Morel K, Bermudez-Millan A, Young S, Damio G, Perez-Escamilla R. Breastfeeding education and support trial for overweight and obese women: a randomized trial. Pediatrics. 2013;131:e162–70.

    Article  PubMed  PubMed Central  Google Scholar 

  22. •• Homøe P, Kværner K, Casey JR, Damoiseaux RAMJ, van Dongen TMA, Gunasekera H, Jensen RG, Kvestad E, Morris PS, Weinreich HM. Panel 1: epidemiology and diagnosis. Otolaryngol Neck Surg. 2017;156:S1–S21. An updated review of the literature on OM epidemiology and risk associations including breastfeeding.

    Article  Google Scholar 

  23. Ajetunmobi OM, Whyte B, Chalmers J, Tappin DM, Wolfson L, Fleming M, MacDonald A, Wood R, Stockton DL. Breastfeeding is associated with reduced childhood hospitalization: evidence from a Scottish birth cohort (1997-2009). J Pediatr. 2015;166:620–625.e4.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Brennan-Jones CG, Whitehouse AJ, Park J, Hegarty M, Jacques A, Eikelboom RH, Swanepoel DW, White JD, Jamieson SE (2014) Prevalence and risk factors for parent-reported recurrent otitis media during early childhood in the Western Australian Pregnancy Cohort (Raine) Study: Risk factors for otitis media. J Paediatr Child Health n/a–n/a.

  25. Todberg T, Koch A, Andersson M, Olsen SF, Lous J, Homøe P. Incidence of otitis Media in a Contemporary Danish National Birth Cohort. PLoS One. 2014;9:e111732.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zhang Y, Xu M, Zhang J, Zeng L, Wang Y, Zheng QY. Risk factors for chronic and recurrent otitis media–a meta-analysis. PLoS One. 2014;9:e86397.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kırıs M, Muderris T, Kara T, Bercin S, Cankaya H, Sevil E. Prevalence and risk factors of otitis media with effusion in school children in eastern Anatolia. Int J Pediatr Otorhinolaryngol. 2012;76:1030–5.

    Article  PubMed  Google Scholar 

  28. Aydemir G, Ozkurt F. Otitis media with effusion in primary schools in princes’ islands, Istanbul: Prevalence and risk factors. J Int Med Res. 2011;39:866–72.

    CAS  Article  PubMed  Google Scholar 

  29. Chantry CJ. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006;117:425–32.

    Article  PubMed  Google Scholar 

  30. Daly KA, Brown WM, Segade F, Bowden DW, Keats BJ, Lindgren BR, Levine SC, Rich SS. Chronic and recurrent otitis media: a genome scan for susceptibility loci. Am J Hum Genet. 2004;75:988–97.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. Fliss DM, Shoham I, Leiberman A, Dagan R. Chronic suppurative otitis media without cholesteatoma in children in southern Israel: incidence and risk factors. Pediatr Infect Dis J. 1991;10:895–9.

    CAS  Article  PubMed  Google Scholar 

  32. Jensen RG, Homøe P, Andersson M, Koch A. Long-term follow-up of chronic suppurative otitis media in a high-risk children cohort. Int J Pediatr Otorhinolaryngol. 2011;75:948–54.

    Article  PubMed  Google Scholar 

  33. Sale MM, Chen W-M, Weeks DE, et al. Evaluation of 15 functional candidate genes for association with chronic otitis media with effusion and/or recurrent otitis media (COME/ROM). PLoS One. 2011;6:e22297.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. • Lodge CJ, Bowatte G, Matheson MC, Dharmage SC. The role of breastfeeding in childhood otitis media. Curr Allergy Asthma Rep. 2016; doi:10.1007/s11882-016-0647-0. A description of the recent literature regarding the protective effekt of breastfeeding. This article states, that there appears to be little doubt of the protective effect of breastfeeding on the risk of OM.

  35. Hörnell A, Lagström H, Lande B, Thorsdottir I. Breastfeeding, introduction of other foods and effects on health: a systematic literature review for the 5th Nordic nutrition recommendations. Food Nutr Res. 2013;57:20823.

    Article  Google Scholar 

  36. •• Bowatte G, Tham R, Allen K, Tan D, Lau M, Dai X, Lodge C. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatr. 2015;104:85–95. A comprehensive systematic meta-analysis, containing most of the existing literature on breastfeeding and the risk of OM with meta-analyzed risk estimates on the effect of various measures of breastfeeding.

    CAS  Article  PubMed  Google Scholar 

  37. Salone LR, Vann WF, Dee DL. Breastfeeding: an overview of oral and general health benefits. J Am Dent Assoc. 2013;144:143–51.

    Article  PubMed  Google Scholar 

  38. Martines F, Salvago P, Ferrara S, Messina G, Mucia M, Plescia F, Sireci F. Factors influencing the development of otitis media among Sicilian children affected by upper respiratory tract infections. Braz J Otorhinolaryngol. 2016;82:215–22.

    Article  PubMed  Google Scholar 

  39. Jensen RG, Koch A, Homøe P, Bjerregaard P. Tobacco smoke increases the risk of otitis media among Greenlandic Inuit children while exposure to organochlorines remain insignificant. Environ Int. 2013;54:112–8.

    CAS  Article  PubMed  Google Scholar 

  40. Salah M, Abdel-Aziz M, Al-Farok A, Jebrini A. Recurrent acute otitis media in infants: analysis of risk factors. Int J Pediatr Otorhinolaryngol. 2013;77:1665–9.

    Article  PubMed  Google Scholar 

  41. Fisk CM, Crozier SR, Inskip HM, Godfrey KM, Cooper C, Roberts GC, Robinson SM, the Southampton Women’s Survey Study Group. Breastfeeding and reported morbidity during infancy: findings from the Southampton Women’s survey: breastfeeding and reported morbidity during infancy. Matern Child Nutr. 2011;7:61–70.

    Article  PubMed  Google Scholar 

  42. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J (2007) Breastfeeding and maternal and infant health outcomes in developed countries. Evid Report Technol Assess 1–186.

  43. Kramer MS, Kakuma R (2012) Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev.

  44. Ladomenou F, Moschandreas J, Kafatos A, Tselentis Y, Galanakis E. Protective effect of exclusive breastfeeding against infections during infancy: a prospective study. Arch Dis Child. 2010;95:1004–8.

    Article  PubMed  Google Scholar 

  45. Kramer MS, Guo T, Platt RW, Sevkovskaya Z, Dzikovich I, Collet J-P, Shapiro S, Chalmers B, Hodnett E, Vanilovich I, et al. Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding. Am J Clin Nutr. 2003;78:291–5.

    CAS  PubMed  Google Scholar 

  46. 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;91:867–72.

    CAS  PubMed  Google Scholar 

  47. Kaur A, Singh K, Pannu MS, Singh P, Sehgal N, Kaur R. The effect of exclusive breastfeeding on hospital stay and morbidity due to various diseases in infants under 6 months of age: a prospective observational study. Int J Pediatr. 2016;2016:1–6.

    Article  Google Scholar 

  48. Li R, Dee D, Li C-M, Hoffman HJ, Grummer-Strawn LM. Breastfeeding and risk of infections at 6 years. Pediatrics. 2014;134:S13–20.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Karunanayake CP, Albritton W, Rennie DC, et al. Ear infection and its associated risk factors in first nations and rural school-aged Canadian children. Int J Pediatr. 2016;2016:1–10.

    Article  Google Scholar 

  50. Brennan-Jones CG, Eikelboom RH, Jacques A, Swanepoel D, Atlas MD, Whitehouse AJO, Jamieson SE, Oddy WH. Protective benefit of predominant breastfeeding against otitis media may be limited to early childhood: results from a prospective birth cohort study. Clin Otolaryngol. 2017;42:29–37.

    CAS  Article  PubMed  Google Scholar 

  51. Boone KM, Geraghty SR, Keim SA. Feeding at the breast and expressed milk feeding: associations with otitis media and diarrhea in infants. J Pediatr. 2016;174:118–25.

    Article  PubMed  Google Scholar 

  52. Usonis V, Jackowska T, Petraitiene S, Sapala A, Neculau A, Stryjewska I, Devadiga R, Tafalla M, Holl K. Incidence of acute otitis media in children below 6 years of age seen in medical practices in five east European countries. BMC Pediatr. 2016; doi:10.1186/s12887-016-0638-2.

  53. Prins-van Ginkel AC, Bruijning-Verhagen PCJ, Uiterwaal CSPM, van der Ent CK, Smit HA, de Hoog MLA. Acute otitis media during infancy: parent-reported incidence and modifiable risk factors. Pediatr Infect Dis J. 2017;36:245–9.

    Article  PubMed  Google Scholar 

  54. Chonmaitree T, Trujillo R, Jennings K, et al. Acute otitis media and other complications of viral respiratory infection. Pediatrics. 2016; doi:10.1542/peds.2015-3555.

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Authors and Affiliations

  1. Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark

    Asbjørn Kørvel-Hanquist, B. D. Djurhuus & P. Homøe

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  1. Asbjørn Kørvel-Hanquist
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  2. B. D. Djurhuus
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  3. P. Homøe
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Correspondence to Asbjørn Kørvel-Hanquist.

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Kørvel-Hanquist, A., Djurhuus, B.D. & Homøe, P. The Effect of Breastfeeding on Childhood Otitis Media. Curr Allergy Asthma Rep 17, 45 (2017). https://doi.org/10.1007/s11882-017-0712-3

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Keywords

  • Breastfeeding
  • Breast milk
  • Otitis media
  • Review
  • Childhood infection
  • Epidemiology