Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis

Acta Paediatr. 2015 Dec;104(467):85-95. doi: 10.1111/apa.13151.


Aim: 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).

Conclusion: 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.

Keywords: Breastfeeding; Child; Formula feeding; Otitis media.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Acute Disease
  • Breast Feeding*
  • Child
  • Child, Preschool
  • Europe / epidemiology
  • Humans
  • Infant
  • Infant, Newborn
  • Otitis Media / epidemiology*
  • Risk Factors
  • Time Factors
  • United States / epidemiology