{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T08:00:35Z","timestamp":1789804835330,"version":"4.0.1"},"reference-count":19,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1997,10,1]]},"abstract":"<jats:p>Objective.\u2003We followed a cohort (N = 306) of infants at well-baby visits in two suburban pediatric practices to assess the relation of exclusive breastfeeding, and other environmental exposures, to episodes of acute otitis media (AOM) and otitis media with effusion (OME).<\/jats:p><jats:p>Methods.\u2003Detailed prospective information about the exclusiveness of breastfeeding, parental smoking, day care attendance, and family history was obtained at scheduled clinic visits. Tympanometric and otoscopic examinations were used in the diagnosis of otitis media (OM). Nasopharyngeal cultures were performed at 1\u20136 months, and at 8, 10, 12, 15, 18, and 24 months of age to detect colonization with middle-ear pathogens.<\/jats:p><jats:p>Results.\u2003Between 6 and 12 months of age, cumulative incidence of first OM episodes increased from 25% to 51% in infants exclusively breastfed and from 54% to 76% in infants formula-fed from birth. Peak incidence of AOM and OME episodes was inversely related to rates of breastfeeding beyond 3 months of age. A twofold elevated risk of first episodes of AOM or OME was observed in exclusively formula-fed infants compared with infants exclusively breast-fed for 6 months. In the logistic regression analysis, formula-feeding was the most significant predictor of AOM and OME episodes, although age at colonization with middle-ear pathogens and day care (outside the home) were significant competing risk factors. A hazard health model suggested additionally that breastfeeding, even for short durations (3 months), reduced onset of OM episodes in infancy.<\/jats:p><jats:p>Conclusions.\u2003Modifiable factors in the onset of AOM and OME episodes during the first 2 years of life include early age at colonization (\u22643 months of age), day care outside the home, and not being breastfed.<\/jats:p>","DOI":"10.1542\/peds.100.4.e7","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:40:17Z","timestamp":1092440417000},"page":"e7-e7","source":"Crossref","is-referenced-by-count":136,"title":["Exclusive Breastfeeding Protects Against Bacterial Colonization and Day Care Exposure to Otitis Media"],"prefix":"10.1542","volume":"100","author":[{"given":"Linda C.","family":"Duffy","sequence":"first","affiliation":[{"name":"From the Departments of Pediatrics, Children's Hospital, and"},{"name":"Social and Preventive Medicine and Statistics, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Faden","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics, Children's Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Wasielewski","sequence":"additional","affiliation":[{"name":"Social and Preventive Medicine and Statistics, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Wolf","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics, Children's Hospital, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra","family":"Krystofik","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics, Children's Hospital, 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