Association between breast feeding, child development and behaviour

doi:10.1016/S0378-3782(97)00062-5

Early Human Development

Volume 49, Supplement, 29 October 1997, Pages S175-S184

https://doi.org/10.1016/S0378-3782(97)00062-5 Get rights and content

Abstract

Consistent data are available to suggest that children who have been breast fed are, on average, intellectually more able than their formula-fed contemporaries. This has been shown in eight of 10 population studies and all three studies of low birthweight infants. In general, the longer the child has been breast fed the more pronounced the effect. There is evidence that breast milk that has been pasteurised before feeding does not have this effect, but that fresh breast milk is effective whether the milk is delivered by tube or by the breast. However no studies have been able to have both sufficient statistical power and the ability to allow for other confounders such as parental ability, parental IQ and other factors that might explain these findings. Additional data from studies of visual acuity show an association between breast feeding and enhanced vision which is hypothesised to be due to the unique fatty acid composition of breast milk. The differences in intellectual development might also be related to these fatty acids. Alternative explanations for the effect on intellectual development concern the possible consequences of early infections, particularly gastroenteritis, which are more common in bottle-fed babies. In contrast with the many publications on cognitive function and breast feeding, there was only one on neurological dysfunction (showing a protective effect of breast feeding) and one on childhood behaviour (using the teacher's assessment no relationship with breast feeding was found). Further research is needed in both areas.

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In humans the process of feeding milk from the breast is called breastfeeding or nursing (Capuco and Akers, 2009; NIH, 2013). It is well known that breast milk represents the main source of nutrition for the newborn for many mammalian species, and alterations in its composition of macronutrients (fat, protein, and carbohydrates) and micronutrients (vitamins and minerals), antibodies, growth factors and hormones are related to future disorders (Golding et al., 1997; Grosvenor et al., 1993; Hahn-Holbrook et al., 2016; Hinde et al., 2015). Currently, the importance of breastfeeding has been well recognized globally by public opinion, mainly due to scientific discoveries in the epidemiological and experimental fields.
The breastfeeding period is one of the most important critical windows in our development, since milk, our first food after birth, contains several compounds, such as macronutrients, micronutrients, antibodies, growth factors and hormones that benefit human health. Indeed, nutritional, and environmental alterations during lactation, change the composition of breast milk and induce alterations in the child's development, such as obesity, leading to the metabolic dysfunctions, cardiovascular diseases and neurobehavioral disorders. This review is based on experimental animal models, most of them in rodents, and summarizes the impact of an adequate breast milk supply in view of the developmental origins of health and disease (DOHaD) concept, which has been proposed by researchers in the areas of epidemiology and basic science from around the world. Here, experimental advances in understanding the programming during breastfeeding were compiled with the purpose of generating knowledge about the genesis of chronic noncommunicable diseases and to guide the development of public policies to deal with and prevent the problems arising from this phenomenon.
This review article is part of the special issue on “Cross talk between periphery and brain”.
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Regarding neural development, lactation in rats is thought to be equivalent to the third trimester of the gestational period in humans (Quinn, 2005). The function of lactation is to provide the primary source of nutrition and immune protection to offspring after birth (Golding et al., 1997). For this reason, we chose to explore the lactation period, which is a critical window for adverse environmental changes that impact cognitive and neurological development by predisposing newborns to metabolic diseases in adulthood (Srinivasan and Patel, 2008).
Metabolic syndrome (MetS) is characterized by increased abdominal fat, dyslipidemia, diabetes mellitus and hypertension. A high MetS prevalence is strongly associated with obesity. Obesity is a public health problem in which several complex factors have been implicated, including environmental pollutants. For instance, maternal smoking seems to play a role in obesogenesis in childhood. Given the association between endocrine disruptors, obesity and metabolic programming, over the past 10 years, our research group has contributed to studies based on the hypothesis that early exposure to nicotine/tobacco causes offspring to become MetS-prone. The mechanism by which tobacco smoking during breastfeeding induces metabolic dysfunctions is not completely understood; however, increased metabolic programming has been shown in studies that focus on this topic. Here, we reviewed the literature mainly based in light of our latest data from experimental models. Nicotine or tobacco exposure during breastfeeding induces several endocrine dysfunctions in a sex- and tissue-specific manner. This review provides an updated summary regarding the hypothesis that early exposure to nicotine/tobacco causes offspring to become MetS-prone. An understanding of this issue can provide support to prevent long-term disorders, mainly related to the risk of obesity and its comorbidities, in future generations.
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In fact, the maternal decision to breastfeed seems to be related to higher maternal intelligence (Jacobson et al., 1992). Moreover, multiple other prenatal, perinatal and postnatal factors, such as maternal prenatal drugs consumption (nicotine, alcohol and other drugs), infant nutrition and infant physical growth status, have also been described as possible factors related to MPD (Anderson et al., 1999; Conroy et al., 2012; Golding et al., 1997; Kiechl-Kohlendorfer et al., 2010; Mortensen, Michaelsen, Sanders, & Reinisch, 2002; Nyaradi et al., 2013), but these variables are not normally included as confounds in the analysis. Some studies have shown that MPD, nutritional status and physical growth are associated with infant head circumference, which is also associated with BF (Ferreira et al., 2013Ferreira, de Assunção, dos Santos, & Horta, 2013).
Breastfeeding (BF) confers numerous benefits on the developing infant in both the short and the long term including psychological development, but there are multiple other factors that must be taken into account when these relationships are studied. To analyse how breastfeeding during the first 4 months of life affects infant mental and psychomotor development (MPD) at 6 and 12 months in a group of healthy infants from a Mediterranean Spanish city considering many important potential confounds. This is a longitudinal study conducted on infants from birth until the age of 12 months. A total of 154 healthy infants were evaluated by Paediatric Unit of Sant Joan University Hospital in Reus, Spain. Type of feeding, clinical history, anthropometry, iron status and mental and psychomotor development were assessed and analysed. At 4 months, 24% of infants received BF and 26% received mixed feeding (MF). Multiple Linear Regression models were applied adjusting for potential prenatal, perinatal and postnatal confounds showing that infants who received BF for at least four months presented higher psychomotor development index (PDI) at 6 and at 12 months of age. Also, gestational age and BMI at 6 m were associated positively with PDI at 6 m, and haemoglobin levels at 12 m and birth height were associated with PDI and MDI at 12 m (respectively).
In conclusion, after the adjustment of important potential confounds, BF during at least four months and adequate infant iron status are related to better psychomotor development during the first year. No associations were found between BF and mental development.
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Citation Excerpt :
Our results suggest that maternal supplementation during pregnancy may have a persistent effect on the cognitive development of children. Our finding that commission errors were decreased by longer duration of breastfeeding is supported by earlier studies, which have shown a positive association between breastfeeding and neuropsychological development during the first years of life (Anderson et al., 1999; Golding et al., 1997). Horwood and Fergusson (1998), for instance, reported positive associations between breastfeeding and cognitive development in school and adolescent children.
Prenatal and early-life exposures can affect the course of children's neuropsychological development well into pre-adolescence, given the vulnerability of the developing brain. However, it is unknown which socio-environmental factors at early childhood can influence specific cognitive processes like attention at a later age. In this study, we aim to determine social and environmental exposures in early childhood that may be associated with attention function of 11-year-olds.
We measured attention function using the continuous performance test-II (CPT-II) on 393 11-year old children from the Menorca's birth-cohort within the INMA-project (Spain), and pre-selected a list of socio-environmental observations taken when they were up to 4 years of age. We found that earlier socio-environmental characteristics, such as parental social class, educational level and maternal mental health are associated with later inattentive and impulsive symptomatology through a higher rate of omission and commission errors. In addition, omission errors were higher in children with atopy and lower in those whose mothers took dietary supplementation with folic acid and vitamins during pregnancy. Breastfeeding played a protective role against commission errors, while higher DDE and PCBs levels at age 4 were associated with slow speed response. Our findings suggest that a number of life socio-environmental factors during prenatal life and early childhood, such as socio-demographic characteristics, breastfeeding, maternal nutritional supplementation with folic acid and vitamins and exposure to some organochlorine compounds may influence inattentive and hyperactive/impulsive symptomatology during pre-adolescence.
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Association between breast feeding, child development and behaviour

Abstract

Soc Sci Med

Early Hum Dev

Lancet

Early Hum Dev

Lancet

Lancet

Early Hum Dev

Breast feeding in Great Britain in 1946. Part II. Infant feeding in relation to survival. health and development

J Obstet Gynaecol Br Commonw

Early feeding history of children with learning disorders

Dev Med Child Neurol

Feeding in infancy and later ability and attainment

Dev Med Child Neurol

Factors associated with the intellectual ability of children born to women with high risk pregnancies

Br Med J