Summary: Babies who are exclusively breastfed or consume a mixed diet of breast and formula milk during the first 8 weeks of life are at lower risk of having learning disabilities compared to those who are exclusively bottle-fed, a new study reports.
Source: University of Glasgow
Children who are exclusively breastfed or fed a mix of formula and breastmilk for the first six to eight weeks of life are at lower risk of having special educational needs and learning disabilities, according to a new study.
The research, led by the University of Glasgow and published in PLOS Medicine, studied data from more than 190,000 children to understand the impact of early life feeding on later development. The findings suggest that being fed breastmilk in the first few weeks of life may help to reduce the risk of having special educational needs, or the learning disabilities and difficulties that often cause this.
The World Health Organization recommends that babies are breastfed for the first six months, however many women struggle to exclusively breastfeed for this long. This study provides evidence that a shorter duration of non-exclusive breastfeeding may still be beneficial for a child’s later learning development.
Researchers looked at the health and educational data for 191,745 children born in Scotland from 2004 onward, and who also attended a state or special needs school between 2009 until 2013.
Of those included in the study, 66.2% of children were formula fed, 25.3% were breastfed, and only 8.5% were mixed fed for the first six to eight weeks.
Overall, 12.1% of children in this study had special education needs. However, when compared with formula feeding, a history of early life mixed feeding and exclusive breastfeeding were both associated with a decrease in the risk of having special educational needs—around 10% and 20% less likely, respectively.
Moreover, exclusively breastfed children were also less likely to have emotional or behavioral difficulties (around 20% less likely) and physical health conditions (around 25% less likely).
The number of children in Scotland with a record of special educational need increased almost four-fold between 2010 and 2018, and by 2020 almost a third of pupils in Scotland had a record of having special educational needs. This represents a significant burden on the education, health, and social sectors, as well as having a substantial impact on the children, their families and wider society.
Children with special educational needs experience lower educational attainment, higher rates of school absenteeism and exclusion, and higher rates of bullying and maltreatment, which can all further impact on their physical and mental health and well-being.
Dr. Michael Fleming, who led the study at the University of Glasgow’s School of Health and Wellbeing, said, “We know that many women struggle to exclusively breastfeed for the full six-months recommended by the WHO, however our study provides evidence that a shorter duration of non-exclusive breastfeeding could nonetheless be beneficial with regards to a child’s learning development.
“The results of this study suggest that feeding method in infancy could be a modifiable risk factor for the causes of special educational need, which in turn has the potential to help reduce the burden for affected children, their families and wider society.”
Children who were born in private hospitals, privately educated, or home-schooled were not included in the study.
Infant feeding method and special educational need in 191,745 Scottish schoolchildren: A national, population cohort study
While special educational needs (SEN) are increasingly recorded among schoolchildren, infant breastfeeding has been associated with reduced incidence of childhood physical and mental health problems. This study investigated relationships between infant feeding method and risk of all-cause and cause-specific SEN.
Methods and findings
A population cohort of schoolchildren in Scotland was constructed by linking together health (maternity, birth, and health visitor records) and education (annual school pupil census) databases. Inclusion was restricted to singleton children, born in Scotland from 2004 onwards with available breastfeeding data and who attended local authority mainstream or special schools between 2009 and 2013.
Generalised estimating equation models with a binomial distribution and logit link function investigated associations between infant feeding method at 6 to 8 weeks and all-cause and cause-specific SEN, adjusting for sociodemographic and maternity factors.
Of 191,745 children meeting inclusion criteria, 126,907 (66.2%) were formula-fed, 48,473 (25.3%) exclusively breastfed, and 16,365 (8.5%) mixed-fed. Overall, 23,141 (12.1%) children required SEN.
Compared with formula feeding, mixed feeding and exclusive breastfeeding, respectively, were associated with decreased all-cause SEN (OR 0.90, 95% CI [0.84,0.95], p < 0.001 and 0.78, [0.75,0.82], p < 0.001), and SEN attributed to learning disabilities (0.75, [0.65,0.87], p < 0.001 and 0.66, [0.59,0.74], p < 0.001), and learning difficulties (0.85, [0.77,0.94], p = 0.001 and 0.75, [0.70,0.81], p < 0.001).
Compared with formula feeding, exclusively breastfed children had less communication problems (0.81, [0.74,0.88], p = 0.001), social–emotional–behavioural difficulties (0.77, [0.70,0.84], p = 0.001), sensory impairments (0.79, [0.65,0.95], p = 0.01), physical motor disabilities (0.78, [0.66,0.91], p = 0.002), and physical health conditions (0.74, [0.63,0.87], p = 0.01).
There were no significant associations for mixed-fed children (communication problems (0.94, [0.83,1.06], p = 0.312), social–emotional–behavioural difficulties (0.96, [0.85,1.09], p = 0.541), sensory impairments (1.07, [0.84,1.37], p = 0.579), physical motor disabilities (0.97, [0.78,1.19], p = 0.754), and physical health conditions (0.93, [0.74,1.16], p = 0.504)).
Feeding method was not significantly associated with mental health conditions (exclusive 0.58 [0.33,1.03], p = 0.061 and mixed 0.74 [0.36,1.53], p = 0.421) or autism (exclusive 0.88 [0.77,1.01], p = 0.074 and mixed 1.01 [0.84,1.22], p = 0.903).
Our study was limited since only 6- to 8-week feeding method was available precluding differentiation between never-breastfed infants and those who stopped breastfeeding before 6 weeks. Additionally, we had no data on maternal and paternal factors such as education level, IQ, employment status, race/ethnicity, or mental and physical health.
In this study, we observed that both breastfeeding and mixed feeding at 6 to 8 weeks were associated with lower risk of all-cause SEN, and SEN attributed to learning disabilities and learning difficulty.
Many women struggle to exclusively breastfeed for the full 6 months recommended by WHO; however, this study provides evidence that a shorter duration of nonexclusive breastfeeding could nonetheless be beneficial with regard to the development of SEN.
Our findings augment the existing evidence base concerning the advantages of breastfeeding and reinforce the importance of breastfeeding education and support.