Summary: Researchers report exclusive breastfeeding until the age of six months is associated with fewer conduct disorders in later childhood. Additionally, enriched play can help enhance cognition.
Source: Grand Challenges Canada.
Canadian Government-funded ‘Saving Brains’ research finds: Babies exclusively breastfed to 6 months old half as likely to have later conduct disorders; Enriched play/stimulation to age 2 creates brighter 4-year-olds.
A pair of new studies further strengthen scientific understanding of the links between what a child experiences in the first years of life and later childhood behaviour and abilities.
Funded by the Government of Canada through Grand Challenges Canada, researchers working in South Africa and Pakistan report their findings in papers launched today.
In the first study, an international team led by Dr Ruth M. Bland of the Royal Hospital for Sick Children and Institute of Health and Wellbeing, University of Glasgow, assessed over 1,500 children in South Africa, 900 of whom had been involved in an early infant feeding study.
They found longer durations of exclusive breastfeeding strongly associated with fewer conduct disorders at ages 7 to 11 years. Children exclusively breastfed for the recommended six months, compared with those exclusively breastfed for less than one month, were approximately half (56 percent) as likely to have conduct disorders at primary school age.
Other highlighted findings, published in PLOS Medicine, included:
- Important determinants of a child’s cognitive development: attending creche (preschool) and mother’s IQ
- Children who attended creche for at least one year were 74 percent more likely to have higher executive function (which enables us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. The brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses. Executive function, therefore, influences educational and social success.)
- Children stimulated at home, such as through play, were one third (36 percent) more likely to have higher executive function scores
- There was weaker evidence that, for boys, exclusive breastfeeding for more than one month improved cognitive development.
The study also examined a number of current life factors that might influence children’s development, finding that children were two-and-a-half times more likely to exhibit emotional-behavioural problems if their mothers had a current mental health problem or severe parenting stress.
“The duration of exclusive breastfeeding of an infant has greater importance than previously realized in several areas of development,” said lead author Dr Tamsen J. Rochat of the Human Science Research Council, Durban, South Africa.
“For example, childhood onset conduct disorders can lead to aggressive or disruptive behaviours, which interfere with learning and peer relationships, in turn leading to low self-esteem and further behavioural problems. Conduct disorders that start in childhood and persist into the teen years are associated with an increase in antisocial (and potentially violent or criminal) behaviours, poor long-term mental health and low academic achievement in later life.”
“Evidence from studies in high-income countries suggests that the economic cost of conduct disorders is enormous,” added Dr Bland. For example, a publication from the United Kingdom cited in the paper estimates the annual cost of crime attributable to people who had a conduct disorder in childhood at US$117 billion.
The study was also one of the first to assess the impact of HIV exposure on the development of primary school-age children in Africa. Previous studies suggested that children, although themselves HIV-negative, were disadvantaged if they were born to HIV-positive mothers, particularly in the areas of emotional and behavioural development. This study found that HIV-negative children born to HIV-positive mothers performed as well as those born to HIV-negative mothers.
Play and communication — “responsive stimulation” — pays dividends for impoverished rural children in Pakistan
The second paper, published by The Lancet Global Health and led by Dr Aisha K. Yousafzai of Aga Khan University, Karachi, followed up a cohort of impoverished children in rural Pakistan whose parents had been guided on strengthening nutritional care and “responsive stimulation” used to the end of age 2.
In the responsive stimulation intervention, caregivers were coached to observe and respond to their child’s cues during play and communication activities, improving the quality of interactions.
The intervention, adapted from the UNICEF and the World Health Organization’s ‘Care for Child Development’ approach (which is readily available online), included using everyday household items or homemade toys to stimulate children’s cognitive, language, motor and affective (emotional/feeling) skills.
At age 4, children who received the responsive stimulation intervention were, to varying degrees, more likely to have:
- Higher IQ
- Better pre-academic skills (in sizes and comparisons, and shapes)
- Better executive functioning
- More pro-social behaviour.
The follow-up study also found parents were better caregivers.
The research involved 1,302 four-year-olds and their mothers from the original study, which had likewise shown that responsive stimulation “significantly benefitted children’s cognitive, language and motor development at two years.” The investigators intend to follow this cohort throughout their schooling.
“The abilities fostered by stimulation are important for readiness and a successful transition to preschool,” said Dr Yousafzai. “The competencies assessed in this study have been shown to predict school engagement and longer-term academic attainment.”
“Other studies have shown that the early success of children clearly links to their productivity and income potential later in life and, at a large scale, impacts the economic well-being of societies.”
The inclusion of stimulation intervention in health programs is important to support healthy development. It is hoped more research will follow that will provide insights on how to optimize integrated packages of health, growth and development.
The newly published research from South Africa and Pakistan closely follows the release of another Grand Challenges Canada study, conducted by Harvard University, showing that one-third of 3- or 4-year-olds in low- and middle-income countries don’t reach expected developmental milestones.
Grand Challenges Canada funded the studies as part of its contribution to the growing international “Saving Brains” partnership, which convenes for a conference in Toronto June 21-22, focused on the results from 11 follow-up studies, including the two publications launched today.
“One in three children in ‘developing’ countries are in fact failing to develop to their full potential. These studies show how parents can help develop smart, social kids who make good decisions: breastfeed babies and play with children,” said Dr Peter A. Singer, Chief Executive Officer of Grand Challenges Canada.
Funding: Grand Challenges Canada funded this study.
Source: Liam Brown – Grand Challenges Canada
Image Source: This NeuroscienceNews.com image is credited to School Transition and Readiness Project, Department of Paediatrics and Child Health, Aga Khan University.
Original Research: Full open access research for “Exclusive Breastfeeding and Cognition, Executive Function, and Behavioural Disorders in Primary School-Aged Children in Rural South Africa: A Cohort Analysis” by Tamsen J. Rochat, Brian Houle, Alan Stein, Hoosen Coovadia, Anna Coutsoudis, Chris Desmond, Marie-Louise Newell, and Ruth M. Bland in PLOS Medicine. Published online June 21 2016 doi:10.1371/journal.pmed.1002044
Full open access research for “Effects of responsive stimulation and nutrition interventions on children’s development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial” by Aisha K Yousafzai, Jelena Obradović, Muneera A Rasheed, Arjumand Rizvi, Ximena A Portilla, Nicole Tirado-Strayer, Saima Siyal, and Uzma Memon in Lancet Global Health. Published online June 21 2016 doi:10.1016/S2214-109X(16)30100-0
[cbtabs][cbtab title=”MLA”]Grand Challenges Canada. “Exclusive Breastfeeding and Early Play Linked to Children’s Later Successes.” NeuroscienceNews. NeuroscienceNews, 22 June 2016.
<https://neurosciencenews.com/child-success-breastfeeding-play-4541/>.[/cbtab][cbtab title=”APA”]Grand Challenges Canada. (2016, June 22). Exclusive Breastfeeding and Early Play Linked to Children’s Later Successes. NeuroscienceNews. Retrieved June 22, 2016 from https://neurosciencenews.com/child-success-breastfeeding-play-4541/[/cbtab][cbtab title=”Chicago”]Grand Challenges Canada. “Exclusive Breastfeeding and Early Play Linked to Children’s Later Successes.” https://neurosciencenews.com/child-success-breastfeeding-play-4541/ (accessed June 22, 2016).[/cbtab][/cbtabs]
Exclusive Breastfeeding and Cognition, Executive Function, and Behavioural Disorders in Primary School-Aged Children in Rural South Africa: A Cohort Analysis
Exclusive breastfeeding (EBF) is associated with early child health; its longer-term benefits for child development remain inconclusive. We examine the associations between EBF, HIV exposure, and other maternal/child factors and the cognitive and emotional-behavioural development of children aged 7–11 y.
Methods and Findings
The Vertical Transmission Study (VTS) supported EBF in HIV-positive and HIV-negative women; between 2012 and 2014, HIV-negative VTS children (332 HIV exposed, 574 HIV unexposed) were assessed in terms of cognition (Kaufman Assessment Battery for Children Second Edition [KABC-II]), executive function (Developmental Neuropsychological Assessment Second Edition [NEPSY-II]), and emotional-behavioural functioning (parent-reported Child Behaviour Checklist, [CBCL]). We developed population means by combining the VTS sample with 629 same-aged HIV-negative children from the local demographic platform. For each outcome, we split the VTS sample into scores above or at/below each population mean and modelled each outcome using logistic regression analyses, overall and stratified by child sex. There was no demonstrated effect of EBF on overall cognitive functioning. EBF was associated with fewer conduct disorders overall (adjusted odds ratio [aOR] 0.44 [95% CI 0.3–0.7], p ≤ 0.01), and there was weak evidence of better cognition in boys who had been exclusively breastfed for 2–5 mo versus ≤1 mo (Learning subscale aOR 2.07 [95% CI 1.0–4.3], p = 0.05). Other factors associated with better child cognition were higher maternal cognitive ability (aOR 1.43 [95% CI 1.1–1.9], p = 0.02, Sequential; aOR 1.74 [95% CI 1.3–2.4], p < 0.001, Planning subscales) and crèche attendance (aOR 1.96 [95% CI 1.1–3.5], p = 0.02, Sequential subscale). Factors positively associated with executive function were home stimulation (aOR 1.36 [95% CI 1.0–1.8], p = 0.04, Auditory Attention; aOR 1.35 [95% CI 1.0–1.8], p = 0.05, Response Set) and crèche (aOR 1.74 [95% CI 1.0–3.0], p = 0.05, Animal Sorting). Maternal mental health problems and parenting stress were associated with increased emotional-behavioural problems on the total CBCL (aOR 2.44 [95% CI 1.3–4.6], p = 0.01; aOR 7.04 [95% CI 4.2–11.9], p < 0.001, respectively). Maternal HIV status was not associated with any outcomes in the overall cohort. Limitations include the nonrandomised study design and lack of maternal mental health assessment at the child’s birth.
EBF was associated with fewer than average conduct disorders and weakly associated with improved cognitive development in boys. Efforts to improve stimulation at home, reduce maternal stress, and enable crèche attendance are likely to improve executive function and emotional-behavioural development of children.
“Exclusive Breastfeeding and Cognition, Executive Function, and Behavioural Disorders in Primary School-Aged Children in Rural South Africa: A Cohort Analysis” by Tamsen J. Rochat, Brian Houle, Alan Stein, Hoosen Coovadia, Anna Coutsoudis, Chris Desmond, Marie-Louise Newell, and Ruth M. Bland in PLOS Medicine. Published online June 21 2016 doi:10.1371/journal.pmed.1002044
Effects of responsive stimulation and nutrition interventions on children’s development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial
A previous study in Pakistan assessed the effectiveness of delivering responsive stimulation and enhanced nutrition interventions to young children. Responsive stimulation significantly improved children’s cognitive, language, and motor development at 2 years of age. Both interventions significantly improved parenting skills, with responsive stimulation showing larger effects. In this follow-up study, we investigated whether interventions had benefits on children’s healthy development and care at 4 years of age.
We implemented a follow-up study of the initial, community-based cluster-randomised effectiveness trial, which was conducted through the Lady Health Worker programme in Sindh, Pakistan. We re-enrolled 1302 mother–child dyads (87% of the 1489 dyads in the original enrolment) for assessment when the child was 4 years of age. The children were originally randomised in the following groups: nutrition education and multiple micronutrient powders (enhanced nutrition; n=311), responsive stimulation (n=345), combined responsive stimulation and enhanced nutrition (n=315), and routine health and nutrition services (control; n=331). The data collection team were masked to the allocated intervention. The original enrolment period included children born in the study area between April 1, 2009, and March 31, 2010, if they were up to 2·5 months old without signs of severe impairments. The primary endpoints for children were development and growth at 4 years of age. Interventions were given in monthly group sessions and in home visits. The primary endpoint for mothers was wellbeing and caregiving knowledge, practices, and skills when the child was 4 years of age. Analysis was by intention to treat. The original trial is registered with ClinicalTrials.gov, number NCT00715936.
1302 mother–child dyads were re-enrolled between Jan 1, 2013, and March 31, 2013, all of whom were followed up at 4 years of age. Children who received responsive stimulation (with or without enhanced nutrition) had significantly higher cognition, language, and motor skills at 4 years of age than children who did not receive responsive stimulation. For children who received responsive stimulation plus enhanced nutrition, effect sizes (Cohen’s d) were 0·1 for IQ (mean difference from control 1·2, 95% CI −0·3 to 2·7), 0·3 for executive functioning (0·18, −0·07 to 0·29), 0·5 for pre-academic skills (7·53, 5·14 to 9·92) and 0·2 for pro-social behaviours (0·08, 0·03 to 0·13). For children who received responsive stimulation alone, effect sizes were 0·1 for IQ (mean difference with controls 1·7, −0·3 to 3·7), 0·3 for executive functioning (0·17, 0·07 to 0·27), 0·2 for pre-academic skills (3·86, 1·41 to 6·31), and 0·2 for pro-social behaviours (0·07, 0·02 to 0·12). Enhanced nutrition improved child motor development, with effect size of 0·2 for responsive stimulation plus enhanced nutrition (0·56, −0·03 to 1·15), and for enhanced nutrition alone (0·82, 0·18 to 1·46). Mothers who received responsive stimulation (with or without enhanced nutrition) had significantly better responsive caregiving behaviours at 4 years of child age than those who did not receive intervention. Effect size was 0·3 for responsive stimulation plus enhanced nutrition (1·95, 0·75 to 3·15) and 0·2 for responsive stimulation (2·01, 0·74 to 3·28). The caregiving environment had a medium effect size of 0·3 for all interventions (responsive stimulation plus enhanced nutrition 2·99, 1·50 to 4·48; responsive stimulation alone 2·82, 1·21 to 4·43; enhanced nutrition 3·52, 1·70 to 5·34).
Responsive stimulation delivered in a community health service can improve child development and care, 2 years after the end of intervention. Future analyses of these data are needed to identify which children and families benefit more or less over time.
Grand Challenges Canada.
“Effects of responsive stimulation and nutrition interventions on children’s development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial” by Aisha K Yousafzai, Jelena Obradović, Muneera A Rasheed, Arjumand Rizvi, Ximena A Portilla, Nicole Tirado-Strayer, Saima Siyal, and Uzma Memon in Lancet Global Health. Published online June 21 2016 doi:10.1016/S2214-109X(16)30100-0