Wednesday, April 09, 2008

New studies on breastfeeding show that benefits are overstated

I am a passionate advocate of breastfeeding and breastfed my four children. Nonetheless, I am disturbed at the way that breastfeeding is wielded by "lactivists" to criticize other women. New studies confirm that many of the purported benefits of breastfeeding simply do not exist.

Effects of Prolonged and Exclusive Breastfeeding on Child Behavior and Maternal Adjustment: Evidence From a Large, Randomized Trial by Kramer et al, in the March 2008 issue of Pediatrics is the largest randomized study of breastfeeding that has ever been conducted. The authors write:
Given the frequently studied and reported associations between breastfeeding and cognitive development and the intimate mother–infant physical and emotional contact during the act of breastfeeding, surprisingly few studies have reported on the long-term effects of infant feeding on child behavior and maternal adjustment. Short-term studies during infancy reported effects on infant crying and fussing and sleep patterns but no effect on mother–infant attachment behavior.
The study included over 17,000 children who were followed until at least 6.5 years of age. The results:
Our results show no consistent and significant differences in behavioral strengths or difficulties in children who were cluster-randomized to a breastfeeding promotion intervention. Despite the substantial increase observed in both the duration and the exclusivity of breastfeeding in the experimental group,12 that increase did not lead to any detectable reductions in emotional difficulties, hyperactivity, or conduct or peer problems or to improvement in prosocial behavior. Because breast milk in Belarus is provided almost exclusively via breastfeeding (less than 0.5% of PROBIT infants were receiving expressed breast milk at any of the follow-up visits during the first 12 months of life), the absence of any behavioral benefits does not support our hypothesized advantage of increased maternal–infant physical contact.
So prolonged breastfeeding appears to have no impact on child behavior or on mother-infant attachment. How about the purported health benefits?

A new study in the Journal of Human Lactation, Breastfeeding and Infant Illness in Low-Income, Minority Women: A Prospective Cohort Study of the Dose-Response Relationship, Vol. 24, No. 1, 14-22 (2008), followed 255 mother-infant pairs to determine if there is any relationship between amount and duration of breastfeeding and ear infections, respiratory illnesses and gastrointestinal illnesses. They found:
... no significant associations between breastfeeding intensity and infant visits for otitis media, respiratory and gastrointestinal illness, or total illness visits. In this low-income, multiethnic sample, breastfeeding intensity was not associated with infant health service use ...
Adriano Canttaneo, an pediatric epidemiologist and enthusiastic supporter of breastfeeding, writing in the Journal of Pediatrics and Child Health earlier this year (The benefits of breastfeeding or the harm of formula feeding?) cautions against making sweeping and unsupported claims about breastfeeding:
... We do not need to use weak and shaky arguments to convince mammals to breastfeed. What we need is effective care to let them breastfeed as much and as long as they wish.
Breastfeeding is desirable and beneficial, and we should promote breastfeeding as much as possible. However, breastfeeding advocates should not overstate the benefits of breastfeeding or overstate the risks of formula feeding. Rather, we should do whatever we can to allow women who wish to breastfeed to start and maintain breastfeeding for as long as they would like.

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