Effects of Breastfeeding on Cognitive Development

1. Effects of Breastfeeding on Cognitive Development Colleen Doorhy Spring 2012 NTR 595 NCSU

2. Introduction • Can breastfeeding help or hinder children’s ability to reach their intellectual potential? • Is there a clear association? • What type of breastfeeding is “best” and for how long? • WHO & UNICEF recommend exclusive BF for 6 months • What are the major confounding factors in these studies?

3. A critical evaluation of the evidence on the association between type of infant feeding and cognitive developmenT (2000) • Review Article • Bachner’s standards for validity • Definition of outcome • Correct classification type of infant feeding • Control of confounders • 6/24 studies met all 3 standards • 19/24 found IQ advantage breast fed compared to formula fed • No comprehensive answer • Need dose-response • Control confounders

4. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age (2006) • Prospective study • Preterm infants • Hypothesis: ELBW infants who received breast milk in NICU have higher Bayley mental, psychomotor & behavior scores at 18-22 months CA • Results: Children in breast milk group more likely to have MDI >85, mean PDI, and BRS %tile • Conclusion: Long term benefits of breast milk in NICU for ELBW may optimize cognitive potential & reduce the need for early intervention and special ed services

5. Table 3 Outcomes by breast milk feeding

6. Breastfeeding is associated with Improved Child Cognitive Development: A Population-based Cohort Study (2012) • Cohort study • Preterm & Term infants • Results: • Term: 2 points for picture similarities (> 4 m), naming vocab (> 6 m) • Pre-term: 4 points for naming vocab (> 4 m), picture similarities (> 2 m) • 6 points for pattern construction (> 2 m) • Conclusion: Breastfed children will be 1-6 months ahead of those never breastfed. • particularly in preterm children

7. Breast feeding and cognitive development at age 1 and 5 years (2001) • Prospective study • Term infants • Null hypothesis: There is no difference in mental development at 13 months and 5 yrs between children who were breast fed for <3 months compared to children who were breast fed for at least 6 months • Results: BF <3 months has risk of test score median MDI (mental index) at 13 months & WPPSI-R at 5 yr • Conclusion: Data suggest longer duration of BF benefits CD

8. Table 2 Bayley scales of Infant Development at 13 months & duration of Breastfeeding Table 5 WPPSI-R score at 5 yrs & duration of Breastfeeding

9. Breastfeeding and Child Cognitive Development (2008) • Intervention study • Term infants • Objective: To assess whether prolonged and exclusive BF improves children’s cognitive ability at age 6.5 yrs • Results: Experimental group had scores for IQ subtypes & teacher evaluations • Conclusion: These results provide strong evidence that prolonged & exclusive BF improves children’s CD

10. Table 3 Weschsler Abbreviated Scales of Intelligence Results Table 4 Teacher Ratings of Academic Performance

11. Effect of exclusive breastfeeding on the development of children’s cognitive function in the Krakow prospective birth cohort study (2012) • Cohort study • Term infants • Hypothesis: cognitive gain in BF children is strong predictor of CD trajectory • Results: mixed feeding total IQ scores at each check-up vs. exclus. BF • strong positive trend for IQ scores & duration exclus. BF • Conclusion: Exclus. BF in infancy enhances cognitive ability; moreover, a beneficial effect was observed after shorter periods of breastfeeding

12. Table 3 Trends for cognitive function in children assessed over the follow-up by the breastfeeding type *Scores shown are mean unadjusted data

13. Conclusions • Evidence suggests benefit of cognitive development with prolonged and exclusive breastfeeding • Especially preterm infants • Boys? • Many, many confounding variables • Be careful of study’s validity • More research is needed

14. References • Drane DL and Logemann JA. A critical evaluation of the evidence on the association between type of infant feeding and cognitive development. Pediatric and Perinatal Epidemiology. 2000;14:349-356. • Vohr BR, Poindexter BB, Dusick AM et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics. 2006;118(1):115-121. • Quigley M, Hockley C, Carson C, Kelly Y, Renfrew M, and Sacker A. Breastfeeding is associated with improved child cognitive development: a population-based cohort study. The Journal of Pediatrics. 2012;160(1):25-32. • Angelsen NK, Vik T, Jacobsen G, Bakketeig LS. Breast feeding and cognitive development at age 1 and 5 years. Arch Dis Child. 2001;85:183-188. • Kramer MS, Aboud F, Mironova E et al. For the Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group Breastfeeding and Child Cognitive Development: New Evidence From a Large Randomized Trial Arch Gen Psychiatry. 2008; 65(5):578-584. • Jedrychowski W, Perera F, Jankowski J et al. Effect of exclusive breastfeeding on the development of children’s cognitive function in the Krakow prospective birth cohort study. European Journal of Pediatrics. 2012;171(1):151-158.

15. References Pictures • http://en.wikipedia.org/wiki/File:Breastfeeding-icon-med.svg • http://mymommatoldme.com/parenting/kids-entertainment-when-will-my-baby-watch-baby-einstein • http://www.zazzle.com/breastfeeding_icon_breast_is_best_teal_sticker-217904936419319543