Breastfeeding and Child Cognitive Development

New Evidence From a Large Randomized Trial

Bibliographic Data

ID23328783
AuthorsMichael S Kramer (0000-0002-5977-8461, McGill University, corresponding author)
Year2008
Volume65
Issue5
Pages578
Publication date2008-05-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueArchives of General Psychiatry (JOURNAL)
Journal identifiersISSN: 0003-990X • E-ISSN: 1538-3636
PublisherAmerican Medical Association (AMA) (PUBLISHER)
DOI10.1001/archpsyc.65.5.578
PMID18458209
OpenAlexW2164092942
LanguageEN
Citations received114
References cited4

CONTEXT: The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother's behavior or her interaction with the infant. OBJECTIVE: To assess whether prolonged and exclusive breastfeeding improves children's cognitive ability at age 6.5 years. DESIGN: Cluster-randomized trial, with enrollment from June 17, 1996, to December 31, 1997, and follow-up from December 21, 2002, to April 27, 2005. SETTING: Thirty-one Belarussian maternity hospitals and their affiliated polyclinics. PARTICIPANTS: A total of 17,046 healthy breastfeeding infants were enrolled, of whom 13,889 (81.5%) were followed up at age 6.5 years. INTERVENTION: Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF. MAIN OUTCOME MEASURES: Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence, and teacher evaluations of academic performance in reading, writing, mathematics, and other subjects. RESULTS: The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months (43.3% for the experimental group vs 6.4% for the control group; P < .001) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures, with cluster-adjusted mean differences (95% confidence intervals) of +7.5 (+0.8 to +14.3) for verbal IQ, +2.9 (-3.3 to +9.1) for performance IQ, and +5.9 (-1.0 to +12.8) for full-scale IQ. Teachers' academic ratings were significantly higher in the experimental group for both reading and writing. CONCLUSION: These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN37687716.

Breastfeeding · Breastfeeding promotion · Cluster (spacecraft) · Cluster randomised controlled trial · Cognition · Confidence interval · Confounding · Intelligence quotient · Intervention (counseling) · Observational study · Psychiatry · Randomized controlled trial · Wechsler Adult Intelligence Scale · Wechsler Intelligence Scale for Children · Wechsler Preschool and Primary Scale of Intelligence · Breastfeeding Practices and Influences · Infant Development and Preterm Care · Maternal Mental Health During Pregnancy and Postpartum · Medicine · Psychology · Pediatrics

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