Breastfeeding and Development 1

Duration of Breastfeeding and Child Development

Elizabeth Heck Idaho State University November 4, 2013

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It is obvious that the important developmental stages of an infant begin in the womb, but the development that occurs after birth is just as important. Breastfeeding is an essential key for providing this means of development and nourishment after birth. Breastfeeding advantages include both short and long term health benefits, nutritional, neurological, and immunological gains. Although there is strong evidence to support these advantages, breastfeeding duration and exclusive breastfeeding occurrences are not happening as often as they were in the early 1900s.1 In todays society there are certain barriers and obstacles that may prevent mothers from breastfeeding, but the support, promotion, and education of this topic can help advocate these health benefits to support healthier infants. Unlike any other animal milk or cows milk-based human milk substitutes (HMSs), human breast milk is species-specific to humans and provides the most optimal nutrients for infants. The American Academy of Family Physicians, Academy of Breastfeeding Medicine, World Health Organization (WHO) and other health organizations recommend exclusive breastfeeding during the first six months of life.3 Exclusive breastfeeding describes an infant only consuming human breast milk and nothing else other than vitamins, minerals, or medications.3 The exclusive features for which human milk provides proves this six month period of breastfeeding to be essential. Human milk is isotonic with plasma which means the infant does not need any outside sources of water. Though less protein is found in human milk it still provides adequate amounts for an infant without harming the immature kidneys.1 Oligosaccharides are the second largest carbohydrates next to lactose in milk and help promote the growth of healthy bacteria in the otherwise sterile intestinal tract of a newborn.1 Oligosaccharides in human milk prevent the binding of pathogenic microorganisms to the gut, thereby preventing infection and diarrhea, and there are over one-hundred and thirty kinds of these present in human milk.1 Long-chain polyunsaturated fatty acids like DHA which plays a key role in retinal and central nervous system development are present in breast milk but only in select HMS products. Interestingly, premature infants naturally have higher levels of DHA in breast milk compared to full-term breastfed infants and formula fed-infants. The bioavailability of minerals in breast milk such as magnesium, calcium, iron, and zinc are protein-bound which makes it easier for the infant to utilize and requires less of the mineral from the mother. Also, flavors of certain foods

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eaten by the mother are passed along to infants and may contribute to their appeal for the milk with the variety of the different tastes.1 The benefits of breast milk surpass the idea of it only supplying energy needs as a food source, for it contains immune-related components and various biologically active substances that contribute to efficient nutrient utilization and gives the child active and passive protection against infections.2 The systemic literature review for the fifth revision of the Nordic Nutrition Recommendations found convincing evidence concerning the protective effects of breastfeeding against childhood obesity, healthy blood pressure and cholesterol levels in adulthood, lower incidences of inflammatory bowel disease, celiac disease, diabetes, and overall infections. A report from WHO states that, the risk for overweight/obesity in childhood and adolescence was twenty to thirty percent lower among breastfed subjects compared with nonbreastfed.2 One study shows that there is a lower risk for a child to be overweight at age six when breastfed for at least four months compared to formula fed or mixed feedings of breast milk and formula. There was also a higher BMI for those up to the age of fourteen who had been breastfed less than four months or given milk from other sources. Another studys evidence supports the conclusion that breast milk protects against acute otitis media, gastrointestinal infections, and respiratory infections, but the result depends on the duration of breastfeeding. In the study, those who were exclusively breastfed for at least four months had a lower risk of developing these infections and those who had only been partially breastfed even for six months did not show any lower risk.2 Studies concerning cancer found that breastfed infants had lower risks for acute lymphoblastic leukemia, Hodgkins disease, and neuroblastoma. There is limited but suggestive evidence for a risk reduction of breastfeeding against childhood leukemia and possibly other childhood cancers. The effect of childhood leukemia seems larger with longer breastfeeding duration of over six months.2 There is currently not strong enough evidence to support any correlation between breastfeeding and any preventative measures of adult cancers.2 Another study shows there is a reduced risk of asthma in children ages four, five, and eight who were breast fed and have a family history of asthma. There was an increased risk of asthma symptoms for those up to the age of four that had a shorter duration of or nonexclusive breastfeeding. With regards to celiac disease, there is strong evidence that there are protective influences when small

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amounts of gluten are introduced by breastfeeding. There are some recommendations of when to introduce gluten to the infant; not earlier than four months and no later than seven months for the first exposure. These suggestions however have somewhat limited evidence to solidly support this recommendation. Also, it is not clear whether the introduction of gluten only postpones celiac disease from occurring or provides assured protection from it.2 Breast fed infants may be associated with advantages related to improved cognitive development. But what are the facts behind this assumption? One study shows that brain-derived neurotrophic factor (BDNF) may be one of the components behind this enhanced cognition. BDNF is, a vital trophic protein for neuronal survival and differentiation in the developing nervous system (and)is involved in different aspects of learning and memory processing, in particular, in memory persistence and storage.4 In this study, BDNF was measured with neurodevelopmental assessment according to whether the infant was breastfed, formula fed, or partially breastfed. The study was done on forty-two infants, four to six months old. They were segregated into three groups of fourteen. One group was exclusively breast fed, the next group was exclusively formula fed, and the last group had mixed feedings of breast and formula milk.2 The end results of the study showed that infants who had received human milk had higher levels of BDNF than those who were formula fed, with the mixed feeding groups BDNF levels in between the two. With these higher BDNF values, the breast fed group had significantly higher levels of cognitive development, which was determined by use of the Bayley scale of infant development-second edition. Moreover, they found that the correlation between breastfeeding and cognitive ability increases with longer duration of breastfeeding. It was found that there is a mean difference of 2.4 points on cognitive testbetween children breastfed for less than five months compared to children breastfed for at least five months.2 Also, exclusively breastfed infants that were fed for more than twelve weeks had a five point higher IQ at age five compared to those exclusively breastfed for less than twelve weeks.2 Though there are wonderful benefits from breastfeeding and it is recommended for nearly everyone, there are some exceptions that may exclude endorsing it. Infants born with the metabolic disorder galactosemia should not breastfeed, for they lack the enzyme to digest galactose. Also, mothers who have active and untreated tuberculosis disease or are positive for human T-cell lymphotropic virus type I or II. Exposure to radioactive materials from therapies

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such as chemotherapy can be passed along from the mother through breast milk. In this case, the mother would be recommended to pump breast milk and then discard it before the next feeding to ensure that there are not radioactive sources in the milk which could be passed along to the infant. Mothers who use drugs of abuse such as amphetamines, heroine, or cocaine, and mothers who have herpes simplex lesions on the breasts should not breast feed. Mothers who are infected with HIV in the United States are told not to breast feed and formula feeding is the alternative to help ensure the infant does not get infected. However, in developing countries where formula may not always be available and there is an, increased risk of other infectious diseases and nutritional deficiencies resulting in increased infant death rates, the mortality risks associated with artificial feeding my outweigh the possible risks of acquiring HIV infection.3 A study done in Africa found that HIV infected mothers who exclusively breastfed for three to six months after birth did not increase the chance of passing the disease to the infant, and infants who had a mixed feeding of breast milk and other sources of milk had higher incidences of infection compared to those who were exclusively formula fed.3 Though the advantages of breastfeeding far outweigh what manufactured formulas can offer, the numbers indicating how many people breastfeed compared to how many choose formula seem to contradict this statement. A study done that investigated the reasons why mothers choose to formula feed helps explain why this contradiction occurs in todays society. The first reason that seems to influence womens decision to formula feed are issues concerning infant feeding support, such as lack of support from their own mothers or their spouse wanting to be a part of the feeding process. Another influential factor is the convenience associated with formula feeding. Mothers who were asked in this study said that it was inconvenient to try to find a private place to breastfeed, especially when out in public. The third underlying factor had to do with embarrassment and the sexualization of breastfeeding in public. While these women admitted that they felt uncomfortable to breastfeed in public because of these factors, they showed support and held high regard for the women who do.5 Fortunately, there are support groups and information available to mothers/parents to help them better understand the process of breastfeeding. The Le Leche League is an international, nonprofit organization that was started by seven women in 1956 to provide encouragement and education to mothers concerning breastfeeding. They believe that breast milk is the superior

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infant food and their mission is to, help mothers worldwide to breastfeed through mother-tomother support, encouragement, information, and education, and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother.6 Another reliable website that provides information and support for breastfeeding is the Office on Womens Health, U.S. Department of Health and Human Services. They provide updated information concerning womens health from the federal government and recommendations from the U.S. Preventive Services Task Force. They provide an array of information from pregnancy to aging, and breastfeeding is one of these categories. They explain the importance of breastfeeding, provide tips on how to breastfeed, information on breastfeeding in public, they explore the challenges associated with breastfeeding, and help provide support through breastfeeding advice videos and even have a national breastfeeding helpline with trained peer counselors.7 With the valuable information provided from the previous organizations and many other organizations, establishments, and support groups that are available to the public, one could only hope that this education and awareness for the benefits of breastfeeding spreads to expecting parents and families like an intellectual wildfire. Gaining the knowledge and information regarding what positive effects human milk has for infants is the key to help reinforce breastfeeding to acquire these advantageous benefits.

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References

1. Brown JE, Isaacs J, Krinke U, et al. Nutrition Through the Life Cycle. Belmont, CA: Cengage Learning; 2011.

2. Hrnell A, Lagstrm H, Lande B, Thorsdottir I. Breastfeeding, introduction of other foods and effects on health: a systematic literature review for the 5th Nordic Nutrition Recommendations. Food & Nutrition Research [serial online]. January 2013;57:1-27. Available from: Academic Search Premier, Ipswich, MA. Accessed September 26, 2013.

3. Eidelman AI, Gartner LM. Breastfeeding and the use of human milk. Pediatrics. 2005;115(2):496-506. Doi: 10.1542/peds.2004-2491.

4. Nassar M, Younis N, El-Arab S, Fawzi F. Neuro-developmental outcome and brainderived neurotrophic factor level in relation to feeding practice in early infancy. Maternal & Child Nutrition [serial online]. April 2011;7(2):188-197. Available from: Academic Search Complete, Ipswich, MA. Accessed September 26, 2013.

5. Bonia K, Twells L, Halfyard B, Ludlow V, Newhook L, Murphy-Goodridge J. A qualitative study exploring factors associated with mothers' decisions to formula-feed their infants in Newfoundland and Labrador, Canada. BMC Public Health [serial online]. August 2013;13(1):1-9. Available from: Academic Search Complete, Ipswich, MA. Accessed September 26, 2013. 6. Le Leche League International. Happy mothers, breastfed babies. Le Leche League International. http://www.lalecheleague.org/. Published 2008. Accessed October 17, 2013. 7. Office on Womens Health. Breastfeeding. Womenshealth.gov. http://www.womenshealth.gov/breastfeeding/index.html. Accessed October 17, 2013.