Infant Benefits of Breastfeeding

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Infant benefits of breastfeeding

Author: Joan Y Meek, MD, MS
Section Editor: Steven A Abrams, MD
Deputy Editor: Alison G Hoppin, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Sep 2022. | This topic last updated: Jun 16, 2022.
INTRODUCTION
Human milk is the optimal source of nutrition for virtually all infants. Exclusive breastfeeding
is recommended for approximately the first six months of life, followed by continued
breastfeeding, with the introduction of appropriate complementary solids for at least the
first year of life and beyond. These recommendations are supported strongly by multiple
medical and professional organizations, such as the American Academy of Pediatrics (AAP)
[1], the American Academy of Family Physicians (AAFP) [2], the American College of
Obstetricians and Gynecologists (ACOG) [3], the World Health Organization (WHO) [4], and
the Canadian Pediatric Society (CPS) [5], based upon both short- and long-term benefits for
the mother and child. The WHO recommends continued breastfeeding at least through the
child's second birthday. Suboptimal breastfeeding is associated with increased risk of infant
and childhood morbidity and mortality, and increased risk of certain chronic conditions.
Benefits of breastfeeding that are specific to the infant and child will be reviewed here.
Maternal, societal, and economic benefits are discussed separately. (See "Maternal and
economic benefits of breastfeeding".)
In analyzing the data, it is important to recognize that not all studies differentiate between
exclusive breastfeeding and any breastfeeding, or quantify the differences between
predominantly breastfed infants and partially breastfed. Dose dependency, in terms of
duration, intensity, and quantity, in addition to exclusivity, has been shown to be important
in quantifying the benefits of breastfeeding for both children and mothers.
BIOLOGICALLY ACTIVE COMPONENTS OF HUMAN MILK
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Human milk is a living biologic substance that is much more complex than the sum of its
nutritional components. Human milk contains not just macro- and micronutrients but also
living cells, growth factors, and immunoprotective substances [6,7]. Many of these factors
are resistant to digestive enzymes in the infant's gastrointestinal tract and are biologically
active at mucosal surfaces.
Biologically active components include:
● Antimicrobial activity – Immunoglobulins (especially secretory immunoglobulin A [IgA]),

lysozyme, lactoferrin, free fatty acids and monoglycerides, human milk bile salt-
stimulated lipase, mucins, white blood cells, stem cells, human milk oligosaccharides
(prebiotic and antimicrobial activities). These antimicrobial actions help to protect
against gastrointestinal and other infections, as well as against developing necrotizing
enterocolitis (NEC).
● Immunomodulatory activity – Platelet-activating factor (PAF) acetylhydrolase,

interleukin 10, polyunsaturated fatty acids, glycoconjugates. These factors help to
protect against NEC [8-11].
● Factors that promote gastrointestinal development and function – Proteases (enzymes

that help digest proteins), hormones (eg, cortisol, somatomedin C, insulin-like growth
factors, insulin, and thyroid hormone), growth factors (eg, epidermal growth factor and
nerve growth factor), gastrointestinal mediators (neurotensin, motilin), and amino
acids that stimulate enterocyte growth (eg, taurine and glutamine) [12-17]. Human milk
also influences optimal development of the gut microbiome and virome [18,19].
These biologically active components of human milk, as well as its nutritional characteristics
(macronutrient and micronutrient content), are discussed in more detail separately. (See
"Nutritional composition of human milk and preterm formula for the premature infant".)
SHORT-TERM BENEFITS WHILE BREASTFEEDING
Breastfeeding confers direct health benefits to the infant during the time of breastfeeding,
some of which persist after weaning. The best studied benefits are the impacts upon the
development of the gastrointestinal and immunologic systems, as well as prevention of
infection.
Neurobehavioral benefits — Breastfeeding appears to have some direct neurobehavioral

benefits. The precise mechanisms have not been established, but some may be related more
to skin-to-skin contact than the human milk feeding itself [20].

Early skin-to-skin contact between mothers and newborns has some short-term
neurobehavioral benefits and may program other benefits during this sensitive period of
adaptation to extrauterine life. In the short term, early skin-to-skin contact appears to
reduce infant crying, increase blood glucose levels, and promote greater cardiorespiratory
stability in late preterm infants [21]. Early skin-to-skin contact also helps to establish
lactation and promote ongoing breastfeeding, which enhances the other benefits of
breastfeeding outlined below.
In addition, there appears to be an analgesic effect of breastfeeding, which may be due to

the enhanced maternal-infant bonding. Breastfed infants experience less stress during
painful procedures than formula-fed infants [22-24]. Skin-to-skin care during a single painful
procedure appears to be both safe and effective as analgesia, as measured by composite
pain indicators with both physiologic and behavioral indicators and, independently, using
heart rate and crying time [25]. A possible mechanism is radiant warmth from the skin-to-
skin contact [26,27]. Higher salivary cortisol levels found in breastfed infants, compared with
formula-fed infants, also are postulated to mediate the analgesic effect of breastfeeding
[28].
Gastrointestinal function — Human milk stimulates optimal growth, development, and

function of the gastrointestinal system and influences optimal development of the
microbiota [18]. Exclusive, early breastfeeding protects the infant's gastrointestinal system
from exposure to highly antigenic substances.
When compared with formula, human milk has been shown to:
● Reduce the risk of gastroenteritis and diarrheal disease (see 'Prevention of illnesses
while breastfeeding' below)
● Increase the rate of gastric emptying [29,30]
● Increase intestinal lactase activity in premature infants [31]
● Decrease the intestinal permeability early in life in premature infants [32,33]
● Reduce the risk of developing necrotizing enterocolitis (NEC) in preterm infants [34,35]
Several components of human milk stimulate gastrointestinal growth and motility, including
growth factors and gastrointestinal mediators. Other factors are protective and decrease the
risk of NEC and other infections, including immunoglobulins, platelet-activating factor (PAF)
acetylhydrolase, polyunsaturated fatty acids, epidermal growth factor, and interleukin 10. In
addition, human milk influences optimal development of the microbiota, including neonatal
intestinal colonization by the beneficial microbes of the Bifidobacteria and Lactobacillus
species rather than potential enteropathogenic bacteria, such as streptococci and Escherichia
coli [18,36,37] (see 'Biologically active components of human milk' above). The benefit of
human milk in prevention of NEC is discussed in greater detail separately. (See "Neonatal
necrotizing enterocolitis: Prevention", section on 'Human milk feeding' and "Human milk
feeding and fortification of human milk for premature infants", section on 'Benefits of
mother's milk'.)
For these reasons, the American Academy of Pediatrics (AAP) recommends human milk,
either mother's own or pasteurized donor milk, for all premature infants born weighing less
than 1500 grams [38]. (See "Approach to enteral nutrition in the premature infant", section
on 'Milk strength and content'.)
Prevention of illnesses while breastfeeding
In both resource-rich and resource-poor nations, human milk, compared with infant
formula, decreases the risk of acute illnesses during the time period in which the infant is
fed human milk. Most of these benefits are related to protection from infectious diseases
[1,39]. In one study, breastfeeding was associated with fewer serious infections requiring
hospitalization during the first year of life, with a 4 percent reduction in hospitalization for
every extra month of any breastfeeding [39].
The protective effect includes:
● Gastroenteritis and diarrhea – Breastfeeding lowers the risk of gastrointestinal

infections and diarrhea in many populations, but this is particularly important in low-
resource settings [40-42]. In a meta-analysis that included studies from both low- and
high-resource settings, the risk of diarrhea in infants <6 months was lower in those
who were breastfed (pooled relative risk 0.37, 95% CI 0.27-0.50) [40]. In a study in the
United Kingdom, infants who were breastfed exclusively for six months had a
decreased risk of severe or persistent diarrhea compared with infants who breastfed
exclusively for less than four months [41]. The protective effects are greater for infants
living in low-resource countries, likely because formula-fed infants are more likely to be
exposed to pathogens through improperly prepared formula and also because they
tend to have worse nutritional status than breastfed infants.
● Respiratory disease – Breastfeeding lowers the risk of respiratory disease in the

infant, based on results of studies from several different types of populations. As
examples, in an study from the United Kingdom, infants who were exclusively breastfed
for six months had a decreased risk of lower respiratory tract infections than infants
who exclusively breastfed for less than four months [41]. In another study conducted in
the United States and Europe, breastfeeding reduced the risk of respiratory infections
in three- to six-month-old infants by approximately 20 percent [42]. Optimizing
breastfeeding in the United States to current recommendations has been estimated to
prevent almost 21,000 hospitalizations and 40 deaths for lower respiratory tract
infections in the first year of life [43].

● Coronavirus disease 2019 (COVID-19) – Vaccination of pregnant people against

COVID-19 is recommended, and vaccine-generated antibodies to the causative virus
cross the placenta and into breast milk to confer passive immunity to newborn infants.
Although antibodies persist in breast milk for at least several months, there is no
definitive evidence regarding how much protection this confers on the infant or how
long it might last [44,45]. (See "COVID-19: Overview of pregnancy issues", section on
'Vaccination in people planning pregnancy and pregnant or recently pregnant people'.)
● Otitis media – The incidence of otitis media and recurrent otitis media are reduced in
breastfed compared with formula-fed infants, primarily for those younger than two
years [42,46,47]. The incidence of two or more episodes of otitis media was reduced in
infants breastfed for one year compared with infants fed formula (34 versus 54
percent) [48]. Feeding directly at the breast appears to be more beneficial than feeding
expressed human milk [49].
● Urinary tract infection – In a case-control study conducted in Sweden, there was a

significantly higher risk of urinary tract infection for infants who were not breastfed
compared with those who were. Longer duration of exclusive breastfeeding reduced
the probability of urinary tract infection, especially in females up to seven months of
age [50]. A separate case-control study found that human milk feeding was associated
with a lower risk of urinary tract infection in premature infants in the neonatal intensive
care unit [51]. A mechanism for this protection has been suggested, based on
observations that breastfed infants have greater contents of oligosaccharides,
lactoferrin, and secretory IgA in their urine compared with formula-fed infants [52].
(See 'Biologically active components of human milk' above.)
● Sepsis – Early institution of exclusive breastfeeding decreases the risk of developing

neonatal sepsis [53-56]. (See "Clinical features, evaluation, and diagnosis of sepsis in
term and late preterm infants".)
● Sudden infant death syndrome (SIDS) – Any breastfeeding is associated with a

decreased risk of SIDS [57-59]. Exclusive breastfeeding and longer duration of
breastfeeding confers the greatest protection [60,61]. (See "Sudden infant death
syndrome: Risk factors and risk reduction strategies", section on 'Protective factors'.)
Mortality and hospitalization — In low- and middle-resource countries, breastfeeding

substantially decreases the risk of childhood mortality [62-64]. In a meta-analysis of 13
studies conducted in these populations, children exclusively breastfed through five months
had lower risk of all-cause and infection-related mortality compared with those only partially
or not breastfed [62]. Children aged 6 to 23 months who were not breastfed had higher risk
of all-cause and infection-related mortality than children who continued breastfeeding. A
separate systematic review showed that initiation of breastfeeding within one hour of birth
decreased neonatal mortality compared with later initiation [63]. It has been estimated that
improving global breastfeeding could prevent 823,000 annual deaths in children younger
than five years [46].
Breastfeeding also reduces the risk of infant mortality in high-resource countries. In a study
of more than 3 million births in the United States, breastfeeding initiation was associated
with reduced risk of mortality during the late perinatal period (7 to 28 days; adjusted odds
ratio [AOR] 0.6, 95% CI 0.54-0.67) and the post-perinatal period (28 to 364 days; AOR 0.81,
95% CI 0.76-0.87) [59]. Significant effects were seen across different racial/ethnic groups and
across all gestational age and birth weight groups, as well as for deaths due to infection,
SIDS, and NEC. (See "Sudden infant death syndrome: Risk factors and risk reduction
strategies", section on 'Protective factors' and "Neonatal necrotizing enterocolitis:
Prevention".)
These data confirm and extend the findings from earlier smaller studies that also found a
beneficial effect of breastfeeding on mortality [46,65,66], as well as associations between
breastfeeding and lower rates of hospitalization and outpatient visits during the first year of
life [46,67-70]. These findings suggest that severity of illness is reduced in the breastfed
infant [48].
LONG-TERM BENEFITS
Limitations of this evidence — Evidence supporting associations between breastfeeding

and beneficial long-term outcomes is inherently limited because it is based primarily on
longitudinal cohort studies, raising the concern of unmeasured or residual confounding
from inadequately controlled factors associated with both breastfeeding and health
outcomes [71]. In particular, breastfeeding in high-resource countries is associated with
higher socioeconomic and educational status and lower rates of maternal obesity and
smoking, and these variables may not be fully captured by available markers. Moreover,
these long-term studies are limited by recall bias, especially for breastfeeding duration.
Evidence from studies designed to better control for confounding (sibling-pair and cross-
population studies and one randomized trial [72-74]) tends to show little or no effect on
obesity or cognitive outcomes.
Nonetheless, certain long-term benefits have been reported in large studies and in a variety
of populations, suggesting the possibility of a true causal effect. The mechanism for such
associations is unclear and may vary among the health outcomes. Possible mediators
include development of the microbiota in this early period [18]; modulation of the immune
system development; and the beneficial impact of skin-to-skin contact on maternal-child
bonding and interactions, with potential decrease in toxic stress [20].

Acute illnesses — Exclusive breastfeeding, compared with formula feeding, has a protective

effect in reducing acute illnesses, even after breastfeeding is discontinued. As an example,
infants in the first 12 months of life who were breastfed for more than six months had a
lower incidence of recurrent otitis media (defined by ≥3 episodes within six months or ≥4
episodes within 12 months) compared with those who were breastfed for less than four
months (10 versus 20.5 percent) [75]. This protective effect is observed after adjustment for
confounding variables, such as socioeconomic status, family history of allergy, family size,
use of daycare, and smoking. A systematic review and meta-analysis provides evidence that
breastfeeding protects against acute otitis media until two years of age, but protection is
greater for exclusive breastfeeding and breastfeeding of longer duration [47].
Post-breastfeeding protection against infectious illnesses appears to increase with the

duration of breastfeeding [76,77]. This was illustrated in a secondary analysis of the National
Health and Nutrition Examination Survey III (NHANES III) of 2277 children between 6 and 24
months of age [77]. After adjusting for demographic variables (including ethnicity and
socioeconomic status), childcare, and smoking exposure, infants who were fully breastfed
for 4 to <6 months compared with those fully breastfed 6 months or longer were more likely
to develop pneumonia (odds ratio [OR] 4.3, 95% CI 1.3-14.4) or to have ≥3 episodes of otitis
media (OR 1.95, 95% CI 1.1-3.6) during the 12-month period immediately preceding the
survey. There were no differences between the groups in the likelihood of having ≥3
episodes of cold/influenza, developing wheezing, or having a first episode of otitis media
before one year of age. In another survey, breastfeeding for ≥9 months was associated with
continued protection against ear, throat, and sinus infections through six years of age but
not upper or lower respiratory tract infections [78].
Chronic disease — There are reported associations between the duration of breastfeeding

and a reduction in incidence of certain chronic conditions [1,46,79], such as obesity, type 1
and type 2 diabetes mellitus, adult cardiovascular disease, certain allergic conditions, celiac
disease, and inflammatory bowel disease (IBD). Studies demonstrate the importance of a
critical period in the first year of life, during which breastfeeding can promote long-term
effects.
Moderate evidence of benefit
● Type 1 diabetes – Breastfeeding appears to substantially reduce the risk for

developing type 1 diabetes. This was shown in an analysis of two large birth cohorts
from Denmark and Norway. Children who were never breastfed had a twofold
increased risk of type 1 diabetes compared with those who were breastfed for ≥12
months (hazard ratio [HR] 2.29, 95% CI 1.14-4.61) or those who were exclusively
breastfed for ≥6 months (HR 2.31, 95% CI 1.11-4.80) [80]. Among the breastfed cohort
studied, there was no evidence that greater duration or intensity of breastfeeding had

additional protective effect. Systematic reviews (which did not include the above study),
however, supported the protective effect of breastfeeding but concluded that longer
breastfeeding duration was more protective than shorter durations [81,82].
Effects of breastfeeding on type 2 diabetes are discussed below. (See 'Limited evidence
for benefit' below.)
● IBD – Breastfeeding probably reduces the risk of developing IBD. In a meta-analysis of

35 studies, any breastfeeding compared with no breastfeeding reduced the risk of
Crohn disease (OR 0.71, 95% CI 0.59-0.85) and ulcerative colitis (OR 0.78, 95% CI 0.67-
0.91) [83]. Moreover, longer durations of breastfeeding were associated with lower
rates of IBD. Systematic reviews that included a subset of these studies also concluded
that breastfeeding duration is associated with reduced risk of IBD, based on limited but
consistent evidence [81,84].
● Wheezing – Breastfeeding appears to be associated with a lower incidence of

wheezing in early childhood [85]. This association may reflect a reduction in the
number of upper respiratory infections because infections are a prominent cause of
wheezing in infants and young children, which is not necessarily associated with later
development of asthma. Associations between breastfeeding and wheezing later in
childhood (eg, after six years, which is more likely to represent atopic asthma) and
other atopic conditions have not been established. These issues are discussed in more
detail separately. (See "The impact of breastfeeding on the development of allergic
disease".)
● Dental health
• Malocclusion – Several systematic reviews and meta-analyses suggest that

malocclusion is more prevalent among children who are not breastfed [86-88].
Exclusive breastfeeding and longer duration of breastfeeding (>12 months) has
additional benefits, regardless of the type of occlusion disorder. (See "Preventive
dental care and counseling for infants and young children", section on 'Dietary
habits'.)
• Dental caries – Breastfeeding lowers the risk for developing dental caries
compared with formula feeding from a bottle [89]. A systematic review showed that
children with more breastfeeding exposure up to 12 months had reduced risk of
dental caries [90]. There was an increase in dental caries after 12 months, which
may be associated with night feedings and poor oral hygiene practices. (See
"Preventive dental care and counseling for infants and young children", section on
'Dietary habits'.)

Limited evidence for benefit
● Leukemia – Breastfeeding has been associated with a modest reduction in the risk of
developing childhood lymphoma and leukemia. A case-control study reported that ever
breastfeeding was associated with decreased risk for childhood leukemia and
lymphoma (OR 0.36, 95% CI 0.22-0.60), with a dose-response effect [91]. A meta-
analysis of 18 studies reported that breastfeeding for six or more months reduced the
risk of childhood leukemia by 19 percent (OR 0.81, 95% CI 0.73-0.89) [92]. A systematic
review concluded that feeding human milk for six months or longer is associated with a
slight reduction in risk of childhood leukemia compared with never feeding human
milk, although the quality of evidence was limited [81,93]. The evidence for an effect of
shorter breastfeeding duration was mixed. For other less common childhood cancers,
there is insufficient evidence to determine an effect of breastfeeding.
● Allergic conditions – There is limited evidence for benefit of breastfeeding on atopic

asthma in older children (after six years of age) or on eczema or allergic rhinitis (in all
age groups). As noted above, breastfeeding appears to be associated with a lower
incidence of wheezing in younger children, which may reflect reductions in upper
respiratory infections rather than atopic wheezing (see 'Moderate evidence of benefit'
above). These issues are discussed in more detail separately. (See "The impact of
breastfeeding on the development of allergic disease".)
Limited evidence suggests that breastfeeding in the first four months of life may
decrease the risk of cow's milk allergy in early childhood [94]. A more general or long-
term impact of breastfeeding on food allergies has not been established. (See "The
impact of breastfeeding on the development of allergic disease", section on
'Breastfeeding and food allergy'.)
● Obesity – Several large prospective cohort studies and meta-analyses report that
breastfeeding or breastfeeding duration is associated with a modestly reduced risk for
overweight or obesity during childhood [95-99]. As an example, a study of almost
200,000 children from low-income families in the United States reported that
breastfeeding for 6 to 12 months was associated with a reduced risk of overweight
among non-Hispanic White children compared with no breastfeeding (adjusted OR
0.70, 95% CI 0.50-0.99) [95]. No such effect was noted for Hispanic or Black children. A
Canadian study found a dose-dependent protective effect of breastfeeding, which was
diminished, but not eliminated, if the breast milk was given by bottle rather than
directly from the breast, suggesting that the effect might be related to the feeding
method rather than the human milk itself [100]. A large randomized trial in Belarus,
however, reported no effect of breastfeeding promotion on childhood obesity (OR 1.17,
95% CI 0.97-1.41) [72].

A meta-analysis of 113 studies reported a 26 percent reduction in risk of overweight or

obesity for children who were ever breastfed compared with those who were never
breastfed (OR 0.74, 95% CI 0.70-0.78), but the effect for the 11 high-quality studies was
marginal (OR 0.87, 95% CI 0.76-0.99) [97]. In general, the reported effect size is greater
in studies that adjust for socioeconomic status and also greater in high-resource
countries (where breastfeeding is more common among mothers with higher
socioeconomic status) versus low- and middle-resource countries (where the opposite
is true) [97,101,102]. Together, these observations suggest the possibility of residual
confounding from socioeconomic status [71]. (See 'Limitations of this evidence' above.)
● Type 2 diabetes – A meta-analysis of 14 studies suggested that breastfeeding

decreases the risk of developing type 2 diabetes (pooled OR 0.67, 95% CI 0.56-0.80)
[103]. The protective effect of breastfeeding was higher for adolescents but also
protective in adults [97,103]. Of note, this analysis did not adjust for body mass index
(BMI), so it is possible that the association is mediated by effects of breastfeeding on
obesity. A systematic review (which did not include the above study) found insufficient
evidence to determine the association between breastfeeding and risk of type 2
diabetes, prediabetes, or related biomarkers including hemoglobin A1c [81].
● Cardiovascular risk factors – Very limited evidence suggests an association between

breastfeeding and cardiovascular risk factors. The best evidence is for effects on blood
pressure. In a study of more than 1500 healthy children, breastfeeding for ≥12 months
was associated with slightly lower blood pressure (reduction of approximately 1
mmHg), which may not be clinically significant [104]. A systematic review also
concluded that breastfeeding is associated with lower blood pressure during childhood
but found insufficient evidence to determine an effect on blood lipids or other
cardiovascular disease risk factors [81,104,105]. Similarly, a protective effect of
breastfeeding on metabolic syndrome or non-alcoholic fatty liver disease in the
offspring is uncertain [105,106].
● Celiac disease – A few small case-control studies have reached conflicting conclusions
regarding whether breastfeeding is associated with a lower risk for developing celiac
disease, as summarized in systematic reviews [81,84]. However, the reviews concluded
that there may be a protective effect because the two studies that controlled for
confounding supported this conclusion [81]. An earlier meta-analysis reached a similar
conclusion [107]. Interpretation of these and other studies is complicated by the
potential relationship of breastfeeding to the timing and quantity of gluten
introduction, which may affect the expression of celiac disease. (See "Epidemiology,
pathogenesis, and clinical manifestations of celiac disease in children", section on
'Feeding practices in infancy and early childhood'.)
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Neurodevelopmental outcomes — Moderate-quality evidence from a variety of

populations suggests that human milk feeding may be associated with slightly improved
neurodevelopmental outcomes compared with formula feeding. However, as for the chronic
disease outcomes discussed above, the evidence is limited by lack of randomized trials, and
the findings may be affected by residual confounding or reverse causation. (See 'Limitations
of this evidence' above.)
Although a mechanism has not been established, proposed mediators are the long-chain
polyunsaturated fatty acids and, particularly, docosahexaenoic acid (DHA) and arachidonic
acid in human milk, which may promote myelinization of and development of the nervous
system. However, trials of DHA supplementation for preterm infants or formula-fed infants
are inconsistent for cognitive or visual outcomes, as outlined in a separate topic review. (See
"Long-chain polyunsaturated fatty acids (LCPUFA) for preterm and term infants".)
● Cognitive development – A meta-analysis shows that breastfeeding may be

associated with slightly improved performance in intelligence tests, and this
association persists after adjustment for maternal intelligence quotient (IQ) [108].
Children who were ever breastfed scored an average of 3.4 points higher on
intelligence tests than those who were never breastfed. Among the studies that
adjusted for maternal intelligence, a breastfeeding benefit of 2.6 points was revealed
(95% CI 1.25-3.98). As with many other studies of long-term breastfeeding outcomes
[109], these conclusions are limited by the possibility of residual confounding and thus
do not establish a causal relationship between breastfeeding and cognitive
development. Indeed, sibling-pair studies (which tend to have less residual
confounding) show a smaller effect of breastfeeding (<1 point) [74]. Similarly, a
Cochrane meta-analysis found no significant effect of donor breast milk versus formula
feeding on neurodevelopmental outcomes in preterm infants [35]. (See 'Limitations of
this evidence' above.)
Other studies suggest that these effects are also seen in adulthood. A prospective,
population-based birth cohort study from Brazil reported that by age 30 years,
participants who were breastfed for 12 months or more had higher IQ scores of 3.8
points, more years of education, and higher monthly incomes compared with those
who were breastfed for less than one month in the adjusted analysis [110]. The analysis
suggested that IQ was responsible for 72 percent of the effect on income. This long-
term cohort study is also limited by potential residual confounding, similar to the
shorter-term studies described above.
● Visual function – Several studies have indicated that human milk-fed term and
premature infants have improved visual function compared with formula-fed infants
[111]. The severity and incidence of retinopathy of prematurity is lower among

breastfed compared with formula-fed infants [112-115]. In a randomized trial, severe

retinopathy of prematurity was less common in infants fed mother's milk (5 percent)
compared with donor human milk (19 percent) or preterm formula (14 percent),
suggesting that the effect may not be related to human milk per se [114].
These benefits have been attributed to DHA, a component of phospholipids found in

brain, retina, and red cell membranes and found in human milk but not in bovine milk
[116,117]. These associations also may relate to the substantial antioxidant capacity of
human milk compared with infant formula [118]. However, trials of DHA
supplementation for preterm infants or formula-fed infants are inconsistent for visual
or cognitive outcomes, as outlined in separate topic reviews. (See "Long-chain
polyunsaturated fatty acids (LCPUFA) for preterm and term infants".)
● Auditory function – Auditory-evoked responses mature faster in breastfed premature

infants [119].
● Attention deficit hyperactivity disorder (ADHD) – A meta-analysis revealed that

children with ADHD had significantly less breastfeeding duration than controls and
were less likely to have been breastfed for 6 to 12 months (OR 0.69, 95% CI 0.49-0.98)
or >12 months (OR 0.58, 95% CI 0.35-0.97) [120]. Affected children were more likely to
not have been breastfed (OR 3.71, 95% CI 1.94-7.11). Similar findings were reported
from a large dataset from the 2011-2012 National Survey of Children's Health in the
United States, in which exclusive breastfeeding for at least six months was associated
with a 60 percent reduction (95% CI 0.15-0.99) in risk of ADHD in preschool-aged
children [121].
● Autism spectrum disorder (ASD) – The association between breastfeeding and ASD is
unclear, and analyses are limited by the possibility of reverse causation. In a sibling
case-control study, exclusive breastfeeding was associated with lower odds for ASD,
while early introduction of supplemental formula was associated with higher odds of
ASD [122]. Similarly, a meta-analysis showed that children with ASD were less likely to
have been breastfed (OR 0.61, 95% CI 0.45-0.83) [123]. In a multisite, case-control study,
breastfeeding initiation rates were no different comparing children diagnosed with ASD
versus not, after adjusting for sociodemographic and pregnancy characteristics [124].
Among those who were breastfed, children with ASD had a shorter duration of
breastfeeding, which remained significant after adjusting for confounding variables.
While this could result in fewer nutrients available to support neurodevelopment, the
authors postulated that children who later developed ASD may be more difficult to
breastfeed or may have early disturbances in emotion, motor development, or sucking
activity, leading to shorter breastfeeding duration, reflecting reverse causation.
Analysis of data from the National Survey of Children's Health in 2007 and 2011 showed

no association between ASD and breastfeeding (adjusted OR 0.97, 95% CI 0.97-1.10) for
each additional month of breastfeeding and for each additional month of exclusive
breastfeeding (adjusted OR 1.04, 95% CI 0.96-1.13) [125]. These data, collected by
phone survey, may be impacted by low response rates and recall bias.
● Child behavior – Data from the English Millennium Cohort study suggests that
breastfeeding for four months or longer was associated with a lower risk of behavior
problems in children at five years of age compared with a shorter duration of
breastfeeding [126].
Abuse and neglect — Data from the National Longitudinal Study of Adolescent to Adult
Health found adolescents breastfed for nine months or longer had a reduced odds of having
experienced neglect (OR 0.54 [0.35-0.83]) and sexual abuse (OR 0.47 [0.24-0.93]) compared
with adolescents never breastfed, after controlling for covariates [127].
SOCIETY GUIDELINE LINKS
Links to society and government-sponsored guidelines from selected countries and regions
around the world are provided separately. (See "Society guideline links: Breastfeeding and
infant nutrition".)
SUMMARY
● Overview of benefits – Breastfeeding for virtually all infants is strongly supported by

both governmental and medical professional organizations because of its
acknowledged direct benefits to the infant's nutrition, gastrointestinal function, host
defense, and psychological well-being. The unique composition of human milk, which
contains antiinfective and antiinflammatory factors, along with the skin-to-skin contact
from direct breastfeeding, promotes optimal health, protects from environmental
exposures, and promotes development of the child's innate immune system. (See
'Biologically active components of human milk' above.)
In addition to its health benefits for the infant, breastfeeding has some health benefits
for the mother and economic benefits for the family. (See "Maternal and economic
benefits of breastfeeding".)
● Short-term health benefits to the infant
• The best-established health benefits of human milk feeding are prevention of

illnesses during the period that the infant is breastfed. These benefits are most
impactful in low- and middle-resource countries, in which lack of breastfeeding is

associated with higher mortality. (See 'Prevention of illnesses while breastfeeding'

above and 'Mortality and hospitalization' above.)
• Human milk, compared with infant formula, also appears to provide continued
protection against acute illnesses, such as otitis media and pneumonia, even after
discontinuation of breastfeeding, during the first few years of life. (See 'Acute
illnesses' above.)
● Long-term health benefits to the infant – Breastfeeding has been associated with
long-term benefits by reducing risk for several chronic diseases. The evidence for these
long-term effects is based primarily on observational cohort studies, which are
necessarily limited by the possibility of residual confounding. (See 'Limitations of this
evidence' above.)
• Moderate-quality evidence exists for prevention of type 1 diabetes mellitus,

inflammatory bowel disease (IBD), and wheezing in young children. (See 'Moderate
evidence of benefit' above.)
• Effects of breastfeeding may exist but are not as well established for leukemia,
atopic asthma, eczema, food allergies, obesity, and neurodevelopmental outcomes.
(See 'Limited evidence for benefit' above and 'Neurodevelopmental outcomes'
above.)
ACKNOWLEDGMENT
The UpToDate editorial staff acknowledges Richard J Schanler, MD, who contributed to an
earlier version of this topic review.
Use of UpToDate is subject to the Terms of Use.
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Topic 5013 Version 64.0
Contributor Disclosures
Joan Y Meek, MD, MS No relevant financial relationship(s) with ineligible companies to
disclose. Steven A Abrams, MD Grant/Research/Clinical Trial Support: Fresenius Kabi[Fatty
acids];Perrigo Nutrition [Food insecurity].
Speaker's Bureau: Abbott Nutrition [Physiology of infant
nutrition].
All of the relevant financial relationships listed have been mitigated. Alison G Hoppin,
MD No relevant financial relationship(s) with ineligible companies to disclose.
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these
are addressed by vetting through a multi-level review process, and through requirements for
references to be provided to support the content. Appropriately referenced content is required of all
authors and must conform to UpToDate standards of evidence.
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BIOLOGICALLY ACTIVE COMPONENTS OF HUMAN MILK

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rela… 1/23

Biologically active components include:

● Antimicrobial activity – Immunoglobulins (especially secretory immunoglobulin A [IgA]),

● Immunomodulatory activity – Platelet-activating factor (PAF) acetylhydrolase,

● Factors that promote gastrointestinal development and function – Proteases (enzymes

SHORT-TERM BENEFITS WHILE BREASTFEEDING

Neurobehavioral benefits — Breastfeeding appears to have some direct neurobehavioral

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rela… 2/23

In addition, there appears to be an analgesic effect of breastfeeding, which may be due to

Gastrointestinal function — Human milk stimulates optimal growth, development, and

Prevention of illnesses while breastfeeding

The protective effect includes:

● Gastroenteritis and diarrhea – Breastfeeding lowers the risk of gastrointestinal

● Respiratory disease – Breastfeeding lowers the risk of respiratory disease in the

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rela… 4/23

● Coronavirus disease 2019 (COVID-19) – Vaccination of pregnant people against

● Urinary tract infection – In a case-control study conducted in Sweden, there was a

● Sepsis – Early institution of exclusive breastfeeding decreases the risk of developing

● Sudden infant death syndrome (SIDS) – Any breastfeeding is associated with a

Mortality and hospitalization — In low- and middle-resource countries, breastfeeding

Limitations of this evidence — Evidence supporting associations between breastfeeding

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rela… 6/23

Acute illnesses — Exclusive breastfeeding, compared with formula feeding, has a protective

Post-breastfeeding protection against infectious illnesses appears to increase with the

Chronic disease — There are reported associations between the duration of breastfeeding

Moderate evidence of benefit

● Type 1 diabetes – Breastfeeding appears to substantially reduce the risk for

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rela… 7/23

● IBD – Breastfeeding probably reduces the risk of developing IBD. In a meta-analysis of

● Wheezing – Breastfeeding appears to be associated with a lower incidence of

• Malocclusion – Several systematic reviews and meta-analyses suggest that

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rela… 8/23

Limited evidence for benefit

● Allergic conditions – There is limited evidence for benefit of breastfeeding on atopic

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rela… 9/23

A meta-analysis of 113 studies reported a 26 percent reduction in risk of overweight or

● Type 2 diabetes – A meta-analysis of 14 studies suggested that breastfeeding

● Cardiovascular risk factors – Very limited evidence suggests an association between

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rel… 10/23

Neurodevelopmental outcomes — Moderate-quality evidence from a variety of

● Cognitive development – A meta-analysis shows that breastfeeding may be

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rel… 11/23

breastfed compared with formula-fed infants [112-115]. In a randomized trial, severe

These benefits have been attributed to DHA, a component of phospholipids found in

● Auditory function – Auditory-evoked responses mature faster in breastfed premature

● Attention deficit hyperactivity disorder (ADHD) – A meta-analysis revealed that

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rel… 12/23

SOCIETY GUIDELINE LINKS

● Overview of benefits – Breastfeeding for virtually all infants is strongly supported by

● Short-term health benefits to the infant

• The best-established health benefits of human milk feeding are prevention of

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rel… 13/23

associated with higher mortality. (See 'Prevention of illnesses while breastfeeding'

• Moderate-quality evidence exists for prevention of type 1 diabetes mellitus,

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2. American Academy of Family Physicians. Breastfeeding, Family Physicians Supporting (P

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rel… 14/23

4. World Health Organization. Breastfeeding. Available at: https://www.who.int/topics/brea

https://www.uptodate.com/contents/infant-benefits-of-breastfeeding/print?search=mal nutrición y lactancia materna&topicRef=5746&source=rel… 15/23