Breastfeeding may have a protective effect against the development of special educational needs (SEN) in children, according to new research published in PLOS Medicine. The new findings emphasize the importance of breastfeeding education and support programs.
Previous studies had shown that breastfeeding is associated with reduced physical and mental health problems in childhood, which are factors contributing to SEN. However, these studies had limitations such as not adjusting for confounders, encountering bias, or using a narrow definition of SEN.
The authors of the new study were particularly interested in understanding the impact of mixed feeding, as previous studies had not investigated its effects. Mixed feeding refers to a feeding method in which an infant is given a combination of breast milk and formula milk as a source of nutrition.
“My research focuses on maternal and child health and particularly on child and adolescent health, neurodevelopmental, and educational outcomes related to childhood chronic conditions, early life factors, neonatal and childhood morbidity and maternal/obstetric factors including exposures in utero,” said study author Michael Fleming, a lecturer in public health and chartered statistician at University of Glasgow.
“Having previously published papers on educational outcomes (including special educational need) related to childhood chronic conditions, and reduced hospitalisation related to breastfeeding, I was keen, considering the known health benefits, to investigate links between breastfeeding and special educational need (SEN).”
To conduct the study, Fleming and his colleagues collected data from various databases in Scotland. These included records from maternity, birth, and health visitor databases, as well as information from the annual school pupil census. By linking these databases together, they could get a comprehensive picture of the children’s health, feeding methods, and educational outcomes.
The study included children born in Scotland from 2004 onwards who had complete information about how they were fed as infants. The researchers looked specifically at children who attended school between 2009 and 2013. They wanted to see if the way the children were fed (breastfeeding, mixed feeding, or formula feeding) had any impact on whether they later required special educational support.
The researchers took into account various factors that could influence the results, such as the child’s age, sex, ethnic group, and socioeconomic status. They also considered information about the mother, such as her age, smoking status, and marital status, as well as details about the pregnancy, like the mode of delivery, gestational age, and the baby’s birth weight.
Out of a total of 191,745 children included in the study, 66.2% were fed with formula, 25.3% were exclusively breastfed, and 8.5% were fed a combination of breast milk and formula. Among all the children, 12.1% of them subsequently required special educational needs (SEN) support.
Compared to children who were formula-fed, Fleming and his colleagues found that children who were exclusively breastfed or mixed-fed had a lower risk of experiencing all-cause SEN and SEN related to learning disabilities and learning difficulties. Exclusively breastfed children additionally had lower risk of SEN attributed to communication problems, social-emotional-behavioural difficulties, sensory impairments, physical motor disabilities, and physical health conditions.
These findings support previous research that found a link between breastfeeding and reduced risk of certain developmental issues. However, the study did not find a significant relationship between breastfeeding or mixed feeding and autism spectrum disorder (ASD).
“The study concludes that there are clear benefits to breastfeeding. Specifically, we observed that both breastfeeding and mixed feeding at 6 to 8 weeks were associated with lower risk of all-cause SEN, and SEN attributed to learning disabilities and learning difficulty,” Fleming told PsyPost.
“Based on these population-wide data, we concluded that, regarding women who struggle to breastfeed for the full 6 months recommended by WHO, a shorter duration of nonexclusive breastfeeding could still be beneficial regarding possible later development of SEN.”
Fleming added that he was “pleasantly surprised to see the patterns emerging whereby even shorter durations of nonexclusive breastfeeding could still be beneficial regarding the development of SEN.”
The study used a large-scale, unselective approach by analyzing national routine data, which helped minimize selection bias and recall bias. However, the findings are based on Scottish data, and rates of breastfeeding may vary in different countries. Further research could also explore the impact of breastfeeding duration, compare breastfeeding and expressed breast milk, and examine specific types of formula feed.
“We only had information on feeding status at 6 to 8 weeks which gives a snapshot picture but cannot be applied to wider time points,” Fleming explained. “We did not have information on the type of formula feed, whether any children received donor milk, or use of expressed breast milk. Nor did we have data on important maternal or paternal factors such as education level, intelligence quotient (IQ), employment status, race/ethnicity, or mental and physical health conditions.”
The study, “Infant feeding method and special educational need in 191,745 Scottish schoolchildren: A national, population cohort study“, was authored by Lisa J. Adams, Jill P. Pell, Daniel F. Mackay, David Clark, Albert King, and Michael Fleming.
