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Breastfeeding may not make smarter babies, according to a new report from the UK, but CDC says it still makes healthier babies overall and hospitals have more work to do in order to provide optimal support for nursing mothers.
Breast is best, according to numerous sources like the World Health Organization (WHO) and the American Academy of Pediatricians (AAP). Yet, in spite of the evidence supporting the many physiological benefits of breastfeeding, a new report out of the United Kingdom found little evidence that breastfeeding necessarily results in longterm cognitive benefits.
“There are many things that happen in a child's life that will affect his or her development-there is no empirical evidence that suggests breastfeeding in particular was going to make a difference (cognitively) rather than, for example, children's educational experiences or their family home environment,” says lead researcher Sophie von Stumm, PhD, a senior lecturer in the department of psychology at Goldsmiths University of London.
The study utilized more than 7000 families involved in a UK twins study, with 62% of children in the study having been breastfed for at least 4 months. Mothers in the study were aged 15 to 50 years, with a mean of 31 years at the time of childbirth. Additionally, the twins were born at 27 to 43 weeks gestations, with a mean of 36.5 weeks.
Researchers found that intelligence tests performed periodically from birth to 16 years of age in the cohort revealed no reliable association between breastfeeding and intelligence quotient (IQ) latent growth factors/cognitive growth trajectories.
“We sought to confirm previous findings that suggested breastfeeding’s nutritional benefits for cognitive development occurred early on and persisted over time but that breastfeeding was not associated with long-term cognitive gains,” the study authors note.
Although girls in the study who were breastfed scored significantly higher on IQ assessments by age 2 than their non-breastfed counterparts, the study states that the connection was “statistically weak and not observed in boys.”
The study authors conclude that cognitive growth is more likely related to socioeconomic status, parental guidance and education, and other situational factors rather than breastfeeding.
“We observed significant gender differences in cognitive development that reflected an IQ advantage of girls over boys in early life and differently shaped developmental curves over time,” the study authors write. “However, gender differences in cognitive development diminished over time and were hardly noticeable after the age of 5 years.”
Von Stumm says that while the study is not meant to diminish the value of breastfeeding, she hopes it will ameliorate feelings by new mothers that they are harming their babies by not breastfeeding.
“I believe it is important to communicate the study findings widely, because mothers in the United Kingdom and elsewhere are frequently judged for not breastfeeding, regardless of what their reasons are. At the same time, the potential negative consequences of not breastfeeding tend to be overemphasized,” says von Stumm. “Being pressured to breastfeed makes many mothers feel inadequate, especially if they cannot breastfeed, Being a new mum is stressful enough without unfounded feelings of guilt. Breastfeeding may have benefits for child development but they don't include IQ-and this isn't the first study to demonstrate this lack of association in a UK sample. Mothers must not believe that they harmed their child's intelligence because they didn't breastfeed.”
Cognitive benefits aside, the Centers for Disease Control and Prevention (CDC) categorizes breastfeeding as a public health concern. Babies who are breastfed have reduced risks of ear, respiratory, and gastrointestinal infections, CDC says, plus lower risks of sudden infant death syndrome, asthma, obesity, diabetes, and more. Mother who breastfeed also reap benefits, CDC says, by experiencing reduced risks of breast and ovarian cancers, diabetes, and cardiovascular disease.
Exclusive breastfeeding is recommended by both AAP and WHO for the first six months of an infant’s life, with complementary breastfeeding to continue as new foods are introduced for the first year or two. Those recommendations contributed to the formation of the Baby-Friendly Hospital Initiative-a global program launched by the WHO and the United Nations Children's Fund that utilizes evidence-based hospital practices to improve breastfeeding outcomes.
As of today, 292 out of 3300 hospitals and birthing centers designated at baby-friendly facilities in the United States, and the number of births in baby-friendly facilities have risen from 2.9% in 2007 to 14.3% today. The CDC reports that breastfeeding rates are on the rise, and in 2014, 79% of mothers breastfed their babies at birth; 49% were still breastfeeding at 6 month of age (19% exclusively); and 27% by 12 months.
A new CDC report on maternity care and support practices reveals that while hospitals are doing more to support breastfeeding, there is much work yet to be done.
Hospitals do a fairly good job of providing initial breastfeeding support, according to the CDC, with roughly 92% of hospitals providing prenatal breastfeeding education, but supportive measures dropped off as time progressed, with 53% of hospitals (up from 29% in 2007) implementing roughly half of the 10-step baby-friendly recommendations. The recommendations include existence of a model breastfeeding policy, staff competency assessments, prenatal breastfeeding education, early initiation of breastfeeding, teaching breastfeeding techniques, limiting provision of non-breastmilk fluids for healthy breastfed infants, rooming-in, teaching feeding cures, limiting use of pacifiers, and post-discharge support.
Despite the identification of at least partial implementation of these best practices, CDC revealed that 60% of mothers who stopped breastfeeding before their baby was 6 months old say they stopped earlier than they wanted. Early breastfeeding experiences set the stage for long-term lactation success, CDC says, and implementation of several of these maternity care practices that may help are “far from optimal.”
“Just over one quarter of hospitals have a model breastfeeding policy, which is the foundation for many of the other steps,” CDC reports. “In addition, fewer than half of hospitals reported routinely keeping healthy infants with their mothers throughout the hospital stay, a practice that allows mothers to become more familiar with their babies' hunger cues, and increases opportunities for breastfeeding.”
Hospitals also need improvement when it comes to limiting fluids other than breast milk to healthy breastfed infants, and providing post-discharge breastfeeding support.
“The provision of non–breast milk fluids to healthy breastfed infants has been associated with suboptimal breastfeeding behaviors, shorter breastfeeding duration, and mothers being less likely to meet their own breastfeeding intentions,” CDC states. “The percentage of hospitals that limited giving fluids other than breast milk to health breastfed infants increased from 20.6% in 2007 to 26.4% in 2013.”
The CDC says the Joint Commission added exclusive breastfeeding during an infant’s hospital stay as a new quality measure in 2010. In 2014, the Joint Commission required this quality measure to be reported by all hospitals with more than 1110 births per year, and all hospitals with more than 300 births per year will have to report this measure by 2016.
In terms of post-discharge support, the number of hospitals providing adequate support increased by only 20% from 2007 to 2013, says CDC. Most problems with insufficient milk supply, latching, and pain occur after discharge, and CDC says as of 2013, there were less than 4 certified lactation counselors per 1000 live births, and only 3.5 board-certified lactation consultants per 1000 live births.