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Breastfeeding and infant size: evidence of reverse causality

Michael S Kramer1, Erica E M Moodie, Mourad Dahhou

  • 1Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada. michael.kramer@mcgill.ca

American Journal of Epidemiology
|March 25, 2011
PubMed

Insights

Smaller infant size, particularly weight for age, increases the risk of weaning or stopping exclusive breastfeeding. This suggests infant growth influences feeding decisions, complicating breastfeeding research.

Area of Science:

  • Pediatrics
  • Human Nutrition
  • Public Health

Background:

  • Prolonged and exclusive breastfeeding is associated with slower infant growth in the first year.
  • Infant feeding and growth are dynamic processes influenced by bidirectional interactions.
  • Previous research may oversimplify the causal link between breastfeeding and growth due to these complex dynamics.

Purpose of the Study:

  • To investigate the influence of infant size on subsequent infant feeding decisions.
  • To assess whether smaller infant size predicts weaning or discontinuation of exclusive breastfeeding.
  • To explore the dynamic relationship between infant growth and feeding patterns.

Main Methods:

  • Observational analysis of 17,046 Belarusian infants from a cluster-randomized trial.
  • Analysis restricted to breastfed infants at the start of follow-up intervals.
  • Examined associations between infant size (weight/length) and subsequent weaning or cessation of exclusive breastfeeding.

Main Results:

  • Smaller infant size, especially weight-for-age, was significantly associated with increased risk of weaning (aOR=1.2-1.6).
  • Smaller size also significantly increased the risk of discontinuing exclusive breastfeeding (aOR=1.2-1.6).
  • These associations were most pronounced between 2 and 6 months of age.

Conclusions:

  • Infant size, particularly smaller size, appears to influence decisions regarding breastfeeding duration and exclusivity.
  • Dynamic processes, including infant size influencing feeding, complicate causal inferences about breastfeeding's effect on growth.
  • Further research is needed to disentangle the complex interplay between infant growth and feeding behaviors.

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