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Long-term behavioural consequences of infant feeding: the limits of observational studies

Michael S Kramer1, Eric Fombonne, Lidia Matush

  • 1Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada.

Paediatric and Perinatal Epidemiology
|October 11, 2011
PubMed

Insights

Observational studies on infant feeding and child behavior may be misleading due to confounding factors. This study found no link between breastfeeding promotion and behavior, suggesting observational findings are biased.

Area of Science:

  • Child Psychology
  • Public Health Interventions
  • Epidemiology

Background:

  • Observational studies on infant feeding and child behavior are susceptible to residual confounding.
  • Maternal psychological attributes and interactional styles can bias results.
  • A large cluster-randomised trial provided an opportunity to investigate this association.

Purpose of the Study:

  • To compare intention-to-treat (ITT) and observational analyses of infant feeding on child behavior.
  • To determine if observed associations between breastfeeding duration and behavior are biased by confounding.
  • To evaluate child behavior using the Strengths and Difficulties Questionnaire (SDQ).

Main Methods:

  • Follow-up of 13,889 Belarusian children aged 6.5 years from a breastfeeding promotion trial.
  • Behavioral assessment via parent and teacher completion of the SDQ.
  • Comparison of ITT (experimental) and observational (feeding received) analyses, with multivariable adjustments.

Main Results:

  • No significant differences in child behavior were found between the randomized intervention and control groups (ITT analysis).
  • Observational analyses showed small, statistically significant associations between early weaning (before 3 months) and higher SDQ scores (total difficulties, conduct problems, hyperactivity).
  • These associations persisted even after multivariable adjustment in observational analyses.

Conclusions:

  • The absence of effects in ITT analyses, contrasted with significant associations in observational analyses, strongly suggests residual confounding in observational studies.
  • Breastfeeding promotion interventions may not directly impact child behavior as suggested by observational data.
  • Careful consideration of confounding factors is crucial when interpreting observational data on infant feeding and child development.

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