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Feeding Infants at the Breast or Feeding Expressed Human Milk: Long-Term Cognitive, Executive Function, and Eating
Sarah A Keim1, Jacqueline A Sullivan2, Kelly Sheppard2
1The Research Institute, Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH; Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH.
Insights
Exclusive breastfeeding at the breast is linked to better executive function, specifically working memory, in children. Expressed milk feeding did not show clear benefits for executive function or cognitive ability.
Area of Science:
- Pediatric Nutrition
- Neurodevelopmental Pediatrics
- Child Psychology
Background:
- Infant feeding practices, including breastfeeding and expressed milk, are crucial for child development.
- Understanding the distinct neurodevelopmental impacts of different human milk feeding methods is essential.
Purpose of the Study:
- To investigate how feeding expressed milk differs from direct breastfeeding in relation to neurodevelopment and behavior.
- To test the hypothesis that exclusive direct breastfeeding is associated with optimal cognitive, executive function, and eating behaviors.
Main Methods:
- The Moms2Moms cohort study tracked infant feeding at 12 months postpartum.
- Children's cognitive ability, executive function, and eating behaviors were assessed at 6 years.
- Regression models analyzed associations between feeding durations (breastfeeding, expressed milk, formula) and outcomes.
Main Results:
- Each month of exclusive direct breastfeeding was associated with a lower risk of executive function deficits (working memory).
- Expressed milk feeding showed no clear association with executive function outcomes.
- No significant associations were found with global cognitive ability; some weak links to eating behaviors were noted.
Conclusions:
- Direct breastfeeding may provide specific advantages for certain aspects of executive function not observed with expressed milk.
- Further research is needed to differentiate the effects of feeding mode from nutritional content.
Objective:
To examine how expressed milk feeding diverges from feeding at the breast in its association with neurodevelopment and behavior. We hypothesized that longer and exclusive feeding at the breast only (ie, no formula, no feeding expressed milk) would be associated with the optimal cognitive developmental, executive function, and eating behaviors and that expressed milk feeding would be associated with less-optimal outcomes.
Study Design:
The Moms2Moms cohort (Ohio, US) reported infant feeding practices at 12 months postpartum and children's global cognitive ability, executive function, and eating behaviors at 6 years. Linear and log-binomial regression models estimated associations with durations of feeding at the breast, expressed milk, human milk (modes combined), and formula.
Results:
Among 285 participants, each month of exclusive feeding at the breast only was associated with a decreased risk of clinically meaningful executive function (working memory) deficit (adjusted relative risk [RR] 0.78, 95% CI 0.63-0.96) but was unassociated with inhibition (adjusted RR 0.92, 95% CI 0.85-1.01). Feeding expressed milk was not clearly related to executive function outcomes. No associations with global cognitive ability were observed. Weak associations were observed with eating behaviors for some feeding practices.
Conclusions:
Feeding at the breast may offer advantages to some aspects of executive function that expressed milk may not. Large, prospective studies exploring mechanisms could further distinguish the effect of feeding mode from that of nutrients.
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