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Breastfeeding and autism

Geoff Ferguson - December 12th 2016

It is well known that there is a positive correlation between breastfeeding an infant and their intellectual development. What has been less studied are any possible links between breastfeeding and the incidence of autism.

A positive correlation between breastfeeding and intellectual development has been shown in many studies. For example, the 2007 WHO report 'Evidence on the long-term effects of breastfeeding'1 discusses several meta-analyses that look at this possible correlation. The WHO report acknowledges two potential avenues for a positive effect of breastfeeding upon intellectual development. The first is the presence of long-chain polyunsaturated fatty acids in breast milk, which are sometimes absent in formula. These compounds play an important role in retinal and cortical brain development. The second possibility is that breastfeeding enhances bonding between mother and infant, which may also contribute the the child's intellectual development.

Of course, as the WHO acknowledges, a correlation between breastfeeding and intellectual development does not prove a causal link. Any number of socio-economic factors that encourage an infant's intellectual development may also be more likely to be present for mothers who breastfeed. However, the studies included in the WHO report attempt to control for such confounding factors. Their review of these studies led the authors of the WHO report to conclude that breastfeeding is positively associated with the child's intellectual development and later educational attainment. They also note one study that suggests that maternal milk is in itself associated with a positive developmental outcome, over and above any bonding effects of the act of breastfeeding.

In contrast to the above work, there have only been a handful of studies that have looked at possible links between breastfeeding and specific developmental problems such as autism spectrum disorders (ASD). For example, one study published in 2006 compared 861 children with Autistic Disorder and 123 control children. The results of this study indicated 'that children who were not breastfed or were fed infant formula without docosahexaenoic acid/arachidonic acid supplementation were significantly more likely to have autistic disorder'.

This results of the above research have been confirmed by a recent multicentre study in Spain2. This study, by O Boucher and others, assessed 1,346 children with a mean age of 4.9 years. The researchers used a maternal questionnaire to record the presence and duration of breastfeeding, and a variety of tools to assess each child's cognitive development, attention, ADHD symptoms, and autistic traits. After adjusting for several confounders, including socio-environmental factors, the study found that 'longer duration of breastfeeding was independently associated with better cognitive development and with fewer autistic traits'.

These are important findings that support recommendations in favour of breastfeeding. We should, however, note a couple of caveats. As noted above, such studies show an association between breastfeeding and positive infant development. They do not definitively prove causality. As Paul Whitely suggests in his blog, in the case of autism it is also possible that a causal link could operate in the reverse direction: that the early stages of autism in an infant could themselves cause difficulties in breastfeeding and so lead to its early cessation.

Much is not known about autism and its causes. It is likely that autistic traits are the result of several inter-relating causes, and that, correspondingly, several different factors could have a protective or ameliorating influence. The studies reported above suggest that breastfeeding could be one protective factor. However, even if this is the case, this would only be one factor amongst many. It is important that a difficulty in breastfeeding does not become a source of blame or guilt for the mother. There are many reasons why a mother does not begin or continue with breastfeeding. A difficulty or disappointment in breastfeeding should not become a barrier to the creation of a good bond between infant and mother.

1Horta, B. L. et al (2007) Evidence on the long-term effects of breastfeeding: systematic review and meta-analyses. WHO, Geneva.
2Boucher, O. (2016) Association between breastfeeding duration and cognitive development, autistic traits and ADHD symptoms: a multicenter study in Spain. Pediatr Res. 2016 Nov 15.


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Welcome to ourNews, where we keep up-to-date with research and other news related to infant mental health. These articles can be of interest to both parents and professionals.
We are keen to know your views and so please do comment on our articles.
Is there a topic that you would like us to write about? Just send us a message via 'Contact us'.

ourAdvice, our other blog, has brief posts with advice for parents.

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