The Long-Term Effects of Breastfeeding on Child and Adolescent Mental Health: A Pregnancy Cohort Study Followed for 14 Years

Published:December 14, 2009DOI:


      To determine whether there was an independent effect of breastfeeding on child and adolescent mental health.

      Study design

      The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnant women and followed the live births for 14 years. Mental health status was assessed by the Child Behaviour Checklist (CBCL) at 2, 6, 8, 10, and 14 years. Maternal pregnancy, postnatal, and infant factors were tested in multivariable random effects models and generalized estimating equations to examine the effects of breastfeeding duration on mental health morbidity.


      Breastfeeding for less than 6 months compared with 6 months or longer was an independent predictor of mental health problems through childhood and into adolescence. This relationship was supported by the random effects models (increase in total CBCL score: 1.45; 95% confidence interval 0.59, 2.30) and generalized estimating equation models (odds ratio for CBCL morbidity: 1.33; 95% confidence interval 1.09, 1.62) showing increased behavioral problems with shorter breastfeeding duration.


      A shorter duration of breastfeeding may be a predictor of adverse mental health outcomes throughout the developmental trajectory of childhood and early adolescence.
      CBCL ( Child Behaviour Checklist), EE ( Estimate of effects), POBW ( Proportion of optimal birth weight)
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        • Zubrick S.R.
        • Silburn S.R.
        • Burton P.R.
        • Blair E.
        Mental health disorders in children and young people: scope, cause and prevention.
        Austr NZ J Psychiatr. 2000; 34: 570-578
        • Belfer M.L.
        Child and adolescent mental disorders: the magnitude of the problem across the globe.
        J Child Psychol Psychiatr. 2008; 49: 226-236
        • Robinson M.
        • Oddy W.H.
        • Li J.
        • Kendall G.E.
        • de Klerk N.H.
        • Silburn S.R.
        • et al.
        Pre- and postnatal influences on preschool mental health: a large-scale cohort study.
        J Child Psychol Psychiatr. 2008; 49: 1118-1128
        • Sacker A.
        • Quigley M.A.
        • Kelly Y.
        Breastfeeding and developmental delay: Findings from the Millennium Cohort Study.
        Pediatrics. 2006; 118: 682-689
        • Oddy W.H.
        • Kendall G.E.
        • Blair E.
        • de Klerk N.H.
        • Stanley F.J.
        • Landau L.I.
        • et al.
        Breast feeding and cognitive development in childhood: a prospective birth cohort study.
        Paediatr Perinatal Epidemiol. 2003; 17: 81-90
        • Drane D.L.
        • Logemann J.A.
        A critical evaluation of the evidence on the association between type of infant feeding and cognitive development.
        Paediatr Perinatal Epidemiol. 2000; 14: 349-356
        • Koletzko B.
        • Aggett P.J.
        • Bindels J.G.
        • Bung P.
        • Ferre P.
        • Gil A.
        • et al.
        Growth, development and differentiation: a functional food science approach.
        Br J Nutr. 1998; 80: S5-S45
        • Farquharson J.
        • Cockburn F.
        • Patrick W.A.
        • Jamieson E.C.
        • Logan R.W.
        Infant cerebral cortex phosholipid fatty-acid composition and diet.
        Lancet. 1992; 340: 810-813
        • Kramer M.S.
        • Fombonne E.
        • Igumnov S.
        • Vanilovich I.
        • Matush L.
        • Mironova E.
        • et al.
        Effects of prolonged and exclusive breastfeeding on child behavior and maternal adjustment: evidence from a large, randomized trial.
        Pediatrics. 2008; 121: E435-E440
        • Der G.
        • Batty G.D.
        • Deary I.J.
        Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis.
        Br Med J. 2006; 333 (945-8A)
        • Newnham J.P.
        • Evans S.F.
        • Michael C.A.
        • Stanley F.J.
        • Landau L.I.
        Effects of frequent ultrasound during pregnancy: a randomised controlled trial.
        Lancet. 1993; 342: 887-891
        • Achenbach T.M.
        Manual for the Child Behavior Checklist/4-18 and 1991 Profile.
        University of Vermont, Department of Psychiatry, Burlington1991
        • Achenbach T.M.
        • Edelbrock C.
        • Howell C.T.
        Empirically based assessment of the behavioural/emotional problems of 2- and 3-year-old children.
        J Abnorm Child Psychol. 1987; 15: 629-650
        • World Health Organization
        Global strategy for infant and young child feeding.
        WHO, Geneva2003
        • Blair E.
        • Liu Y.
        • de Klerk N.
        • Lawrence D.
        Optimal fetal growth for the Caucasian singleton and assessment of appropriateness of fetal growth: an analysis of a total population perinatal database.
        BMC Pediatrics. 2005; 5: 13
        • Hoefer C.
        • Hardy M.
        Later development of breast fed and artificially fed infants.
        JAMA. 1929; 92: 615-619
        • Pollock J.I.
        Long-term associations with infant feeding in a clinically advantaged population of babies.
        Dev Med Child Neurol. 1994; 36: 429-440
        • Rutter M.
        Attachment from infancy to adulthood. The major longitudinal studies.
        J Child Psychol Psychiatr. 2006; 47: 974-977
        • Golding J.
        • Emmett P.M.
        • Rogers I.S.
        Does breast feeding have any impact on non-infectious, non-allergic disorders?.
        Early Hum Dev. 1997; 49 (S131-S42)
        • Horne R.S.
        • Parslow P.M.
        • Ferens D.
        • Watts A.M.
        • Adamson T.M.
        Comparison of evoked arousability in breast and formula fed infants.
        Arch Dis Child. 2004; 89: 22-25
        • Vohr B.R.
        • Poindexter B.B.
        • Dusick A.M.
        • McKinley L.T.
        • Wright L.L.
        • Langer J.C.
        • et al.
        Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age.
        Pediatrics. 2006; 118: e115-e123
        • Lucas A.
        • Morley R.
        • Cole T.J.
        • Gore S.M.
        A randomised multicentre study of human milk versus formula and later development in preterm infants.
        Arch Dis Child. 1994; 70: F141-F146
        • Hart S.
        • Boylan M.
        • Carroll S.
        • Musick Y.
        • Lampe R.M.
        Brief Report: Breast-fed one-week-olds demonstrate superior neurobehavioral organization.
        J Pediatr Psychol. 2003; 28: 529-534
        • Montgomery S.M.
        • Ehlin A.
        • Sacker A.
        Breast feeding and resilience against psychosocial stress.
        Arch Dis Child. 2006; 91: 990-994
        • Jain A.
        • Concato J.
        • Leventhal J.M.
        How good is the evidence linking breastfeeding to intelligence?.
        Pediatrics. 2002; 109: 1044-1053
        • Huizink A.C.
        • Robles de Medina P.G.
        • Mulder E.J.H.
        • Visser G.H.A.
        • Buitelaar J.K.
        Stress during pregnancy is associated with developmental outcome in infancy.
        J Child Psychol Psychiatr. 2003; 44: 810-818
        • Liu D.
        • Diorio J.
        • Day J.C.
        • Francis D.D.
        • Meaney M.J.
        Maternal care, hippocampal synaptogenesis and cognitive development in rats.
        Nature Neuroscience. 2000; 3: 799-806
        • Lavelli M.
        • Poli M.
        Early mother-infant interaction during breast- and bottle-feeding.
        Infant Behav Dev. 1998; 21: 667-684
        • Crowell J.
        • Waters E.
        Attachment representations, secure-base behavior, and the evolution of adult relationships: the Stony Brook Adult Relationships Project.
        in: Grossmann KE Grossmann K Waters E Attachment from infancy to adulthood: the major longitudinal studies. Guilford Press, New York2005
        • Yehuda S.
        • Rabinovitz S.
        • Mostofsky D.I.
        Essential fatty acids are mediators of brain biochemistry and cognitive functions.
        J Neurosci Res. 1999; 56: 565-570
        • DiPietro J.A.
        • Larson S.K.
        • Porges S.W.
        Behavioral and heart rate pattern differences between breast-fed and bottle-fed neonates.
        Dev Psychol. 1987; 23: 467-474
        • Niegel S.
        • Ystrom E.
        • Hagtvet K.A.
        • Vollrath M.E.
        Difficult temperament, breastfeeding, and their mutual prospective effects: the Norwegian Mother and Child Cohort Study.
        J Dev Behav Pediatr. 2008; 29: 458-462
        • Prior M.
        • Smart D.
        • Sanson A.
        • Oberklaid F.
        Longitudinal predictors of behavioural adjustment in pre-adolescent children.
        Austr NZ J Psychiatr. 2001; 35: 297-307
        • Anderson J.W.
        • Johnstone B.M.
        • Remley D.T.
        Breast-feeding and cognitive development: a meta-analysis.
        Am J Clin Nutr. 1999; 70: 525-535
        • Li J.
        • Kendall G.E.
        • Henderson S.
        • Downie J.
        • Landsborough L.
        • Oddy W.H.
        Maternal psychosocial wellbeing in pregnancy and breastfeeding duration.
        Acta Paediatrica. 2008; 97: 221-225