Breastfeeding and Child Cognitive Development: New Evidence From a Large Randomized Trial
Abstract
CONTEXT: The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother's behavior or her interaction with the infant. OBJECTIVE: To assess whether prolonged and exclusive breastfeeding improves children's cognitive ability at age 6.5 years. DESIGN: Cluster-randomized trial, with enrollment from June 17, 1996, to December 31, 1997, and follow-up from December 21, 2002, to April 27, 2005. SETTING: Thirty-one Belarussian maternity hospitals and their affiliated polyclinics. PARTICIPANTS: A total of 17,046 healthy breastfeeding infants were enrolled, of whom 13,889 (81.5%) were followed up at age 6.5 years. INTERVENTION: Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF. MAIN OUTCOME MEASURES: Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence, and teacher evaluations of academic performance in reading, writing, mathematics, and other subjects. RESULTS: The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months (43.3% for the experimental group vs 6.4% for the control group; P < .001) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures, with cluster-adjusted mean differences (95% confidence intervals) of +7.5 (+0.8 to +14.3) for verbal IQ, +2.9 (-3.3 to +9.1) for performance IQ, and +5.9 (-1.0 to +12.8) for full-scale IQ. Teachers' academic ratings were significantly higher in the experimental group for both reading and writing. CONCLUSION: These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN37687716.
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Postnatal maternal health risks have potential knock-on effects for child development through altered mother-child interactions and lower rates of breastfeeding.
“with potential knock-on effects for the child’s development through altered mother-child interactions16 and lower rates of breastfeeding17–19”
From The relation between cesarean birth and child cognitive development (2017) · cites this paper as [17]
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- Authors
- Kramer, M. S.
- Affiliations
- McGill University (CA)
- Corresponding author
- Kramer, Michael S.
- ORCID
- Kramer, Michael S.
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2008-05-01
- Volume
- 65
- Issue
- 5
- Pages
- 578
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2164092942
- Cited by
- 1,016
- References
- 27
- Citations by year
- 2026: 23 · 2025: 42 · 2024: 43 · 2023: 52 · 2022: 55 · 2021: 52 · 2020: 55 · 2019: 56 · 2018: 62 · 2017: 64 · 2016: 61 · 2015: 67 · 2014: 62 · 2013: 88 · 2012: 68
- FWCI
- 39.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
- Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Keywords
- breastfeeding, exclusive breastfeeding, prolonged breastfeeding, child cognitive development, infant intelligence, IQ, academic performance, breastfeeding promotion, Baby-Friendly Hospital Initiative, mother-infant interaction
- MeSH terms
- Age Factors, Breast Feeding, Child, Child Development, Cognition, Female, Humans, Male, Neuropsychological Tests, Prevalence
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