Effect of feeding practices on behavioural and emotional health during early years of life

Exclusive breastfeeding for the first 6 months and continuing up to 13-18 months, whether exclusively or with supplementation, benefits childhood development, supporting WHO guidelines.

To determine how different feeding practices may be linked with variations in childhood behavioural and emotional development.

In this Chinese prospective cohort study, the information regarding infant feeding practices during the first 6 months of life, the duration of breastfeeding and subsequent emotional and behavioural outcomes of 2489 mother-child pairs were gathered. Feeding practices during the initial 6 months were categorized into exclusive breastfeeding (EBF) and non-exclusive breastfeeding (non-EBF, encompassing mixed feeding or feeding with formula). The duration of breastfeeding (either EBF or mixed feeding) was further classified into four groups: less than equal to 6 months, 7 to 12 months, 13 to 18 months, and more than 18 months.

Emotional and behavioural issues such as externalizing and internalizing difficulties were assessed using the Child Behavior Checklist (CBCL), with clinical cutoffs (T scores ≥64). The possible link between feeding practices and CBCL outcomes was examined via multivariable linear and logistic regression.

At the time of outcome assessment, the median age of the children was 32 months (interquartile range: 17 months). Compared to infants who were not exclusively breastfed for the first 6 months, those who exclusively breastfed showed a reduction in T scores for internalizing problems (adjusted mean difference [aMD]: -1.31; 95% confidence interval [95% CI]: -2.53, -0.10) and a marginal decrease in T scores for externalizing problems (aMD: -0.88; 95% CI: -1.92, 0.15). When categorized, EBF versus non-EBF was linked to a reduced risk of externalizing problems (adjusted odds ratio [aOR]: 0.54, 95% CI: 0.34, 0.87) and a bordering decrease in the risk of internalizing problems (aOR: 0.75, 95% CI: 0.54, 1.06).

In terms of breastfeeding duration, breastfeeding for 13 to 18 months compared to ≤6 months was associated with lower T scores for both internalizing and externalizing problems. Breastfeeding for over 18 months versus ≤6 months was associated with lower T scores for externalizing problems.

Feeding durations of 7-12 months, 13-18 months and over 18 months were associated with reduced risks of externalizing problems (adjusted odds ratios [aORs] [95% CI]: 0.96 [0.92, 0.99], 0.94 [0.91, 0.98], 0.96 [0.92, 0.99], correspondingly).

Breastfeeding exclusively for the first 6 months and continuing with either exclusive or mixed feeding thereafter contribute positively to behavioural and emotional development during childhood.