Pulse
The Brain-Boosting Benefits of Breastfeeding
Despite overwhelming evidence about the benefits of breastfeeding, fewer than one-third of new moms are doing so after six months.
Medical professionals have long believed that breastfeeding holds significant benefits over
formula-feeding. Research has shown that breastfeeding decreases the risk of acute conditions such as otitis media and lower respiratory infections, may help protect babies against chronic diseases such as allergies and diabetes, and helps strengthen the bond between mother and infant. As if that weren’t enough, evidence is also building that breastfeeding can enhance babies’ cognitive development.
“The caveat is that randomizing people to either breastfeeding or not breastfeeding is unethical and has not been done; but that said, the literature in the last 20 years has demonstrated that breastfed babies are smarter,” says Michael Georgieff, M.D., professor of pediatrics and child development at the University of Minnesota and director of the University’s Center for Neurobehavioral Development. Georgieff was a member of an American Academy of Pediatrics’ committee on nutrition and a liaison to the Academy’s 1997 breastfeeding workgroup, which issued a policy statement advocating the benefits of breastfeeding. The policy statement was revised last February to reflect new research.
Since the mid 1990s, several studies have been published documenting that breastfed children score higher on intelligent quotient (IQ) tests than those who are formula-fed. Results of a study published in the British Medical Journal in 1998 by Alan Lucas, M.D., and his team from the Cambridge University department of pediatrics found that preterm babies who were tube-fed breastmilk had an 8.3 IQ-point advantage over babies who were tube-fed formula by the time they reached 8 years of age—after adjusting for the parents’ occupations, the mother’s educational attainment, and the birth order of the child.
Erik Mortensen, M.D., of Copenhagen University Hospital, studied the relationship between the duration of breastfeeding and IQ scores. He and his colleagues found that adults who were breastfed less than one month as infants had a mean IQ of 99.4, while those who were continuously breastfed up to 7 or 9 months of age scored a mean of 106. Mortenson’s results were published in the Journal of the American Medical Association in 2002. “That’s a direct positive correlation,” says Georgieff. “A lot of people interpreted that article as a nice dose-response study.”
In an article published in Pediatrics in 1998, John Harwood, M.D., and his team of researchers at the Christchurch School of Medicine in New Zealand found that among children ages 8 to 18 years, those who were breastfed for four months or less had higher mean scores on tests of cognitive ability than those who were not; performed better on standardized tests of reading, mathematics, and scholastic ability; were rated as performing better in reading and mathematics by their teachers; had higher levels of achievement in examinations upon leaving school; and less often left school without educational qualifications.
Spilled Milk
Given the benefits of breastfeeding, one would think that the decision to initiate and continue nursing would be—no pun intended—a no-brainer. Not so, says Georgieff. In 1997, when the policy statement was drafted, the breastfeeding initiation rate was close to 59 percent and the continuation rate at 6 months of age was only 19 percent, he explains. Today, the initiation rates have risen to around 70 percent, but the continuation rate still remains only in the high 20 percent range.
Georgieff says mothers are most likely to stop breastfeeding during week one because they don’t have lactation support at the hospital or clinic, at week six because they go back to work, or at three months, when most maternity leaves end.
“Women really need help from the very beginning,” says Carolyn McKay, M.D., a pediatrician with Fairview Staub Pediatric Clinic in Minneapolis. “They get home from the hospital, they get tired, the cracks and engorgement start showing up, and things can fall apart. Sure, breastfeeding is natural, but so was Hurricane Katrina. There are plenty of problems that can go along with nursing.”
The good news, says McKay, is that the solutions to breastfeeding challenges—while not well understood by a new mom—are relatively simple. “What becomes so important is to have knowledgeable, supportive consultants on hand to help navigate the process and offer some guidance,” she says. Such services range from bedside consultations in the hospital to breastfeeding classes to ongoing telephone or in-person support during those first few months.
Milk Money
Increasing the rates of breastfeeding initiation and continuation has become a national health objective. One of the goals of the Healthy People 2010 initiative, for example, is to “increase to at least 75 percent the proportion of mothers who breastfeed their babies in the early postpartum period and to at least 50 percent the proportion who continue breastfeeding until their babies are 5 to 6 months old.”
It may be a tall order. Funding for lactation support services is of constant concern to many hospitals and clinics. Most services are not covered by insurance, and as a result, some programs in the Twin Cities are being discontinued—offering instead enhanced training of hospital nursing staff and primary or pediatric physicians and nurses.
McKay thinks this could be a mistake. “Providing this kind of support takes time,” she says. It’s not realistic to think that physicians can provide these services if they are supposed to be spending only 10 or 15 minutes with each patient.”
McKay introduced a resolution to the Minnesota Medical Association (MMA) advocating that all Minnesota hospitals providing maternity care also provide lactation support services, “preferably by formally trained lactation consultants.” The MMA adopted a version of the resolution at its annual meeting last September. “Truly, if we care about the human race,” McKay says, “the lactation support services simply cannot dwindle.”—J. Mettner