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Pediatrics. 2002 Jun;109(6):1044-53.

How good is the evidence linking breastfeeding and intelligence?

Author information

  • 1Section of General Pediatrics, Department of Pediatrics, University of Chicago Children's Hospital, Chicago, Illinois, USA. ajain@peds.bsd.uchicago.edu

Abstract

BACKGROUND:

We conducted a critical review of the many studies that have tried to determine whether breastfeeding has a beneficial effect on intellect.

DESIGN/METHODS:

By searching Medline and the references of selected articles, we identified publications that evaluated the association between breastfeeding and cognitive outcomes. We then appraised and described each study according to 8 principles of clinical epidemiology: 1) study design, 2) target population: whether full-term infants were studied, 3) sample size, 4) collection of feeding data: whether studies met 4 standards of quality- suitable definition and duration of breastfeeding, and appropriate timing and source of feeding data, 5) control of susceptibility bias: whether studies controlled for socioeconomic status and stimulation of the child, 6) blinding: whether observers of the outcome were blind to feeding status, 7) outcome: whether a standardized individual test of general intelligence at an age older than 2 years was used, and 8) format of results: whether studies reported an effect size or some other strategy to interpret the clinical impact of results.

RESULTS:

We identified 40 pertinent publications from 1929 to February 2001. Twenty-seven (68%) concluded that breastfeeding promotes intelligence. Many studies, however, had methodological flaws. Only 2 papers studied full-term infants and met all 4 standards of high-quality feeding data, controlled for 2 critical confounders, reported blinding, used an appropriate test, and allowed the reader to interpret the clinical significance of the findings with an effect size. Of these 2, 1 study concluded that the effect of breastfeeding on intellect was significant, and the other did not.

CONCLUSION:

Although the majority of studies concluded that breastfeeding promotes intelligence, the evidence from higher quality studies is less persuasive.

PMID:
12042541
[PubMed - indexed for MEDLINE]
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