I’m starting to wonder if the health journalism community needs some lessons in scientific reading comprehension, or if we’re all just so convinced of the benefits of breastfeeding that we read every study with rose colored glasses. Either way, the discrepancies in the reporting of a group of new infant feeding studies are so alarming that I don’t even know where to start.
You know what? I do know where to start. How about the studies themselves.
All come from a special supplement published in the journal Pediatrics, using evidence from the 2005–2007 IFPS II (Infant Feeding Practices Study II) and follow-up data collected when the children were 6 years old.
A couple articles from this publication are specifically making headlines, the first being Breastfeeding and the Risk of Infection at 6 Years. The results:
The most common past-year infections were colds/upper respiratory tract (66%), ear (25%), and throat (24%) infections. No associations were found between breastfeeding and colds/upper respiratory tract, lung, or urinary tract infections. Prevalence of ear, throat, and sinus infections and number of sick visits differed according to breastfeeding duration, exclusivity, and timing of supplementing breastfeeding with formula (P < .05). Among children ever breastfed, children breastfed for ≥9 months had lower odds of past-year ear (adjusted odds ratio [aOR]: 0.69 [95% confidence interval (95% CI): 0.48–0.98]), throat (aOR: 0.68 [95% CI: 0.47–0.98]), and sinus (aOR: 0.47 [95% CI: 0.30–0.72]) infections compared with those breastfed >0 to <3 months. High breast milk intensity (>66.6%) during the first 6 months was associated with lower odds of sinus infection compared with low breast milk intensity (<33.3%) (aOR: 0.53 [95% CI: 0.35–0.79]).
Translation: No link between breastfeeding for any duration and the risk of colds/upper respiratory infections, lung infections, or UTIs. Babies breastfed for any amount of time had lower risk of ear, throat and sinus infections, and babies primarily breastfed for the first 6 months had lower odds of sinus infections.
The second one to cause a stir is Infant Feeding Practices and Reported Food Allergies at 6 Years. The researchers found:
In this cohort of 6-year-old US children, socioeconomic (higher maternal education and income) and atopic (family history of food allergy and infant eczema) factors were significant predictors of pFA (probable food allergy). Our analysis did not find a significant association between pFA and feeding practices at established dietary milestones in infancy. However, among children who did not have pFA by age 1 year, exclusive breastfeeding of ≥4 months was marginally associated with lower odds of developing pFA at age 6 years. This potential benefit was not observed among the high-risk atopic children, which suggests the need to separate children according to atopic risk when studying preventive benefits of exclusive breastfeeding on food allergy.
Translation: Kids in higher socioeconomic demographics, kids with higher-educated moms, and those with family history of food allergies were at higher risk for food allergies by the age of 6 than their peers. The only time breastfeeding or not seemed to make a difference was in kids with none of the risk factors I just mentioned, who had been breastfed at least 4 months.
A slew of other studies were also included in this supplement, and were summarized by a team of AAP researchers:
The first set of articles examines child health outcomes at 6 years of age. The study by Li and colleagues demonstrates that longer breastfeeding and later introduction of foods or beverages other than breast milk are associated with lower rates of ear, throat, and sinus infections in the year preceding the survey. However, they find no associations with upper or lower respiratory or urinary tract infections. Luccioli and co-workers find no significant associations between exclusive breastfeeding duration or timing of complementary food introduction and overall food allergy at 6 years old. Pan and colleagues examine childhood obesity at 6 years of age and show that consumption of sugar-sweetened beverages by infants doubles the odds of later obesity. Lind et al describe how breastfeeding is associated with various aspects of psychosocial development. They show a protective relationship between duration of breastfeeding and emotional, conduct, and total psychosocial difficulties, but these relationships become statistically nonsignificant after other confounding factors are controlled for. Though certainly not conclusive, these studies demonstrate that infant feeding is predictive of some later health outcomes (eg, some infectious diseases and childhood obesity) but not others (eg, food allergy and psychosocial development).
The American Academy of Pediatrics reported these findings, publishing an entry on its website called “How infant feeding practices affect children at age 6: A follow up.” Great, neutral, accurate title. Here is what they report:
The longer a mother breastfeeds and waits to introduce foods and drinks other than breastmilk, the lower the odds her child will have ear, throat, and sinus infections at 6 years of age.
Children who breastfeed longer consume water, fruit, and vegetables more often at 6 years of age and consume fruit juice and sugar-sweetened beverages less often.
When children drink sugar-sweetened beverages during the first year of life, this doubles the odds that they will drink sugar-sweetened beverages at 6 years of age.
When children eat fruit and vegetables infrequently during the first year of life, this increases the odds that they will continue to eat fruit and vegetables infrequently at 6 years of age.
Study authors conclude the data emphasize the need to establish healthy eating behaviors early in life, as this could predict healthy eating behaviors later in life. For more information about the IFPS-II and the IFPS-II follow-up study, visit www.cdc.gov/ifps.
Pretty clear, right?
From ABC News: Breastfeeding May Influence Kids’ Eating Habits at Age 6
“Childhood nutrition experts not involved with the study said the findings provide additional weight to the importance of shaping a child’s diet early. Dr. David Katz, editor-in-chief of the journal Childhood Obesity and director of the Yale University Prevention Research Center, said the findings serve to underscore the long-established relationship between breastfeeding and health in mothers and children.
“The question we need to be asking is not ‘Why should mothers breastfeed?’ but, ‘Why shouldn’t they?’” Katz said. “For all mammals, our first food is breast milk.”
For the love of god. At least now we know about the publication bias of Childhood Obesity.
No mention of the fact that the researchers themselves stressed that breastfeeding was only protective in certain ways, and not others, and that aside from consuming more veggies/fruits/water, there were no other nutritional advantages associated with breastfeeding in this study. No mention that they found no positive association between breastfeeding and food allergies in the highest-risk populations.Just a skewed interpretation that makes it sound like breastfeeding is the MOST important part of your child’s future health and nutrition, instead of ONE important part.
Strange framing also comes from Today.com:
Breast-feeding in infancy also increased the likelihood that children would be consuming a healthy diet later on. At age 6, children who were breast-fed drank sugary beverages less often and consumed water, fruits and vegetables more often than those who were bottle-fed, CDC researchers found.
That all makes sense, Scanlon said. “We know from other studies that children’s eating behaviors and preferences develop very early and are influenced by a variety of factors,” she explained. “They seem to have an innate preference for sweet and salty foods and dislike bitter flavors, which are found in vegetables.”
That can be changed when children are exposed to in utero and through breast milk to the flavors found in vegetables, Scanlon said. “Breast-fed infants are more open to different flavors,” she added.
Sure, that makes sense. But considering the same study found that breastfed infants were just as likely to eat junky savory/salty snacks, I am not sure that one could say breastfeeding = “healthy diet”. What the study did find was that they drank a statistically significant less juice, and ate more fruits and veggies at age 6. My daughter can’t stand juice and eats her weight in brussel sprouts, broccoli, and blueberries. But she also pours sugar on oatmeal and sneaks chocolate chips from my fridge and basically lives on soy yogurt. I wouldn’t call that a “healthy diet”.
WebMD’s title suggests a much different story than the one we can glean from the studies – “Breast-Feeding Lowers Kids’ Allergy, Infection Risk” – and frames the findings in a way that is…. well, see for yourself:
They found that children who had been exclusively breast-fed for four months or more had about half the odds of developing a food allergy compared to children who had been breast-fed for a lesser amount of time.
As Wu noted, the finding did have one limitation, however. “While breast-feeding did not decrease food allergies in high-risk populations, such as families who already have a history of food allergy, there was a decrease in low-risk populations,” she said.
“One limitation, however”? Um, considering the highest rates of allergy were found in the “high risk populations”, and this particular finding was somewhat brushed aside by the researchers themselves, it’s puzzling that WebMD latched on (sorry) to it.
And then -
Another expert said the studies provide valuable information.
Nina Eng, chief clinical dietitian at Plainview Hospital in Plainview, N.Y., said the findings “point out two of the many important benefits of breast-feeding.”
“These articles provide evidence that should inspire new moms to breast-feed their children,” she said.
Does it? Will it? I don’t know about you, but I don’t think any of these findings are so convincing that they might “inspire” a mom to breastfeed if she’s already decided not to. For those who have chosen to breastfeed, sure, maybe they will be somewhat heartening…. but I find it seriously odd that the media is spinning these studies as evidence of a “breastfeeding boost” (thank you, Today.com) instead of the more realistic framing: we now have a body of evidence that shows that choosing better foods at weaning and being responsive to feeding cues may have lasting effects.
In other words, give your kids produce and don’t force feed them. But that’s not as sexy as talking about breastfeeding, so…. BOOBS. There you go. Problem solved.