Infant feeding method and special educational need in 191,745 Scottish schoolchildren: A national, population cohort study

Abstract

Background While special educational needs (SEN) are increasingly recorded among schoolchildren, infant breastfeeding has been associated with reduced incidence of childhood physical and mental health problems. This study investigated relationships between infant feeding method and risk of all-cause and cause-specific SEN. Methods and findings A population cohort of schoolchildren in Scotland was constructed by linking together health (maternity, birth, and health visitor records) and education (annual school pupil census) databases. Inclusion was restricted to singleton children, born in Scotland from 2004 onwards with available breastfeeding data and who attended local authority mainstream or special schools between 2009 and 2013. Generalised estimating equation models with a binomial distribution and logit link function investigated associations between infant feeding method at 6 to 8 weeks and all-cause and cause-specific SEN, adjusting for sociodemographic and maternity factors. Of 191,745 children meeting inclusion criteria, 126,907 (66.2%) were formula-fed, 48,473 (25.3%) exclusively breastfed, and 16,365 (8.5%) mixed-fed. Overall, 23,141 (12.1%) children required SEN. Compared with formula feeding, mixed feeding and exclusive breastfeeding, respectively, were associated with decreased all-cause SEN (OR 0.90, 95% CI [0.84,0.95], p Conclusions In this study, we observed that both breastfeeding and mixed feeding at 6 to 8 weeks were associated with lower risk of all-cause SEN, and SEN attributed to learning disabilities and learning difficulty. Many women struggle to exclusively breastfeed for the full 6 months recommended by WHO; however, this study provides evidence that a shorter duration of nonexclusive breastfeeding could nonetheless be beneficial with regard to the development of SEN. Our findings augment the existing evidence base concerning the advantages of breastfeeding and reinforce the importance of breastfeeding education and support. In a cohort of 191,745 Scottish schoolchildren, Michael Fleming and colleagues explore infant feeding methods and special educational need. Author summary Why was this study done? Infant breastfeeding has been associated with reduced physical and mental health problems in childhood which contribute toward special educational need (SEN). Previous studies have not investigated the impact of mixed feeding, have not adjusted for child, maternal, and pregnancy confounders, have encountered bias, or have used a narrow definition of SEN. What did the researchers do and find? We linked national, routinely collected, health data (maternity, birth, and health visitor records) and education data (annual school pupil census) together to investigate the association between mode of infant feeding at 6 to 8 weeks of age and both all-cause and cause-specific SEN in Scotland. Our study cohort comprised all singleton children, born in Scotland from 2004 onwards with available breastfeeding data and who attended local authority mainstream or special schools in Scotland between 2009 and 2013. Outcomes for 48,473 exclusively breastfed children and 16,365 mixed-fed children, respectively, were compared to 126,907 formula-fed children, adjusting for sociodemographic and maternity factors. Compared to children who were formula-fed, we observed that, after adjusting for available sociodemographic and maternity factors, exclusively breastfed children and mixed-fed children both had lower risk of all-cause SEN and SEN attributed to learning disabilities and learning difficulties. Exclusively breastfed children additionally had lower risk of communication problems, social–emotional–behavioural difficulties, sensory impairments, physical motor disabilities, and physical health conditions. What do these findings mean? For women who struggle to breastfeed for the full 6 months recommended by WHO, our study suggests that a shorter duration of nonexclusive breastfeeding could still be beneficial with regard to the development of SEN. Our findings augment the existing evidence base concerning the advantages of breastfeeding and reinforce the importance of breastfeeding education and support.