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PEDIATRICS Vol. 109 No. 6 June 2002, pp. 1044-1053

How Good Is the Evidence Linking Breastfeeding and Intelligence?

Anjali Jain, MD*,{ddagger}, John Concato, MD, MPH{ddagger},||,¶ and John M. Leventhal, MD§

* Section of General Pediatrics, Department of Pediatrics, University of Chicago Children’s Hospital, Chicago, Illinois
{ddagger} Robert Wood Johnson Clinical Scholars Program, Yale University, New Haven, Connecticut
§ Section of General Pediatrics, Department of Pediatrics, Yale University, New Haven, Connecticut
|| Department of Medicine, Yale University, New Haven Connecticut
Clinical Epidemiology Unit, West Haven Veterans Affairs Medical Center, West Haven, Connecticut

--> 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.

Key Words: breastfeeding • infant feeding • intelligence • cognition • meta-analysis

Abbreviations: WISC-R, Wechsler Intelligence Scale for Children-Revised • HOME, Home Observation for Measurement of the Environment

Received for publication Aug 17, 2001; Accepted Dec 5, 2001.




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