Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. e1436-e1443 (doi:10.1542/peds.2005-2916)
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ARTICLE

Breastfeeding, Sensitivity, and Attachment

John R. Britton, MD, PhD, Helen L. Britton, MD and Virginia Gronwaldt, PhD

Department of Pediatrics, University of Arizona Health Sciences Center, Tucson, Arizona

OBJECTIVE. Our goal was to test the hypothesis that breastfeeding is associated with enhanced infant-mother attachment and its antecedent maternal sensitivity.

METHODS. Breastfeeding intent and practice were assessed by questionnaires administered to 152 mothers between 32 weeks of gestation and 12 months postpartum. Early maternal sensitivity was measured by the Sensitivity to Cues subscale of the Nursing Child Assessment Satellite Training Feeding Scale at 3 months, and quality of the mother-infant interaction was measured by the Nursing Child Assessment Satellite Training Feeding Scale at 6 months. Security of attachment was evaluated by the Ainsworth Strange Situation at 12 months.

RESULTS. A direct relationship between attachment security and breastfeeding practice was not identified. The quality of the mother-infant interaction at 6 months, rather than the type of feeding, predicted security of attachment. However, mothers who chose to breastfeed displayed greater sensitivity in dyadic interactions with their infants 3 months postnatally than those who chose to bottle feed, and intended breastfeeding duration prenatally correlated with sensitivity 3 months postpartum. Although a path analysis failed to demonstrate contributions of early breastfeeding duration to either sensitivity or security, it did substantiate a significant path between prenatal breastfeeding intent and attachment security mediated by sensitivity. In addition, multivariate analyses revealed that early sensitivity among breastfeeding mothers was an independent predictor of the duration of any and exclusive breastfeeding during the first year.

CONCLUSIONS. Although the quality of the dyadic interaction in infancy, rather than feeding type, is predictive of attachment security, mothers who choose to breastfeed display enhanced sensitivity during early infancy that, in turn, may foster secure attachment. Among breastfeeding mothers, higher sensitivity is associated with longer duration of breastfeeding during the first postpartum year. These findings suggest a link between attachment security and breastfeeding.

Key Words: breastfeeding • mother-infant attachment • maternal sensitivity

Abbreviations: NCAST—Nursing Child Assessment Satellite Training • ANOVA—analysis of variance • OR—odds ratio • CI—confidence interval

Accepted May 24, 2006.


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