Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e435-e440 (doi:10.1542/peds.2007-1248)

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ARTICLE

Effects of Prolonged and Exclusive Breastfeeding on Child Behavior and Maternal Adjustment: Evidence From a Large, Randomized Trial

Michael S. Kramer, MD^a,b, Eric Fombonne, MD^a,c, Sergei Igumnov, MD^d, Irina Vanilovich, MD^d, Lidia Matush, MD^d, Elena Mironova, MD^d, Natalia Bogdanovich, MD, PhD^d, Richard E. Tremblay, PhD^e, Beverley Chalmers, PhD^f, Xun Zhang, PhD^a, Robert W. Platt, PhD^a,b for the Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group

^a Departments of Pediatrics
^b Epidemiology and Biostatistics
^c Psychiatry, McGill University Faculty of Medicine, Montreal, Quebec, Canada
^d National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
^e Groupe de recherche sur l'inadaptation psychosociale chez l'enfant, Université de Montréal, Montreal, Quebec, Canada
^f Department of Epidemiology and Community Health, Queen's University, Kingston, Ontario, Canada

OBJECTIVE. The objective of this study was to assess the long-term effects of breastfeeding on child behavior and maternal adjustment.

METHODS. We followed up children who were in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative. A total of 17046 healthy, breastfeeding mother–infant pairs were enrolled from 31 Belarussian maternity hospitals and affiliated polyclinics; 13889 (81.5%) were followed up at 6.5 years. Mothers and teachers completed the Strengths and Difficulties Questionnaire and supplemental questions bearing on internalizing and externalizing behavioral problems. Mothers also responded to questions concerning their relationships to their partner and child and their breastfeeding of subsequently born children.

RESULTS. The experimental intervention led to a large increase in exclusive breastfeeding at 3 months (43.3% vs 6.4%) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. No significant treatment effects were observed on either the mother or the teacher Strengths and Difficulties Questionnaire ratings of total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, or prosocial behavior or on the supplemental behavioral questions. We found no evidence of treatment effects on the parent's marriage or on the mother's satisfaction with her relationships with her partner or child, but the experimental intervention significantly increased the duration of any breastfeeding, and mothers in the experimental group were nearly twice as likely to breastfeed exclusively the next-born child for at least 3 months.

CONCLUSIONS. On the basis of the largest randomized trial ever conducted in the area of human lactation, we found no evidence of risks or benefits of prolonged and exclusive breastfeeding for child and maternal behavior. Breastfeeding promotion does, however, favorably affect breastfeeding of the subsequent child.

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Key Words: breastfeeding • child behavior • conduct disorder • ADHD • peer relations • randomized trial

Abbreviations: PROBIT—Promotion of Breastfeeding Intervention Trial • SDQ—Strengths and Difficulties Questionnaire • CI—confidence interval • OR—odds ratio • ICC—intraclass correlation coefficient

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Accepted Jul 20, 2007.

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