The effect of exclusive breastfeeding on development and incidence of infection in infants

Impact of the Duration of Breastfeeding on the Intelligence of Children: A Systematic Review with Network Meta-Analysis

Objective: To evaluate the impact of the duration of breastfeeding on the intelligence of children. Materials and Methods: Eight electronic databases were searched to identify studies that investigated the impact of breastfeeding on the intelligence of children. Data were pooled, and the ratio of means (RoM) and the corresponding 95% confidence interval (95% CI) were calculated using a pairwise meta-analysis and network meta-analysis. Risk of bias was assessed using a tool developed by the CLARITY group. Data were analyzed using R version 3.5.1. Results: A total of 15 studies with 12,316 subjects were included in the review. Half of the studies were at low risk of bias. A meta-analysis indicated that breastfed children had a score 1.04-fold higher in intelligence tests compared with those that had never been breastfed (RoM: 1.04, 95% CI: 1.02-1.06, p < 0.05). Evidence from a network meta-analysis indicated that breastfeeding for ≤6 months resulted in score 1.04-fold higher in intelligence tests (RoM: 1.04, 95% CI: 1.03-1.06, p < 0.05) and children breastfed for >6 months had a score 1.06-fold higher (RoM: 1.06, 95% CI: 1.05-1.08, p < 0.05) than children that had never been breastfed. Thus, breastfeeding for >6 months demonstrated a slightly higher score than breastfeeding for ≤6 months (RoM: 1.02, 95% CI: 1.00-1.04, p < 0.05). Conclusion: Breastfeeding could significantly improve the intelligence of children, with a duration of >6 months showing a slight but significantly higher intelligence score than for ≤6 months.

Associations between breastfeeding and cognitive function in children from early childhood to school age: a prospective birth cohort study

BACKGROUND

Despite evidences of breastfeeding for preventing acute physical illnesses in infants, the evidence for the association between breastfeeding and long-term cognitive development is not yet convincing.

METHODS

The data of nationwide representative sample of 1752 children born between 2008 and 2009 in Korea were prospectively assessed from the fetal period to examine the benefits of breastfeeding and cognitive development. Breastfeeding duration was prospectively assessed by parents. The Korean Ages and Stages Questionnaire and the Korean version of Denver II were used to assess early development annually from 5.5 to 26.2 months of age. Language development at 3 years of age was assessed with Receptive and Expressive Vocabulary Tests. Cognitive function at 8 years of age was assessed using multifactorial intelligence test.

RESULTS

In the analysis of categorical variables, children who were breastfed for > 1 and ≤ 3 months displayed significantly higher odds ratios for delayed development assessed with Korean Ages and Stages Questionnaire at 14.1 months than those breastfed for > 3 and ≤ 6 months (OR = 2.21; 95% CI: 1.08, 4.50), but no significant differences in other rounds of assessments. In the analysis with continuous variables, there were significant differences among six groups of breastfeeding duration in communication (F = 3.72; p < 0.002) and problem solving (F = 3.09; p < 0.009) at 14.1 months, expressive language (F = 3.74; p = 0.002) at 3 years, and calculation (F = 2.43; p < 0.033) at 8 years. When analyzed by two groups, children breastfed for > 3 months scored significantly higher on the communication (F = 17.71; p < 0.001) and problem-solving (F = 11.26; p < 0.001) subscales at 14.1 months, and expressive language (F = 12.85; p < 0.001) at 3 years, and vocabulary (F = 6.78; p = 0.009) and language inference (F = 5.62; p = 0.018) at 8 years, compared to children breastfed for 3 months or less.

CONCLUSION

We found that cognitive development was improved in children that were breastfed for > 3 months. Although these results are supported by previous studies, it is important to note that other factors were reported as larger determinants of cognitive development than breastfeeding. Future studies that examine the underlying mechanism for the association between breastfeeding and cognitive development are warranted.

Economic Analysis of Exclusive Human Milk Diets for High-Risk Neonates, a Canadian Hospital Perspective

Background: There is increasing evidence that premature newborns and infants with low birth weight can benefit substantially from an exclusive human milk-based diet (EHMD), consisting of human milk supplemented with a pasteurized donor human milk-derived fortifier. However, compared with the standard infant diet, EHMD also represents a significant added cost to the hospital and/or health system, thereby raising important questions about the economic feasibility of incorporating EHMD into newborn care. Design: We conducted a cost analysis and estimated the potential cost savings to a Canadian tertiary hospital based on the attributable complications averted from EHMD among low-weight neonates. A meta-analysis was performed to derive input parameters. A probabilistic analysis was conducted to determine the probability that EHMD is cost saving and 95% confidence interval (CI) around our estimates. Results: Our findings show that providing EHMD to preterm infants under 750 g at birth and at the highest risk of developing major complications is likely to be cost saving in the amount of $107,567 (95% CI: -145,229 to 360,362) per year. Extending EHMD to higher weight classes may be economically feasible depending on the pricing of the human milk-derived fortifier and the baseline risk of complications in the hospital setting. Conclusions: This comprehensive study provides critical insight for hospital-based decision makers to evaluate the potential gains and uncertainties associated with improved nutritional care for neonatal patients.

Social marketing and breastfeeding: a literature review

Aims:

Through the review of relevant literature this study illuminates the concepts of social marketing and breastfeeding. It specifically discusses the positioning of the link between social marketing and breastfeeding within different fields of study and develops a theoretical framework that tries to bridge the gap between those disciplines.

Method:

Various electronic databases were used and through systematic selection 11 scientific articles were identified that this literature review is based on.

Results:

The review indicates that the relationship between social marketing and breastfeeding is complex. There are indications that this relationship is being investigated within three distinct fields of research: psychology/education, public health and marketing. Depending on the research field the emphasis is put on either breastfeeding or social marketing as well as on the other concepts that were discovered to be of importance within this relationship. Namely, group and individual demography as well as behaviour were revealed to be important elements of the link between social marketing and breastfeeding.

Conclusions:

Based on the results this study concludes that a more multidimensional view on the relationship between the concepts under study is needed since the focus of previous studies is very one-sided and limited to just one element when all elements should be integrated equally.

Family medicine obstetrics: pregnancy and nutrition

This article discusses pregnancy and nutrition in 3 main timeframes, the prepregnancy nutritional health evaluation, nutrition during pregnancy, and nutrition during the puerperium, and also includes comments on nutrition and lactation. This article begins with a brief review of the risks of obesity (increased body mass index [BMI]) and anorexia (decreased BMI), with special attention to these undesired conditions during pregnancy, followed by a section on nutrients other than calories. Information on body weight, minerals, and vitamins during pregnancy is reviewed. This article ends with information on nutrition in the postpartum period.

Breast milk macro- and micronutrient composition in lactating mothers from suburban and urban Shanghai

AIM

The objective of this study was to measure and compare the macro- and micronutrient composition of breast milk in urban and suburban lactating mothers living in Shanghai, China.

METHODS

Primiparous women residing in three urban regions (n= 30/region) and a suburban area of Shanghai (n= 30) were recruited. Breast milk samples were collected 8-10 days postpartum and dietary intake was determined.

RESULTS

Women from the suburban area were of lower socio-economic status as indicated by levels of education, occupation and income. With the exception of carbohydrates, mothers in all urban areas had significantly higher macronutrient intake levels than suburban area mothers. Sodium, potassium, phosphorus and calcium intake levels were significantly lower in suburban compared to all urban women. Concentrations of protein, lipids, copper, sodium, potassium, chlorine, zinc, manganese, phosphorus and iron were all significantly lower in milk obtained from suburban compared to urban women. Concentrations of carbohydrates in milk from suburban women were significantly higher than concentrations in than two of the three urban groups. Offspring from women in Chongming county gained significantly less weight between birth and 6 months than did offspring born to women from the three other counties.

CONCLUSIONS

In summary, there were significant differences in macro- and micronutrient intake levels and breast milk concentrations between women from urban and suburban Shanghai. These differences may have important implications for the growth and development of breastfed infants.

Exploratory Study: Knowledge about the Benefits of Breastfeeding and Barriers for Initiation in Mothers of Children with Spina Bifida

The aim of the study is to identify the level of knowledge on breastfeeding by mothers of infants with spina bifida and the barriers encountered in initiating breastfeeding. A non-probabilisitic sample (n=30) of mothers was used in this study. The sample was obtained in two institutions specializing in care for infants with congenital anomalies in Puerto Rico. A self-administered questionnaire was used consisting of six sections. Descriptive statistics were used for data analysis. Among participants, 56.7% had adequate knowledge on the benefits of breastfeeding. The most frequently encountered barriers in initiating breastfeeding were related to the neonatal intensive care unit (NICU). Problems with the medical and nursing procedures, routines, support from personnel, and adequacy of the environment were the most frequent. It is important to develop a education to encourage nurses and other health care professionals need suggest, support and encourage breastfeeding to mothers of infants with neural tube defects.

Full breastfeeding and hospitalization as a result of infections in the first year of life

OBJECTIVE

Our objective was to assess the effect of breastfeeding on the probability of hospitalization as a result of infectious processes during the first year of life

METHODS

We followed 1385 infants from birth to age 1 year between 1996 and 1999. Recruitment and data collection were done at the 6-month well-infant visit under the National Child Health Program. Full breastfeeding, hospital admission, and other relevant variables related to the delivery, infant, mother, health services system, and sociologic aspects were recorded. The statistical analysis included Kaplan-Meier test, Cox regression to obtain the hazard ratio, and the adjusted attributable risk.

RESULTS

Full breastfeeding at discharge after delivery and at 3, 4, and 6 months of age were 85%, 52%, 41%, and 15%, respectively; 78 hospital admissions as a result of infections were recorded (38 respiratory tract, 16 gastrointestinal tract). Mean age at admission was 4.1 months. After estimating the attributable risk, it was found that 30% of hospital admissions would have been avoided for each additional month of full breastfeeding. Seemingly, 100% of full breastfeeding among 4-month-old infants would avoid 56% of hospital admissions in infants who are younger than 1 year.

CONCLUSIONS

On the basis of the present data, we conclude that full breastfeeding would lower the risk for hospital admission as a result of infections among infants who are younger than 1 year within an industrialized country.

Breast-feeding influences cognitive development in Filipino children

The importance of breast-feeding (BF) for cognitive development has been researched widely over the past several decades. Although scholars agree that children who breast-feed are generally more intelligent, it is uncertain whether this advantage is due to BF effects or to other accompanying healthy characteristics of women who breast-feed. This is a problem in nearly every study, and even in studies controlling for known confounding variables, residual confounding remains a concern. This study tried a new approach, evaluating the relation between BF and cognitive development or ability in a population in which BF was inversely correlated with socioeconomic advantages and other healthy maternal behaviors. Normal birthweight (NBW, n = 1790) and low birthweight (LBW, n = 189) (<2500 g) infants born in 1983-84 in Metropolitan Cebu, Philippines were followed from birth through middle childhood. Cognitive ability was assessed at ages 8.5 and 11.5 y with the Philippines Nonverbal Intelligence Test. Multivariable linear regressions were created to estimate crude and adjusted relations of various BF measures and later cognitive ability. After controlling for confounding variables, scores at 8.5 y were higher for infants breast-fed longer (1.6 points and 9.8 points higher among NBW and LBW infants, respectively, breast-fed for 12 to <18 mo vs. <6 mo). BF coefficients in both NBW and LBW 11.5-y models were attenuated but remained positive. This analysis highlights the importance of long-term BF after initial introduction of complementary foods, particularly in LBW infants born close to term.

[Epidemiology of community-acquired pneumonia in children aged less than 5 years old in the Autonomous Community of Valencia (Spain)]

OBJECTIVE

To assess the incidence of community acquired pneumonia in the Autonomous Community of Valencia in Spain, and describe its treatment and complications.

METHODS

A retrospective cohort comprising 654 children born in 1995 and 1996 in Valencia and followed-up during the first 5 years of life by nine pediatricians was studied. The number of cases of pneumonia, treatment, complications and interventions was recorded.

RESULTS

Ninety-nine episodes of community-acquired pneumonia in 80 children were recorded (1.24 cases/child). Fifty-one cases (51.1 %) occurred before the child's third birthday and 38 (38.4 %) occurred between the third and the fourth. Of the 99 cases, 51 were diagnosed in primary care and 46 in the emergency room. There was a mean of 2.44 visits per process in primary care (range 1-6). All the children were treated with antibiotics. The most frequently used were amoxicillin-clavulanate (43.3 %) and cefuroxime (26.3 %). Fourteen patients required a change of antibiotic. Twenty-three percent of the children were hospitalized.

CONCLUSION

The incidence of community-acquired pneumonia in Valencia was 30.3 cases/1000 children aged less than 5 years/ year (95 % CI: 18.7-46.8), and the incidence of hospitalization was 7.03 cases/1000 children aged less than 5 years/year.

Breastfeeding and intelligence of preschool children

AIM

To investigate whether breastfeeding during infancy is a determinant of intelligence at 3.5 y.

METHODS

Five hundred and fifty European children enrolled at birth in the Auckland Birthweight Collaborative Study were assessed at 3.5 y of age. Approximately half were small for gestational age (SGA < or =10th percentile) at birth and half were appropriate for gestational age (AGA >10th percentile). Duration of breastfeeding was recorded at maternal interview, and the intelligence of children was assessed using the Stanford Binet Intelligence Scale. Regression analysis was used to calculate estimates of difference in intelligence scores between breastfeeding groups for the total sample and the group of SGA children. Analyses of the total sample were weighted to account for the disproportionate sampling of SGA children.

RESULTS

Breastfeeding was not significantly related to intelligence scores in the total sample despite a trend for longer periods of breastfeeding to be associated with higher intelligence scores. However, in the SGA group, breastfeeding was significantly related to IQ at 3.5 y. Small for gestational age children who were breastfed for longer than 12 mo had adjusted scores 6.0 points higher than those who were not breastfed (p=0.06).

CONCLUSION

Breastfeeding may be particularly important for the cognitive development of preschool children born small for gestational age.

Increasing breastfeeding rates in New York City, 1980-2000

Our objective was to determine temporal patterns of breastfeeding among women delivering infants in New York City (NYC) and compare national breastfeeding trends. All hospitals in NYC with obstetric units were contacted in May and June 2000 to provide information on the method of infant feeding during the mother's admission for delivery. Feeding was categorized as "exclusive breastfeeding," "breast and formula," or "exclusive formula." The first two categories were further grouped into "any breastfeeding" in the analysis. Hospitals were classified as "public" and "private," and patients were classified by insurance type as "service" and "private." Data between public and private hospitals and service and private patients were compared. Breast-feeding trends over time were compared by using previous iterations of the same survey. Of 16,932 newborns, representing approximately 80.0% of all reported live births in the city during the study period, 5,305 (31.3%) were exclusively breastfed, 6,189 (36.6%) were fed a combination of breast milk and formula, and the remaining 5,438 (32.1%) were exclusively formula-fed. Infants born in private hospitals were 1.6 times more likely to be exclusively breastfed compared with infants discharged from public hospitals (33% vs. 21%, respectively). Similarly, private patients were more likely than service patients to exclusively breastfeed their infants (39.6% vs. 22.9%, respectively) and to use a combination of breast and formula (i.e., any breastfeeding) (73.6% vs. 62.0%, respectively). From 1980 to 2000, the proportion of exclusive breastfeeding increased from 25.0% to 31.0%, the percentage of combined feeding increased from 8.0% to 37.0%, and the percentage of any breastfeeding increased from 33.0% to 68.0%. NYC has more than doubled the rate of breastfeeding since 1980. However, there is much progress to be made, and continued efforts are vital to maintain current gains in breastfeeding, improve the rates further, and prolong the duration of breastfeeding.

Breastfeeding prevalence and practices among Singaporean Chinese, Malay and Indian mothers

The National Breastfeeding Survey 2001 was the first comprehensive study on breastfeeding conducted on a national level in Singapore. It aimed to establish the prevalence of breastfeeding among Chinese, Malay and Indian mothers and to identify factors influencing breastfeeding. A total of 2098 mothers were interviewed in this two-phase study, with the first interview conducted 2 months after delivery and the second interview 6 months after birth among mothers who were still breastfeeding at 2 months. Frequency distributions of breastfeeding prevalence and types of breastfeeding practices at different time intervals (from birth to 6 months) were produced. Multivariate logistic regression was carried out to construct a model with predictive information on factors which influence continued breastfeeding till 2 months and 6 months after delivery respectively. The study found that about 94.5% of the mothers attempted breastfeeding. At 1 month, 71.6% were still breastfeeding, 49.6% continued to do so at 2 months, and 29.8% persisted till 4 months. By 6 months, the breastfeeding prevalence rate fell to 21.1%. The results of this study show higher breastfeeding prevalence rates compared to past studies in Singapore. Despite this, exclusive breastfeeding is still not a common practice. Various factors were found to be significant in influencing mothers' decision to breastfeed. Factors such as ethnicity, age, educational attainment, religion and baby's sex are non-modifiable in the short term or at an individual level. However, factors such as awareness of breastfeeding benefits, advice from health professionals and previous breastfeeding experience are potentially modifiable. Efforts aimed at promoting breastfeeding in Singapore need to take these modifiable factors into consideration so as to better tailor health promotion efforts on breastfeeding to women.

Influence of breast-feeding and parental intelligence on cognitive development in the 24-month-old child

This study was designed to analyze the relationship between breast-feeding and mental development at 24 months of age, independently of the influence of other factors. A total of 238 babies born between October 1995 and February 1998 were enrolled in an observational prospective cohort study. Cognitive development was assessed using the Bayley Infant Development Scale. The results of multiple linear regression analysis showed that infants breast-fed for longer than 4 months scored 4.3 points higher on the mental development scale than those breast-fed for less time. No differences were found in psychomotor development as a function of feeding regimen or duration. The positive linear correlation observed between parental IQ and mental development scores at 24 months was also statistically significant (mother: r = 0.39; p < 0.001; father: r = 0.43; p < 0.001). It may be concluded that breast-feeding for longer than 4 months has a positive effect on the child's mental development at 24 months of age. Parental intelligence also appears to influence cognitive development.

Influence of breast-feeding on mental and psychomotor development

The purpose of this study was to analyze the effects of breast-feeding on cognitive and motor development. A prospective cohort study was carried out enrolling 249 babies from 2 rural and urban areas. Cognitive development was assessed at the age of 18 months. Results show that adjusted scores on the mental development index were 4.6 points higher in babies breast-fed for longer than 4 months than in those breast-fed for less time. No differences in psychomotor development were found as a function of type of feeding. A statistically-significant linear correlation was observed between the duration of breast-feeding and scores for Bayley's mental development index. These data suggest that breast-feeding for longer than 4 months has a positive effect on the baby's mental development measured at 18 months of age. Parental intelligence quotient also seems to have an influence on cognitive development.

How good is the evidence linking breastfeeding and intelligence?

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.

PCDDs, PCDFs, and PCBs concentrations in breast milk from two areas in Korea: body burden of mothers and implications for feeding infants

We determined breast milk concentration of polychlorinated dibenzo-p-dioxins (PCDDs)/polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) in 24 mothers living in Korea, and assessed the maternal body burden based on PCDDs/PCDFs and PCBs concentrations in breast milk and an infant intake rate through breast-feeding based on their concentration in breast milk. PCDDs/PCDFs and PCBs levels in breast milk from primipara mothers were found to be higher than those from multipara mothers. For total PCDDs/PCDFs TEQ level, 2,3,4,7,8-PeCDD was the predominant congener, and the proportion of 2,3,7,8-TCDD was less than 3% of total PCDDs/PCDFs TEQ level. For PCBs TEQ level, PCB-126 was the predominant congener. Maternal body burden levels of PCDDs/PCDFs and PCBs based on their concentrations in breast milk were 268-622 TEQ ng. The daily dioxin intakes of mothers were predicted to be 0.78-2.18 TEQ pg/kg/day for PCDDs/PCDFs and 0.34-0.66 TEQ pg/kg/ day for PCBs. For the first year, the body burden of an infant was predicted to be 212 TEQ ng and the daily intake of an infant was predicted to be 85 TEQ pg/kg/day, assuming the mean dioxin-related compounds concentration (27.54 TEQ pg/g fat).

A critical evaluation of the evidence on the association between type of infant feeding and cognitive development

This paper presents a critical evaluation of 24 studies on the association between type of infant feeding and cognitive development published over the past 20 years. Validity and generalisability of study findings were assessed according to three methodological standards: clearly defined outcome, specification of partial vs. exclusive breast feeding and control of confounding. Only six of the 24 investigations met all three standards. The most frequent study flaw was failure to distinguish between partial and exclusive breast feeding. Studies which made this distinction found larger IQ advantages to breast-fed infants than studies that did not. Four of the six studies meeting all three standards found an advantage in cognitive development to breast-fed infants of the order of two to five IQ points for term infants and eight points for low birthweight infants. We conclude that the question of whether breast feeding and formula feeding have differential effects on cognitive development has not yet been comprehensively answered. Research to date provides only an indication of the effect of relatively brief durations of partial breast feeding and even briefer durations of exclusive breast feeding. Future studies should measure breast feeding as a continuous dose-type variable, examine longer durations of breast feeding and control for a full range of confounders using techniques that deal appropriately with multicollinearity.

Knowledge and attitudes of pediatric office nursing staff about breastfeeding

This descriptive study documents nurses' breastfeeding knowledge and attitudes. The nursing staffs of 27 private pediatric practices in North Carolina were surveyed. The 42-item questionnaire included questions about who was responsible for breastfeeding support, what staff nurses knew and believed about breastfeeding, and where their breastfeeding education was obtained. The response rate was 59% (134 out of 227). Only 5% responded that a breastfeeding patient experiencing problems would be referred to a physician, whereas 81% selected a lactation consultant, and 38% selected a member of the nursing staff. Knowledge scores ranged from 19 to 33 (out of 33). Attitude scores ranged from 10 to 30 (out of 30). Only 46% of respondents reported having received breastfeeding education in their training programs; 85% had received on-the-job training. The nurses surveyed were involved in breastfeeding support, yet many had incorrect information and negative attitudes toward breastfeeding.

Breastfeeding and the use of human milk. American Academy of Pediatrics. Work Group on Breastfeeding

This policy statement on breastfeeding replaces the previous policy statement of the American Academy of Pediatrics, reflecting the considerable advances that have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, in the mechanisms underlying these benefits, and in the practice of breastfeeding. This document summarizes the benefits of breastfeeding to the infant, the mother, and the nation, and sets forth principles to guide the pediatrician and other health care providers in the initiation and maintenance of breastfeeding. The policy statement also delineates the various ways in which pediatricians can promote, protect, and support breastfeeding, not only in their individual practices but also in the hospital, medical school, community, and nation.

Economic benefit of breast-feeding infants enrolled in WIC

OBJECTIVES

To determine whether breast-feeding of infants enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is associated with a reduction in Medicaid expenditures during the first 6 months of life; if so, to determine whether the reduction in Medicaid expenditures represents a positive economic benefit to society when WIC costs for these infants and their mothers are considered.

DESIGN

Cohorts of exclusively breast-fed and formula-fed infants were tracked for 6 months to compare WIC costs and Medicaid expenditures.

SUBJECTS

The sample consisted of 406 healthy infants who were breast-fed exclusively for at least 3 months and 470 healthy infants who were formula-fed exclusively. The infants, born between August 1, 1993, and December 31, 1993, were enrolled in WIC and Medicaid. COST AND BENEFIT MEASURES: WIC costs included redeemed WIC vouchers for formula and foods for infants and mothers, plus administrative expenses for 6 months, minus manufacturers' rebates for formula. Benefit was determined from Medicaid expenditures for health care initiated in the first 180 days of each infant's life. STATISTICAL AND BENEFIT-COST ANALYSES: Economic benefit was calculated as net benefit and as benefit-cost ratios. Regression techniques were used to estimate Medicaid expenditures associated with breast-feeding, adjusted for demographic and prenatal care variables.

RESULTS

Compared with formula-feeding, breast-feeding each infant enrolled in WIC saved $478 in WIC costs and Medicaid expenditures during the first 6 months of the infant's life, or $161 after consideration of the formula manufacturer's rebate. A Medicaid cost saving of $112 per infant was realized by the breast-feeding cohort, and Medicaid pharmacy reimbursement costs for breast-fed infants were significantly lower-half that of formula-fed infants.

APPLICATIONS

The promotion of breast-feeding among low-income populations through nutrition programs such as WIC is an effective cost-containment measure.

Breastfeeding promotion for the employed mother

Increasing numbers of mothers are returning to work during the first year of their infant's life. Maternal employment has been associated with decreased duration of breastfeeding. Breast milk remains the optimal source of infant nutrition, yet only 50% of families choose breastfeeding for their newborns. Clinicians in pediatrics are well positioned to promote the specific benefits to mother and baby that breastfeeding provides through advocacy, education, and support with regard to breastfeeding and employment. Anticipatory guidance specifics such as feeding patterns, guidelines for pumping and storing breast milk, and information regarding available resources are clinical knowledge areas that pediatric health care providers must have to increase breastfeeding rates and duration among women who return to the work force after the birth of their baby.