I started my career doing nutrition research in the laboratory of Dr. Lucille Hurley, who was famous for her work on the impact of nutritional deficiencies on development. While working with her I came to not only know the literature on how nutrient deficiencies can impair development, but saw the dramatic impact with my own eyes. Thus, the overwhelming literature showing that breastfeeding results in improved cognitive development came as no surprise. Yet, I have to admit to being surprised again by the power of parenting. A recent report concludes that the well-documented impact of breastfeeding on cognitive development is actually a proxy for parenting.
How Parenting Assessment Showed Breastfeeding’s Impact on School Readiness is Just a Proxy
The report by Benjamin Gibbs and Renate Foste in The Journal of Pediatrics worked to tease apart the parenting and the nutritional aspects of breastfeeding (J Pediatr 2014;164:487-93). The study participants were 7500 children in the Early Childhood Longitudinal Study Birth Cohort. Feeding practices were assessed by a survey completed by parents to determine whether and how long the infants were breastfed, and the frequency parents read to their children. At 9 months of age, maternal sensitivity and cognitive development were assessed using the 3 Bag Test parenting assessment. The 3 Bag Test assesses similar parenting behaviors as the Keys to Interactive Parenting Scale (KIPS). When the children were 4 years old their math and reading skills were assessed.
So what did the researchers find? As in previous studies, they found that children who were breastfed showed higher math and reading abilities when they were 4 years old. However, when they entered maternal parenting factors into their regression models, the impact of breastfeeding was no longer statistically significant.
This led Gibbs and Foste to rather bluntly conclude:
Overall, the evidence is clear—breastfeeding is not associated with cognitive development in early childhood. It is, however, a proxy for the kinds of parenting behaviors that do matter for children’s cognitive development. (J Pediatr 2014;164:487-93, p. 491)
This issue of The Journal of Pediatrics also included a commentary by Sandra Jacobson, Colin Carter and Joseph Jacobson, which reminds us that, beyond cognitive development, there are many benefits of breastfeeding.
The importance of the nutritional benefits of breastfeeding for a broad range of health outcomes should not be underestimated, however. These include reduced rates of asthma, allergies, and atopy; improved body mass index and reduced obesity rates; reduced rates of cardiovascular disease; and marked decreases in mortality, particularly in resource-poor settings. (J Pediatr 2014;164:440-42, p.441).
The commentary goes on to stress the importance of breastfeeding in reducing infectious diseases. They further point out that the results on cognitive development would be different if a poor quality substitute for human milk was used to feed infants, if high quality formula was diluted, or if the formula was prepared with contaminated water.
There is another important consequence of this study. Many mothers who don’t breastfeed feel guilty, even when they have chosen not to for a variety of reasons (e.g., chemotherapy, antidepressants, job constraints). The results of this study can be taken to assuage this guilt. If parents are providing quality parenting and quality formula, they are doing what it takes to nurture their children. A parenting assessment tool, like the 3 Bag Test or KIPS, can be used to assess parents’ skills and guide them in providing optimal parenting that not only helps get children ready for school, but has a wide range of benefits which we explore in this blog.
A Nutritionist Goes for the Rebound
Not long ago I reviewed a paper showing that parenting education resulted in a much more significant reduction in childhood obesity than any known nutrition intervention could. Here again is an example of how powerful parenting can be, and how parenting influences children’s development in unexpected ways. As a card-carrying nutritionist, I find this humbling. On the other hand, there’s another way to look at the implications of feeding studies. Bottle-fed infants, when controlled for parenting quality, develop as well as breastfed infants. This is a tribute to nutrition science, as the formula created by nutritionists seems to do a pretty good job when compared to mom’s milk.
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