Our inbox went a bit crazy this morning with a link to this article in the Daily Mail reporting on this research paper and claiming ‘babies who were breastfed developed fewer behavioural problems when older’. So, we are going to dig a little deeper into the paper and give our perspective as parents…
The researchers start by acknowledging that previous research looking at the impact of breastfeeding on behaviour outcomes has found mixed results (uh-huh… It still has mixed results). They decided to look at associations between breastfeeding duration and behaviour outcomes, as measured by the Strengths and Difficulties Questionnaire (SDQ) at age 3, 5, 7, 11 and 14. The SDQ is a brief screening tool for behavioural and emotional problems in children and adolescents.
They looked at data from a longitudinal study of 18522 families of children born in the UK between September 2000 and January 2002. They looked at singleton children (i.e., not twins or multiples). Specifically, they looked at the association between child behaviour and breastfeeding duration. They statistically controlled for many confounding factors (that is, factors that might be associated with both breastfeeding and behaviour outcomes). These included child sex, ethnicity, birthweight, gestational age, parental income, area-based deprivation, siblings, maternal smoking, maternal age, maternal education, maternal psychological distress, maternal attachment and paternal… (Oh, wait… No… no paternal factors were controlled for…)
And what do you know? Surprise to nobody, breastfeeding duration correlated with lower mother-reported SDQ scores at all time points, with confounding variables controlled for. Breastfeeding duration correlated with lower teacher-reported SDQ scores at age 7, but not at 11.
So the researchers conclude… that the evidence points to breastfeeding playing a ‘crucial’ (yes, ‘crucial’) role in children’s socio-emotional development. They claim that their results support current healthcare policy to encourage mothers to exclusively breastfeed for the first 6 months.
Explaining their results in the Daily Mail article, the authors speculate about the role of oxytocin, ‘the love hormone’. But there is absolutely no possibility to test this in their data. And, honestly, calling oxytocin the ‘love hormone’ is so pop psychology, so please don’t do that! (Here’s a link to one of our favourite threads about oxytocin by an actual scientist who studies it and a snippet from the now late, but forever great, Scott Lilienfeld.)
We digress. Back to their results…
They used some fancy-pants statistics to test whether breastfeeding was associated with different trajectories in SDQ scores. The general pattern is that SDQ scores decrease after age 3 and then increase in adolescence. Well, surprise (not), breastfeeding was associated with a slower reduction in SDQ scores and a slightly faster increase in SDQ scores over time, but lower scores on average.
So, are the researchers right that their results support the idea that breastfeeding is ‘crucial’ for children’s socio-emotional development? Do these results support current policy to encourage mothers to exclusively breastfeed for the first 6 months of life?
Absolutely not! First off, once again, let us re-emphasise that correlation is not causation, and however fancy-pants your statistics are, there is always a possibility of residual confounding in studies like this one (i.e., we cannot rule out the possibility that other factors might explain the relationship). And they didn’t actually measure clinically significant behavioural and emotional problems. They used a screening tool. The average scores were well below the cut-off point whereby further assessment might be recommended, in every single category they studied. In other words, the levels of behavioural and emotional problems were low, whether or not babies were breastfed. One might conclude from this that measuring an average temperature of 37°C in group A and an average temperature of 37.2°C in group B means group B are more likely to have a fever.
So, this study is absolutely not evidence that increasing duration of breastfeeding will have a significant effect on emotional and behavioural problems in children and adolescence and it is a very big stretch of the data to draw that conclusion. To make that recommendation on the basis of such flimsy data shows, in our opinion, a fundamental disregard for women’s needs and realities. Many of our members experienced detrimental effects of breastfeeding on our health and wellbeing, or those of our babies. The recommendation also shows a disregard for babies and children. There are many factors that contribute to the emotional health of children and young people. Public health policy should invest in targeting those where there is evidence to demonstrate clear return of investment.
We suspect that these researchers, along with policymakers and healthcare leadership, dramatically underestimate the demands they are placing on women and the negative impact of these policies, and we make no apology for standing up and giving a very firm NO to these conclusions. We believe that individual families are best placed to weigh up what is important to them and to make their own decisions about how to feed their baby and that it is high time to stop drawing such firm conclusions from such inconclusive data. For many of us, a decision to formula feed has brought significant benefits to our physical and mental health – something that is clearly of benefit to the emotional wellbeing of our babies and children. Something that public health discourse persistently refuses to acknowledge.
It is time that public health policy got off its breastfeeding high horse and allowed our healthcare providers to focus on the needs of the families they serve. If they could do that, maybe fewer of our babies would have been readmitted to hospital with the complications of insufficient milk intake in the first few days of life. Maybe fewer of us would have tortured ourselves about the – often necessary – decision to introduce formula, either in combination with breastfeeding or to bring it to an end. Maybe more of us would have had a lot more contentment in the first few weeks of our babies’ lives. Maybe fewer of us would be left with a distrust of healthcare professionals, who denied our reality, refused to discuss all our options and seemed more interested in breastfeeding than in the health and wellbeing of our babies and ourselves. And imagine what an impact that would have on the mental health of mothers and the emotional health of babies and children?
So look, we know this is hard to hear and we know many people are likely to feel irate and defensive about this but, please… pause. Take a breath and connect with the part of you that genuinely wants to help new families. We know you’ve assumed getting us to breastfeed is the way to do that, but it really isn’t. Focus on us and on our needs, and stop creating public health policies that mislead us and coerce us into making decisions that we might not make if we had a more realistic perspective on this data. Trust us. We will make good decisions for ourselves and our babies. But if you can’t do that, you’re going to hear us roar, because we are not accepting the effect of the status quo on us, our babies or our families any longer.
P.S. We couldn’t see a measure of effect size in the paper. An issue with large studies is the ability to detect statistical significance from tiny effects. If someone more statistically skilled than we are can figure out how much variance in SDQ scores is explained by breastfeeding, please contact us!
This is an edited version of a review first published as a thread on Twitter.