BREASTFEEDING MEDICINE Volume 9, Number 7, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2014.0073
Breastfeeding, Early Brain Development, and Epigenetics—Getting Children Off to Their Best Start Thomas K. McInerny 1,2
P
ediatricians and other healthcare professionals have a critical role to play as advocates and supporters of successful breastfeeding. Given the documented shortand long-term health benefits of breastfeeding, the American Academy of Pediatrics (AAP) believes infant nutrition should not be considered merely a lifestyle choice but a public health issue. Breastfeeding is one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself. The most comprehensive review and analysis of scientific literature comparing short- and long-term health outcomes of breastfeeding is ‘‘Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries’’1 from the evidence-based practice centers of the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services. The data suggest dose–response relationships between the duration of breastfeeding and many of its protective outcomes. Although the nutritional benefits are well documented, breastfeeding has also been reported to promote a unique emotional connection between mother and baby. For decades, the AAP has recommended that all mothers breastfeed for their child’s first year of life. The AAP Section on Breastfeeding is home to experts in breastfeeding medicine as well as pediatricians who want to learn more about breastfeeding. The Section on Breastfeeding conducts activities that protect, promote, and support breastfeeding in their state, chapters, and communities. The Section provides resources that will help all pediatricians provide optimal breastfeeding care. A few notable AAP resources include:
the 2012 AAP policy statement, ‘‘Breastfeeding and the Use of Human Milk,’’2 which reaffirms its recommendation of exclusive breastfeeding for about 6 months the Breastfeeding Residency Curriculum Web site a variety of professional and consumer Web sites publications such as Breastfeeding Handbook for Physicians,3 New Mother’s Guide to Breastfeeding,4 and Breastfeeding Telephone Triage and Advice.5 At present, the AAP Section on Breastfeeding and the AAP Early Brain and Child Development Workgroup are examining opportunities to expand resources that specifically address the benefits of breastfeeding and early brain and child development. 1 2
The linkage between breastfeeding and early brain and child development is a new science that is reinforcing the crucial importance of the first 1,000 days of life and redefining the way we look at health across the life span. During the first few years of life, safe, stable, and nurturing relationships promote healthy brains by decreasing toxic stress and encouraging foundational mental skills. Ecology (early social and environmental experiences) and biology (genetic predispositions) influence development of adaptive behaviors, learning capacities, lifelong physical/mental health, and future economic productivity. The prevailing consensus from large epidemiological studies suggests a longer duration of breastfeeding is associated with improved measures of IQ and cognitive functioning in later childhood.6 New evidence also suggests that human milk has beneficial effects on health via the epigenetic process. Breastfed children have a lower risk of necrotizing enterocolitis, infectious diseases, obesity, and related disorders; breastfeeding mothers may have a lower risk of breast cancer, even if a genetic predisposition for the development of these diseases is present.7 The different epigenetic mechanisms involved have yet to be defined. Further studies are necessary to provide more explanation about the relationship between human breastmilk and gene expression, particularly regarding prevention of noncommunicable diseases to potentially benefit the infant’s health and adult life. The AAP has formed a multidisciplinary leadership group composed of members representing genetics, environmental health, early brain and child development, and bioethics. This team has developed a plan to bring member pediatricians who are not well versed in epigenetics up-to-speed and to help them look at child health and life course issues through a new lens. It is imperative that we translate the advances in developmental science into effective policies and practices for families with children to improve education, health, and lifelong productivity. Poverty also affects a child’s short- and long-term health. Children living in poverty have
increased emotional problems decreased intellectual development suffer from more chronic diseases
Breastfeeding improves cognitive outcomes of preterm and term infants, even when adjusted for family socioeconomic
University of Rochester Medical Center, Rochester, New York. Immediate Past President, American Academy of Pediatrics, Elk Grove Village, Illinois.
333
334
MCINERNY
status and educational attainment. Last summer, the AAP added ‘‘poverty and child health’’ as a strategic priority to the AAP Agenda for Children. By designating ‘‘poverty and child health’’ as a strategic priority, the AAP has embarked on a 3-year effort to help pediatricians care for children and families in poverty as well as promote effective state and federal policy strategies. Federal- and state-level support for breastfeeding is essential to confront challenges and address disparities. The AAP advocates for breastfeeding on the federal level and encourages the efforts of AAP state chapters and local coalitions. Progress has been made with the Patient Protection and Affordable Care Act of 2010, which provides two major provisions that encourage mothers to achieve their breastfeeding goals:
reasonable break time to express milk and health insurance benefits to defray the costs associated with providing breastmilk to infants, including coverage of breastfeeding education and supplies.
In addition, the Family Leave Act, sponsored by Representative Rosa DeLauro (D, CT) and Senator Kirsten Gillibrand (D, NY), addresses paid maternal leave to increase likelihood of prolonged breastfeeding. Although these advancements are noteworthy, more is needed. Additional funding for breastfeeding counseling provided through the National WIC Association is crucial to the success of the peer-to-peer counseling program and the rates of breastfeeding. And, health professionals must continue to serve as breastfeeding advocates, educators, and community resources to foster a strong foundation for children’s lifelong learning, behavior, and health. Acknowledgments
Ngozi Onyema-Melton, MPH, CHES is thanked for her expert assistance in preparing this commentary.
Disclosure Statement
No competing financial interests exist. References
1. Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep) 2007;(153):1–186. 2. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012;129:e827–e841. 3. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Breastfeeding Handbook for Physicians, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics, 2014. 4. Meek JY, ed. New Mother’s Guide to Breastfeeding, 2nd ed. New York: Bantam Books, 2011. 5. Bunik M. Breastfeeding Telephone Triage and Advice. Elk Grove Village, IL: American Academy of Pediatrics, 2013. 6. Belfort MB, Rifas-Shiman SL, Kleinman KP, et al. Infant feeding and childhood cognition at ages 3 and 7 years: Effects of breastfeeding duration and exclusivity. JAMA Pediatr 2013;167:836–844. 7. Verduci E, Banderali G, Barberi S, et al. Epigenetic effects of human breast milk. Nutrients 2014;6:1711–1724.
Address correspondence to: Ngozi Onyema-Melton, MPH, CHES Manager, Maternal & Child Health Initiatives American Academy of Pediatrics 141 Northwest Point Boulevard Elk Grove Village, IL 60007 E-mail: [email protected]
Breastfeeding, Early Brain Development, and Epigenetics—Getting Children Off to Their Best Start Thomas K. McInerny 1,2
P
ediatricians and other healthcare professionals have a critical role to play as advocates and supporters of successful breastfeeding. Given the documented shortand long-term health benefits of breastfeeding, the American Academy of Pediatrics (AAP) believes infant nutrition should not be considered merely a lifestyle choice but a public health issue. Breastfeeding is one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself. The most comprehensive review and analysis of scientific literature comparing short- and long-term health outcomes of breastfeeding is ‘‘Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries’’1 from the evidence-based practice centers of the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services. The data suggest dose–response relationships between the duration of breastfeeding and many of its protective outcomes. Although the nutritional benefits are well documented, breastfeeding has also been reported to promote a unique emotional connection between mother and baby. For decades, the AAP has recommended that all mothers breastfeed for their child’s first year of life. The AAP Section on Breastfeeding is home to experts in breastfeeding medicine as well as pediatricians who want to learn more about breastfeeding. The Section on Breastfeeding conducts activities that protect, promote, and support breastfeeding in their state, chapters, and communities. The Section provides resources that will help all pediatricians provide optimal breastfeeding care. A few notable AAP resources include:
the 2012 AAP policy statement, ‘‘Breastfeeding and the Use of Human Milk,’’2 which reaffirms its recommendation of exclusive breastfeeding for about 6 months the Breastfeeding Residency Curriculum Web site a variety of professional and consumer Web sites publications such as Breastfeeding Handbook for Physicians,3 New Mother’s Guide to Breastfeeding,4 and Breastfeeding Telephone Triage and Advice.5 At present, the AAP Section on Breastfeeding and the AAP Early Brain and Child Development Workgroup are examining opportunities to expand resources that specifically address the benefits of breastfeeding and early brain and child development. 1 2
The linkage between breastfeeding and early brain and child development is a new science that is reinforcing the crucial importance of the first 1,000 days of life and redefining the way we look at health across the life span. During the first few years of life, safe, stable, and nurturing relationships promote healthy brains by decreasing toxic stress and encouraging foundational mental skills. Ecology (early social and environmental experiences) and biology (genetic predispositions) influence development of adaptive behaviors, learning capacities, lifelong physical/mental health, and future economic productivity. The prevailing consensus from large epidemiological studies suggests a longer duration of breastfeeding is associated with improved measures of IQ and cognitive functioning in later childhood.6 New evidence also suggests that human milk has beneficial effects on health via the epigenetic process. Breastfed children have a lower risk of necrotizing enterocolitis, infectious diseases, obesity, and related disorders; breastfeeding mothers may have a lower risk of breast cancer, even if a genetic predisposition for the development of these diseases is present.7 The different epigenetic mechanisms involved have yet to be defined. Further studies are necessary to provide more explanation about the relationship between human breastmilk and gene expression, particularly regarding prevention of noncommunicable diseases to potentially benefit the infant’s health and adult life. The AAP has formed a multidisciplinary leadership group composed of members representing genetics, environmental health, early brain and child development, and bioethics. This team has developed a plan to bring member pediatricians who are not well versed in epigenetics up-to-speed and to help them look at child health and life course issues through a new lens. It is imperative that we translate the advances in developmental science into effective policies and practices for families with children to improve education, health, and lifelong productivity. Poverty also affects a child’s short- and long-term health. Children living in poverty have
increased emotional problems decreased intellectual development suffer from more chronic diseases
Breastfeeding improves cognitive outcomes of preterm and term infants, even when adjusted for family socioeconomic
University of Rochester Medical Center, Rochester, New York. Immediate Past President, American Academy of Pediatrics, Elk Grove Village, Illinois.
333
334
MCINERNY
status and educational attainment. Last summer, the AAP added ‘‘poverty and child health’’ as a strategic priority to the AAP Agenda for Children. By designating ‘‘poverty and child health’’ as a strategic priority, the AAP has embarked on a 3-year effort to help pediatricians care for children and families in poverty as well as promote effective state and federal policy strategies. Federal- and state-level support for breastfeeding is essential to confront challenges and address disparities. The AAP advocates for breastfeeding on the federal level and encourages the efforts of AAP state chapters and local coalitions. Progress has been made with the Patient Protection and Affordable Care Act of 2010, which provides two major provisions that encourage mothers to achieve their breastfeeding goals:
reasonable break time to express milk and health insurance benefits to defray the costs associated with providing breastmilk to infants, including coverage of breastfeeding education and supplies.
In addition, the Family Leave Act, sponsored by Representative Rosa DeLauro (D, CT) and Senator Kirsten Gillibrand (D, NY), addresses paid maternal leave to increase likelihood of prolonged breastfeeding. Although these advancements are noteworthy, more is needed. Additional funding for breastfeeding counseling provided through the National WIC Association is crucial to the success of the peer-to-peer counseling program and the rates of breastfeeding. And, health professionals must continue to serve as breastfeeding advocates, educators, and community resources to foster a strong foundation for children’s lifelong learning, behavior, and health. Acknowledgments
Ngozi Onyema-Melton, MPH, CHES is thanked for her expert assistance in preparing this commentary.
Disclosure Statement
No competing financial interests exist. References
1. Ip S, Chung M, Raman G, et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep) 2007;(153):1–186. 2. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012;129:e827–e841. 3. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Breastfeeding Handbook for Physicians, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics, 2014. 4. Meek JY, ed. New Mother’s Guide to Breastfeeding, 2nd ed. New York: Bantam Books, 2011. 5. Bunik M. Breastfeeding Telephone Triage and Advice. Elk Grove Village, IL: American Academy of Pediatrics, 2013. 6. Belfort MB, Rifas-Shiman SL, Kleinman KP, et al. Infant feeding and childhood cognition at ages 3 and 7 years: Effects of breastfeeding duration and exclusivity. JAMA Pediatr 2013;167:836–844. 7. Verduci E, Banderali G, Barberi S, et al. Epigenetic effects of human breast milk. Nutrients 2014;6:1711–1724.
Address correspondence to: Ngozi Onyema-Melton, MPH, CHES Manager, Maternal & Child Health Initiatives American Academy of Pediatrics 141 Northwest Point Boulevard Elk Grove Village, IL 60007 E-mail: [email protected]
