BREASTFEEDING MEDICINE Volume 9, Number 5, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2014.9985
Editorial
The Risks of Not Breastfeeding: New Associations Ruth A. Lawrence
T
he risks of not breastfeeding are well established and include infections, malnutrition, deficiencies, and underdevelopment, to oversimplify the list. The association with the attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) and insufficient or absent breastfeeding are presented in this issue of Breastfeeding Medicine.1,2 Two hundred children and adolescents 7–17 years of age who had been diagnosed as having ADHD were studied by Sabuncuoglu et al.1 The Connors Parent and Teacher Rating Scales were used to determine the presence of any behavioral disturbances. A questionnaire including the breastfeeding period, early feeding history, and parafunctional oral habits was distributed to parents. The results involved 200 confirmed ADHD children and 175 healthy schoolchildren confirmed not to have ADHD. The affected children had earlier initiation and longer duration of bottle feeding. In addition, they had earlier and more extensive use of pacifiers, variable nail and toenail biting in addition to pencil biting, bruxism, and snoring proportional to the length of bottle feeding. These habits were also associated with greater risks of malocclusion and disordered dentofacial development. The authors proceed to note the association of sleepdisordered breathing on executive functions such as cognitive flexibility, task initiation, self-monitoring, planning, organization, and self-regulation. After summarizing their results, Sabuncuoglu et al.1 concluded that the ADHD group had different early feeding
practices and an increased rate of parafunctional oral habits. An important additional parameter that needs study is whether these infants were difficult to breastfeed, and did this struggle result in shorter breastfeeding duration? Furthermore, in families with a history of ADHD, should greater effort to breastfeed be made by the mother and her lactation professionals? The association of early weaning and formula feeding with ASD is suggested by Shafai et al.2 in a letter to the Editor in this issue. They reported 145 parents who responded to a questionnaire: 60 of their children had ASD, and 85 did not. Increased duration of breastfeeding was associated with a decline in the diagnosis of ASD. The authors attributed this to the decrease in sensory experiences inherent in bottle feeding and a possible association with oxytocin release. Long before autism was identified and catalogued, astute clinicians noted that some babies were like inanimate pieces of wood, whereas most infants mold to the caregiver’s body when held. These board-like infants were difficult to breastfeed and continued to relate passively to their caregivers. The research for causes of lactation failure continues, but it is clear that there is association with better outcomes in multiple parameters when breastfeeding is continued exclusively for 6 months and longer while adding complementary feedings. More studies that investigate the experience the infant has with feeding, especially, with breastfeeding, should help us understand the
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EDITORIAL
possible relationship with a lack of breast- References feeding and neuropsychiatric disorders. 1. Sabuncuoglu O, Orengul C, Bikmazer A, This apparent association between lack et al. Breastfeeding and parafunctional of breastfeeding and neuropsychiatric disororal habits in children with and without ders provides the typical chicken-and-the-egg attention-deficit/hyperactivity disorder. question. Which came first: the disorder or the Breastfeed Med 2014;9:244–250. inability to breastfeed? Is the neuropsychiat- 2. Shafai T, Curtis A, Mustafa M, et al. Inric problem a cause or an effect of inadequate fluence of infant feeding methods (breastbreastfeeding? And can it be prevented with feeding, breastmilk, or formula feeding) on good experienced care during lactation? Do the prevalence of autism spectrum disorthe infants who appear to reject the breast ders. Breastfeed Med 2014;9:275–276. suffer from the early manifestations of one of the neuropsychiatric disorders such as ADHD —Ruth A. Lawrence, MD, FABM or ASD? Editor-in-Chief This is the first step in a long journey.
Editorial
The Risks of Not Breastfeeding: New Associations Ruth A. Lawrence
T
he risks of not breastfeeding are well established and include infections, malnutrition, deficiencies, and underdevelopment, to oversimplify the list. The association with the attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) and insufficient or absent breastfeeding are presented in this issue of Breastfeeding Medicine.1,2 Two hundred children and adolescents 7–17 years of age who had been diagnosed as having ADHD were studied by Sabuncuoglu et al.1 The Connors Parent and Teacher Rating Scales were used to determine the presence of any behavioral disturbances. A questionnaire including the breastfeeding period, early feeding history, and parafunctional oral habits was distributed to parents. The results involved 200 confirmed ADHD children and 175 healthy schoolchildren confirmed not to have ADHD. The affected children had earlier initiation and longer duration of bottle feeding. In addition, they had earlier and more extensive use of pacifiers, variable nail and toenail biting in addition to pencil biting, bruxism, and snoring proportional to the length of bottle feeding. These habits were also associated with greater risks of malocclusion and disordered dentofacial development. The authors proceed to note the association of sleepdisordered breathing on executive functions such as cognitive flexibility, task initiation, self-monitoring, planning, organization, and self-regulation. After summarizing their results, Sabuncuoglu et al.1 concluded that the ADHD group had different early feeding
practices and an increased rate of parafunctional oral habits. An important additional parameter that needs study is whether these infants were difficult to breastfeed, and did this struggle result in shorter breastfeeding duration? Furthermore, in families with a history of ADHD, should greater effort to breastfeed be made by the mother and her lactation professionals? The association of early weaning and formula feeding with ASD is suggested by Shafai et al.2 in a letter to the Editor in this issue. They reported 145 parents who responded to a questionnaire: 60 of their children had ASD, and 85 did not. Increased duration of breastfeeding was associated with a decline in the diagnosis of ASD. The authors attributed this to the decrease in sensory experiences inherent in bottle feeding and a possible association with oxytocin release. Long before autism was identified and catalogued, astute clinicians noted that some babies were like inanimate pieces of wood, whereas most infants mold to the caregiver’s body when held. These board-like infants were difficult to breastfeed and continued to relate passively to their caregivers. The research for causes of lactation failure continues, but it is clear that there is association with better outcomes in multiple parameters when breastfeeding is continued exclusively for 6 months and longer while adding complementary feedings. More studies that investigate the experience the infant has with feeding, especially, with breastfeeding, should help us understand the
237
238
EDITORIAL
possible relationship with a lack of breast- References feeding and neuropsychiatric disorders. 1. Sabuncuoglu O, Orengul C, Bikmazer A, This apparent association between lack et al. Breastfeeding and parafunctional of breastfeeding and neuropsychiatric disororal habits in children with and without ders provides the typical chicken-and-the-egg attention-deficit/hyperactivity disorder. question. Which came first: the disorder or the Breastfeed Med 2014;9:244–250. inability to breastfeed? Is the neuropsychiat- 2. Shafai T, Curtis A, Mustafa M, et al. Inric problem a cause or an effect of inadequate fluence of infant feeding methods (breastbreastfeeding? And can it be prevented with feeding, breastmilk, or formula feeding) on good experienced care during lactation? Do the prevalence of autism spectrum disorthe infants who appear to reject the breast ders. Breastfeed Med 2014;9:275–276. suffer from the early manifestations of one of the neuropsychiatric disorders such as ADHD —Ruth A. Lawrence, MD, FABM or ASD? Editor-in-Chief This is the first step in a long journey.
