Top

Published in:

Open Access 01-12-2024 | Postpartum Depression | Research

Examining psychosocial pathways to explain the link between breastfeeding practices and child behaviour in a longitudinal cohort

Authors: Sarah E. Turner, Leslie Roos, Nathan Nickel, Jacqueline Pei, Piushkumar J. Mandhane, Theo J. Moraes, Stuart E. Turvey, Elinor Simons, Padmaja Subbarao, Meghan B. Azad

Published in: BMC Public Health | Issue 1/2024

Abstract

Objective

Breastfeeding is associated with reduced postpartum depression, stronger parent-child relationships, and fewer behavioral disorders in early childhood. We tested the mediating roles of postpartum depression and parent-child relationship in the association between breastfeeding practices and child behavior.

Study design

We used standardized questionnaire data from a subset of the CHILD Cohort Study (n = 1,573) to measure postpartum depression at 6 months, 1 year and 2 years, parent-child relationship 1 year and 2 years, and child behavior at 5 years using the Child Behavior Checklist (range 0-100). Breastfeeding practices were measured at 3 months (none, partial, some expressed, all direct at the breast), 6 months (none, partial, exclusive), 12 months, and 24 months (no, yes). Confounders included birth factors, maternal characteristics, and socioeconomic status.

Results

Breast milk feeding at 3 or 6 months was associated with − 1.13 (95% CI: -2.19-0.07) to -2.14 (95% CI: -3.46, -0.81) lower (better) child behavior scores. Reduced postpartum depression at 6 months mediated between 11.5% and 16.6% of the relationship between exclusive breast milk feeding at 3 months and better child behavior scores. Together, reduced postpartum depression at 1 year and reduced parent-child dysfunction at 2 years mediated between 21.9% and 32.1% of the relationship between breastfeeding at 12 months and better child behavior scores.

Conclusion

Postpartum depression and parent-child relationship quality partially mediate the relationship between breastfeeding practices and child behavior. Breastfeeding, as well as efforts to support parental mental health and parent-child relationships, may help to improve child behavior.

Available only for authorised users

Horta BL, De Sousa BA, De Mola CL. Breastfeeding and neurodevelopmental outcomes. Curr Opin Clin Nutr Metab Care. 2018;21(3):174–8. https://doi.org/10.1097/MCO.0000000000000453.CrossRefPubMed

Evenhouse E, Reilly S. Improved estimates of the benefits of breastfeeding using sibling comparisons to reduce selection bias. Health Serv Res. 2005;40(6):1781–802. https://doi.org/10.1111/j.1475-6773.2005.00453.x.CrossRefPubMedPubMedCentral

The World Health Organization. Breastfeeding. Published 2022. Accessed August 28, 2022. https://www.who.int/health-topics/breastfeeding#tab=tab_2.

Statistics Canada. Exclusive breastfeeding, at least 6 months, by age group. Published 2022. Accessed November 18., 2022. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009622.

Horta B, Bahl R, Martines J, Victora C. Evidence on the long-term effects of breastfeeding: Systematic reviews and meta-analyses. World Heal Organ. Published online 2007:1–52.

Feldman R, Eidelman AI. Direct and indirect effects of breast milk on the neurobehavioral and cognitive development of premature infants. Dev Psychobiol. 2003;43(2):109–19. https://doi.org/10.1002/dev.10126.CrossRefPubMed

Speyer LG, Hall HA, Ushakova A, Murray AL, Luciano M, Auyeung B. Longitudinal effects of breast feeding on parent-reported child behaviour. Arch Dis Child. 2020;21–6. https://doi.org/10.1136/archdischild-2020-319038.

Wallenborn JT, Levine GA, Grisi S. Breastfeeding, physical growth, and cognitive development. Pediatrics. 2021;147(5):1–10. https://doi.org/10.1542/peds.2020-008029.CrossRef

Klopp A, Vehling L, Becker AB, et al. Modes of infant feeding and the risk of childhood asthma: a prospective birth cohort study. J Pediatr. 2017;190:192–199e2. https://doi.org/10.1016/j.jpeds.2017.07.012.CrossRefPubMed

10.

Keim S, Sullivan J, Sheppard K, et al. Feeding infants at the breast or feeding expressed human milk: long-term cognitive, executive function, and eating behavior outcomes at age 6 years. J Pediatr. 2021;233:66–73. https://doi.org/10.1016/j.jpeds.2021.02.025.CrossRefPubMedPubMedCentral

11.

Figueiredo B, Pinto TM, Costa R. Exclusive breastfeeding moderates the association between prenatal and postpartum sepression. J Hum Lact. 2021;00(0):1–11. https://doi.org/10.1177/0890334421991051.CrossRef

12.

Shimao M, Matsumura K, Tsuchida A, Kasamatsu H, Hamazaki K, Inadera H. Influence of infants’ feeding patterns and duration on mothers’ postpartum depression: a nationwide birth cohort ―The Japan Environment and Children’s study (JECS). J Affect Disord. 2021;285:152–9. https://doi.org/10.1016/j.jad.2021.02.011.CrossRefPubMed

13.

Statistics Canada. Maternal Mental Health in Canda. Published 2019. https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2019041-eng.htm.

14.

Peñacoba C, Catala P. Associations between breastfeeding and mother–infant relationships: a systematic review. Breastfeed Med. 2019;14(9):1–14. https://doi.org/10.1089/bfm.2019.0106.CrossRef

15.

Roth MC, Humphreys KL, King LS, Gotlib IH, Robakis TK. Breastfeeding difficulties predict mothers’ bonding with their infants from birth to age six months. Matern Child Health J. 2021;25:777–85. https://doi.org/10.1007/s10995-020-03036-9.CrossRefPubMed

16.

Bagner D, Pettit J, Lewinsohn P, Seeley J. Effect of maternal depression on child behaviour: a sensitive period? J Am Acad Child Adolesc Psychiatry. 2010;49(7):699–707. https://doi.org/10.1016/j.jaac.2010.03.012.Effect.CrossRefPubMedPubMedCentral

17.

Bernier A, Beauchamp MH, Carlson SM, Lalonde G. A secure base from which to regulate: attachment security in toddlerhood as a predictor of executive functioning at school entry. Dev Psychol. 2015;51(9):1177–89. https://doi.org/10.1037/dev0000032.CrossRefPubMed

18.

Hicks AM, Korbel C. Attachment theory. In: Gellman MD, Turner JR, editors. Encyclopedia of behavioral medicine. New York: Springer; 2013. pp. 149–55. https://doi.org/10.1007/978-1-4419-1005-9_939.CrossRef

19.

Bowlby J. Attachment and loss. Basic Books; 1969.

20.

Gibbs BG, Forste R, Lybbert E. Breastfeeding, parenting, and infant attachment behaviors. Matern Child Health J. 2018;22(4):579–88. https://doi.org/10.1007/s10995-018-2427-z.CrossRefPubMed

21.

Gribble KD. Mental health, attachment and breastfeeding: implications for adopted children and their mothers. Int Breastfeed J. 2006;1(1):5. https://doi.org/10.1186/1746-4358-1-5.CrossRefPubMedPubMedCentral

22.

Vando J, Rhule-Louie DM, McMahon RJ, Spieker SJ. Examining the link between infant attachment and child conduct problems in grade 1. J Child Fam Stud. 2008;17(5):615–28. https://doi.org/10.1007/s10826-007-9173-y.CrossRef

23.

Moberg KU, Prime DK. Oxytocin effects in mothers and infants during breastfeeding. Infant. 2013;9(6):201–6.

24.

Bigelow AE, Power M. Mother–infant skin-to-skin contact: short- and long-term effects for mothers and their children born full-term. Front Psychol. 2020;11(August). https://doi.org/10.3389/fpsyg.2020.01921.

25.

Britton JR, Britton HL, Gronwaldt V. Breastfeeding, sensitivity, and attachment. Pediatrics. 2006;118(5):e1436–43. https://doi.org/10.1542/peds.2005-2916.CrossRefPubMed

26.

Kobak R, Cassidy J, Lyons-Ruth K, Ziv Y. Attachment, stress and psychopathology: A developmental pathways model. In: Cohen DJ, Cicchetti D, eds. Developmental Psychopathology: Volume One: Theory and Method. 2015:333–369. https://doi.org.uml.idm. https://doi.org/10.1002/9780470939383.ch10.

27.

Subbarao P, Anand SS, Becker AB, et al. The Canadian healthy infant Longitudinal Development (CHILD) study: examining developmental origins of allergy and asthma. Thorax. 2015;70(10):998–1000. https://doi.org/10.1136/thoraxjnl-2015-207246.CrossRefPubMed

28.

Achenbach TM, Ruffle TM. The child Behavior Checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatr Rev. 2000;21(8):265–71. https://doi.org/10.1542/pir.21-8-265.CrossRefPubMed

29.

Rescorla LA. Assessment of young children using the Achenbach System of empirically based Assessment (ASEBA). Ment Retard Dev Disabil Res Rev. 2005;11(3):226–37. https://doi.org/10.1002/mrdd.20071.CrossRefPubMed

30.

Radloff LS, The CES-D, Scale. A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401. https://doi.org/10.1177/014662167700100306.CrossRef

31.

Abidin R. Parenting stress index – short Form Guide (PSI/SF). Published Online 1990:88–90. https://edge.edx.org/assets/courseware/v1/50118bb4c48f62c9f2f38a9ef276adf3/asset-v1:GeorgetownX+CCHD+2016+type@asset+block/PSI.pdf.

32.

Williams TC, Bach CC, Matthiesen NB, Henriksen TB, Gagliardi L. Directed acyclic graphs: a tool for causal studies in paediatrics. Pediatr Res. 2018;84(4):487–93. https://doi.org/10.1038/s41390-018-0071-3.CrossRefPubMedPubMedCentral

33.

Cohen S, Kamarak T, Mermelstein R. A global measure of perceived stress. J Heal Soc Behav. 1983;24(4):385–96.CrossRef

34.

Cohen S. Perceived Stress Scale.; 1994. http://www.mindgarden.com/products/pss.htm.

35.

Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–82. https://doi.org/10.1037/0022-3514.51.6.1173.CrossRefPubMed

36.

Park S, Kim BN, Kim JW, Shin MS, Yoo H, Cho SC. Protective effect of breastfeeding with regard to children’s behavioral and cognitive problems. Nutr J. 2014;13:1–5. https://doi.org/10.1186/1475-2891-13-111. https://nutritionj.biomedcentral.com/articles/.CrossRef

37.

Thul TA, Corwin EJ, Carlson NS, Brennan PA, Young LJ. Oxytocin and postpartum depression: a systematic review. Psychoneuroendocrinology. 2020;120:1–28. https://doi.org/10.1016/j.psyneuen.2020.104793.Oxytocin.CrossRef

38.

Feldman R, Gordon I, Zagoory-Sharon O. Maternal and paternal plasma, salivary, and urinary oxytocin and parent-infant synchrony: considering stress and affiliation components of human bonding. Dev Sci. 2011;14(4):752–61. https://doi.org/10.1111/j.1467-7687.2010.01021.x.CrossRefPubMed

39.

Dennis CL, McQueen K. Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatr Int J Paediatr. 2007;96(4):590–4. https://doi.org/10.1111/j.1651-2227.2007.00184.x.CrossRef

40.

Figueiredo B, Canário C, Field T. Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychol Med. 2014;44(5):927–36. https://doi.org/10.1017/S0033291713001530.CrossRefPubMed

41.

Davey HL, Tough SC, Adair CE, Benzies KM. Risk factors for sub-clinical and major postpartum depression among a community cohort of Canadian women. Matern Child Health J. 2011;15(7):866–75. https://doi.org/10.1007/s10995-008-0314-8.CrossRefPubMed

42.

Smith JP, Ellwood M. Feeding patterns and emotional care in breastfed infants. Soc Indic Res. 2011;101(2):227–31. https://doi.org/10.1007/s11205-010-9657-9.CrossRef

43.

Kiff C, Lengua L, Zalewski M. Nature and nurturing: parenting in the context of child temperament. Clin Child Fam Psychol Rev. 2011;14(3):251–301. https://doi.org/10.1007/s10567-011-0093-4.Nature.CrossRefPubMedPubMedCentral

44.

Baker C, Kuhn L. Mediated pathways from maternal depression and early parenting to children’s executive function and externalizing behaviour problems. Infant Child Dev. 2018;27(1):1–12. https://doi.org/10.1002/icd.2052.CrossRef

45.

Banerjee PN, McFadden KE, Shannon JD, Davidson LL. Does breastfeeding account for the association between maternal sensitivity and infant cognitive development in a large, nationally representative cohort? BMC Pediatr. 2022;22(61):1–11. https://doi.org/10.1186/s12887-022-03133-4.CrossRef

46.

Kalmakis KA, Meyer JS, Chiodo L, Leung K. Adverse childhood experiences and chronic hypothalamic-pituitary-adrenal activity. Stress. 2015;18(4):446–50. https://doi.org/10.3109/10253890.2015.1023791.CrossRefPubMed

47.

Dahmen B, Puetz VB, Scharke W, Von Polier GG, Herpertz-Dahlmann B, Konrad K. Effects of early-life adversity on hippocampal structures and associated HPA axis functions. Dev Neurosci. 2018;40(1):13–22. https://doi.org/10.1159/000484238.CrossRefPubMed

48.

Andiarena A, Balluerka N, Murcia M, Ibarluzea J, Glover V, Vegas O. Evening salivary cortisol and alpha-amylase at 14 months and neurodevelopment at 4 years: sex differences. Horm Behav. 2017;94(September 2016):135–44. https://doi.org/10.1016/j.yhbeh.2017.07.008.CrossRefPubMed

49.

Bridgett DJ, Burt NM, Edwards ES, Deater-Deckard K. Intergenerational transmission of self-regulation: a multidisciplinary review and integrative conceptual framework. Psychol Bull. 2015;141(3):602–54. https://doi.org/10.1037/a0038662.Intergenerational.CrossRefPubMedPubMedCentral

50.

Kang S, Choi N. Prolonged breastfeeding can reduce internalizing problem behaviours of young children by enhancing mothers’ social parenting. Early Child Dev Care. 2020;0(0):1–11. https://doi.org/10.1080/03004430.2020.1828398.CrossRef

51.

Rose G. Sick individuals and sick populations. Int J Epidemiol. 2001;30:427–32. https://doi.org/10.1093/ije/30.3.427.CrossRefPubMed

52.

Hahn-holbrook J, Fish A, Glynn LM. Human milk omega-3 fatty acid composition is associated with infant temperament. Nutrients. 2019;11(12):1–12. https://doi.org/10.3390/nu11122964.CrossRef

53.

Oliveros E, Martín MJ, Torres-espinola FJ, et al. Human milk levels of 2 ´ -fucosyllactose and 6 ´ -sialyllactose are positively associated with infant neurodevelopment and are not impacted by maternal BMI or diabetic status. J Nutr Food Sci. 2021;4(1):1–11.

54.

Carlson AL, Xia K, Azcarate-Peril MA, et al. Infant gut microbiome associated with cognitive development. Biol Psychiatry. 2018;83(2):148–59. https://doi.org/10.1016/j.biopsych.2017.06.021.CrossRefPubMed

55.

Gartstein MA, Bridgett DJ, Dishion TJ, Kaufman NK. Depressed mood and maternal report of child behavior problems: another look at the depression-distortion hypothesis. J Appl Dev Psychol. 2009;30(2):149–60. https://doi.org/10.1016/j.appdev.2008.12.001.CrossRefPubMedPubMedCentral

56.

Liskola K, Raaska H, Lapinleimu H, Lipsanen J, Sinkkonen J, Elovainio M. The effects of maternal depression on their perception of emotional and behavioral problems of their internationally adopted children. Child Adolesc Psychiatry Ment Health. 2021;15(1):1–9. https://doi.org/10.1186/s13034-021-00396-0.CrossRef

57.

Richters J, Pellegrini D. Depressed mothers’ judgments about their children: an examination of the depression-distortion hypothesis. Child Dev. 1989;60(5):1068–75. https://doi.org/10.1111/j.1467-8624.1989.tb03537.x.CrossRefPubMed

Title: Examining psychosocial pathways to explain the link between breastfeeding practices and child behaviour in a longitudinal cohort
Authors: Sarah E. Turner
Leslie Roos
Nathan Nickel
Jacqueline Pei
Piushkumar J. Mandhane
Theo J. Moraes
Stuart E. Turvey
Elinor Simons
Padmaja Subbarao
Meghan B. Azad
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Postpartum Depression
Postpartum Depression
Mood Disorders
Affective Disorder
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-17994-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Examining psychosocial pathways to explain the link between breastfeeding practices and child behaviour in a longitudinal cohort

Abstract

Objective

Study design

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Study design

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Prediction of adolescent weight status by machine learning: a population-based study

Unlocking gender dynamics in food and nutrition security in Ghana: assessing dietary diversity, food security, and crop diversification among cocoa household heads in the Juaboso-Bia cocoa landscape

Exploring pre-pandemic patterns of vaccine decision-making with the 5C model: results from representative surveys in 2016 and 2018

Assessing food availability and healthier options in an urban Chinese university: a case study using the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S)

Associations between COVID-19 incidence, weight status, and social participation restrictions in the U.S.: evidence from the national population, cross-sectional study

Landscaping tuberculosis multimorbidity: findings from a cross-sectional study in India