Does Breastfeeding Protect Against Early Childhood Hospitalization?
Ajetunmobi OM, Whyte B, Chalmers J, et al; Glasgow Centre for Population Health Breastfeeding Project Steering Group. Breastfeeding is associated with reduced childhood hospitalization: evidence from a Scottish birth cohort (1997-2009). J Pediatr. 2015;166(3):620.e4-625.e4
Breastfeeding offers children a number of long-lasting health effects such as a lower risk of developing respiratory tract infections, diarrhea, and otitis media.1 But just how much children’s health benefits from breastfeeding sometimes is questioned in developed countries, because the studies providing evidence have limitations such as small sample size or confounding factors such as socioeconomic status.
With this in mind, a team at the Breastfeeding Project Steering Group of the Glasgow Centre for Population Health in Scotland created a retrospective cohort study examining the patterns of hospitalization for selected conditions in early childhood as they relate to the pattern of feeding (ie, exclusive breastfeeding, exclusive formula feeding, and mixed breastfeeding and formula feeding) described at 6 to 8 weeks of life and adjusted for a number of socioeconomic factors.2
Data about infant’s hospital admissions in Scotland between 1997 and 2012 were analyzed to identify variables associated with admissions for selected common conditions (respiratory, gastrointestinal, and urinary tract infections, among others) and the independent contributions of infant feeding. Adjustments were made for parental factors, delivery and infant health characteristics, and features of the health care system.
A total of 502,948 singletons born between 1997 and 2009 were included. At 6 to 8 weeks of age, 27% of the infants were breastfeeding exclusively, 9% were receiving a mix of breastfeeding and formula feeding, and 64% were formula feeding exclusively. During the study period, 27% of the infants had been hospitalized at least once for any of the selected conditions.
Infants who were exclusively breastfed at 6 to 8 weeks were older at their first hospital admission and had a shorter stay. Hospitalization rates among exclusively breastfed, mixed fed, and formula-fed infants were 21%, 24%, and 31%, respectively. Multivariate analysis showed that infants who were formula-fed and mixed fed at the 6- to 8-week review had a significantly greater relative risk of admission. Other factors that led to a higher risk of admission were living in a socioeconomically deprived area, having a father with a semiroutine or routine occupation, having single parents or parents living apart, and having siblings.
The conditions leading to admission also were examined separately, and after adjusting for outside factors, a greater risk of hospitalization was noted among formula-fed infants for infections of the gastrointestinal, upper and lower respiratory, and urinary tracts, as well as for otitis media. These findings are in agreement with those of other studies.
This study’s large sample size and examination of important factors such as individual socioeconomics gives it an appreciable depth. Nevertheless, despite the authors having taken measures to address potential confounding factors, it is possible that sample sizes as large as this study’s can lead to associations that are without academic merit. It also would be preferable to obtain data about feeding practices beyond the 6- to 8-week age mark. Still, this thorough work contributes to the growing body of evidence supporting the benefits of breastfeeding on child health in developed countries. n
Jessica Tomaszewski, MD, is an assistant clinical professor of pediatrics at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania, and a hospitalist pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.
Charles A. Pohl, MD—Series Editor, is a professor of pediatrics, senior associate dean of student affairs and career counseling, and associate provost for student affairs at the Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania.
1. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.
2. Ajetunmobi OM, Whyte B, Chalmers J, et al; Glasgow Centre for Population Health Breastfeeding Project Steering Group. Breastfeeding is associated with reduced childhood hospitalization: evidence from a Scottish birth cohort (1997-2009). J Pediatr. 2015;166(3):620.e4-625.e4.