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The Effect of Exclusive Breastfeeding on Development and Incidence of Infection in Infants

Ya Sun Wang and Shi Yi Wu
J Hum Lact 1996 12: 27
DOI: 10.1177/089033449601200107

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 The Effect of Exclusive Breastfeeding on Development and
Incidence of Infection in Infants

Ya Sun Wang, MD, and Shi Yi Wu, MD

ABSTRACT - Of 145 normal fullterm infants studied during the first year after birth,
those exclusively breastfed for the first four months differed significantly from those not
exclusively breastfed in physical and behavioral development, and resistance to infec-
tion. At four months of age, the mean weight of the exclusively breastfed group was
higher (p<0.05). At one year, the exclusively breastfed group showed more advanced.
Personal-Social (p=0.05) and Gross Motor development (p<0.05) on the Denver Develop-
mental Screening Test, and lesser cumulative incidence of infectious diseases (p<0.05).
This study demonstrated the beneficial effects of breastfeeding on development and resis-
tance to infection in infants. JHL 12:27-30, 1996.

KEY WORDS: breastfeeding, exclusive; development, infant, infection

INTRODUCTION MATERIALS AND METHODS

Human milk is the most suitable food for human
infants. It contains the proper balance of nutrients,
enzymes, immunoglobulins, and growth factors.’
Many researchers have shown the advantage of
breastfeeding in either its protective effect against
infection or in promoting child development. Breast-
fed infants had lower incidence of otitis media,2
respiratory syncytial virus infection,3wheezing,
bronchitis, bronchiolitis, and pneumonia44 than
infants fed artificial milks. Breastmilk-fed premature
infants had higher IQ scores at age seven to eight
years than those artificially fed.5Since 1991, more
mothers in China have begun to exclusively breast-
feed their infants for at least four to six months of
age. However, in some families whose members are
accustomed to supplementing babies earlier than four
months of age, there is fear that exclusive
breastfeeding for four to six months might lead to
undernourishment6 and subsequent negative impact
on the infant’s development. This study sought to
compare the differences in infant development and
resistance to infection during the first year of life
between those infants exclusively breastfed for at
least four months and those who were not exclusively
breastfed.
The 145 infants studied were born in the Interna-
tional Peace Maternity and Child Health Hospital
from July 1991 to January 1992. They were all full
term normal babies, delivered vaginally, who weighed
more than 2500 gm at birth, and who showed no signs
of asphyxia, birth injury, or infection during their
hospital stay. All the mothers lived in Xu Hui Dis-
trict around the hospital; all had more than nine years
of formal education. Average annual family income
approximated the median in Shanghai. All mothers
received at least three hours of lecture and video
instruction on breastfeeding during antenatal visits,
and instruction and consultation every day during
hospitalization (average length of stay was five days).
Mothers were encouraged to breastfeed their babies
without any supplement for the first four months
after delivery’ Infants were examined at 1/2, 1,
11/2, 2 1/2, 4 months, and at one year of age. During
each visit, the mothers were asked as to the mode of
infant feeding-exclusive or non-exclusive breastfeed-
ing, number of feedings/day, the type of supplemen-
tary food given, if any, and its frequency. The volume
of breastmilk was measured by weighing the baby
before and after breastfeeding, together with the
mother’s surplus milk obtained by expressing after
feeding. The importance of breastfeeding was empha-
sized to the mothers again at each of these follow-up
visits. At the four-month visit, mothers were instruc-
ted on introducing supplementary food. Infants were
then divided into two groups according to their feed-
ing patterns since birth. Fifty-seven infants who had
been exclusively breastfed were allotted to the exclu-
sive breastfeeding group. The other 83 infants who
were partially breastfed or finally bottle-fed were

designated as non-exclusively breastfed.

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Assessments. The physical development of the infants
was assessed by measuring their weights and lengths
at four months and one year of age. The developmen-
tal status was assessed at one year by two specially
trained medical personnel using the Denver Devel-
opmental Screening Test. The responses to the items
in the four areas (personal-social, fine motor-adap-
tive, language, and gross motor) were recorded and
qualified as &dquo;A&dquo; or &dquo;B&dquo; according to the standards for
Chinese children.8 &dquo;A&dquo; meant that the infant was
able to pass all the items for his (or her) chronologi-
cal age, or even other items for older ages in the same
area. &dquo;B&dquo; meant that the infant failed to perform spe-
cific items for his (or her) chronological age, or even
other items for younger ages in the same area. Cum-
ulative incidence of infectious diseases was based on
the data from physical examinations conducted at the
follow-up visits as well as the medical records for
examinations between visits. The incidence of respi-
ratory, gastrointestinal, and skin infections were
recorded during each month up to one year of age.
Statistical analyses. A t-test was used to analyze the
differences between two groups in gestational age at
birth; weight and length at birth, four months and
one year of age, and the cumulative incidence of infec-
tious diseases recorded at one year of age. A chi-
square test was used to analyze the differences of
Denver Developmental Screening Test scores between
the two groups.
RESULTS
At birth, the two groups were comparable in gesta-
tional age, weight and length (see Table 1). At four
months of age, the mean weight of the exclusively
breastfed was significantly higher than that of the
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non-exclusively breastfed (see Table 2). In the exclu-
sively breastfed group, 45 infants (79 percent) were
qualified A in the Personal-Social section compared
with 64 percent in the non-exclusively breastfed
group. Significant differences were also observed in
the Gross Motor section between the two groups. The
developmental status assessment at one year showed
more advanced Personal-Social and Gross Motor
development in the exclusively breastfed group (see
Table 3). The mean cumulative incidence of infectious
diseases recorded during the first year was lower in
the exclusively breastfed infants (see Table 4). All
results demonstrated that exclusively breastfed
infants had better development and lower incidence
of infection, especially lower respiratory and gastro-
intestinal tract infections, than those non-exclusively
breastfed infants during their first year of life.
DISCUSSION
Our data show that infants exclusively breastfed for
four months showed a growth pattern comparable to
the normal standards for the physical development
of infants in Shanghai. Thus, we recommend exclu-
sive breastfeeding for the first four to six months
after birth followed by gradual addition of supple-
ments, and continued breastfeeding up to second year.
Our study is consistent with that of Morrow-Tlucak,
et al,9 which found that scores on the Bayley Mental
Development Index were higher in breastfed infants
than in artificially-fed infants at one to two years of
age. This study also found a positive relationship
between scores and the duration of breastfeeding.9
Breastmilk has much higher concentration of tau-
rine, essential lipids, and lactose than any other
animal milk. Among other biologic roles, taurine may
be a neurotransmitter or neuromodulator in the brain
and retina.l° Essential lipids can be converted into
long-chain polyunsaturates, which are important for
fluidity of membrane lipids and prostaglandin syn-
thesis in the brain and visual cells.ll Lactose is a
readily available source of galactose, which is essen-
tial to the production of galactolipids. These galac-
tolipids are essential to central nervous system
developmentMother-to-infant interactions during
lactation-the mother’s face, voice, odor, and the taste
of milk-may tend to stimulate the infant’s visual,
auditory, olfactory, and taste organs, thus promoting
the development of the sensory organs of the infant.1
It might be that both the breastmilk composition and
the feeding activity are beneficial to the development
of the infant’s central nervous system.
Compared to cow’s milk, breastmilk contains abun-
dant SIgA, lactoferrin, lysozyme, immunocompetent
cells, bifidus factor and a-tumour necrosis factor, all
of which protect against infection and enhance
maturation of the immunologic system.1,12,13 For
infants, especially newborns whose immunocompe-
tency is limited, these components can help to reduce
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the incidence of respiratory and gastrointestinal
infections. Breastfeeding enhances serum as well
as secretory responses to commonly used vaccines;
significantly higher serum IgG to diphtheria toxoid
and serum neutralization of poliovirus at 21-40
months of age, and saliva secretory IgA to tetanus,
diphtheria toxoid and poliovirus at 3 to 4 months of
age after vaccination in breastfed babies compared
to that of artificially-fed infants. 14 All of these find-
ings point out that the immunologic factors in breast-
milk enhance both passive and active immunizing
function of the newborn and infant, thus reducing
the susceptibility to infectious diseases.
Our data make clear that, through exclusive breast-
feeding for at least four to six months after birth,
the infant’s physical and mental growth and devel-
opment will not only proceed normally, but also will
attain a more advanced mental developmental state
than those who are not exclusively breastfed. Non-
exclusive breastfeeding limits the benefits of breast-
feeding to the infant and increases the likelihood of
infection in the infant in the first year of life. The
results of this study provide evidence for mothers and
their care providers in promoting a more ideal breast-
feeding behavior.
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