Running Head: EFFECTS OF BREASTFEEDING VERSUS FORMULA FEEDING

Effects of Breastfeeding versus Formula Feeding on Growth and Development from Infancy

through Childhood

Shauna R. Letcher, Nicole L. Redmond, Meredith A. Cavour, Madison L. Aranda, Michael W.

Audi

04/02/2018

NURS 3947: Nursing Research

Dr. Valerie O’Dell

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1

Abstract

The objective of this research paper is to examine the different effects that breastfeeding and

formula feeding have on the growth and development on an infant throughout childhood.

Weight, motor development, neurodevelopment, immunology and disease and emotional

development were topics that were looked at in depth. Several databases were used to collect

both qualitative and quantitative research. The research obtained from the studies that were

looked at showed a strong argument for the benefits of breastfeeding when it comes to weight

and its ability to help prevent obesity in childhood and adulthood. In addition to that,

breastfeeding showed an undeniable relationship between neurodevelopment and how it has been

linked to increasing a child’s IQ and white matter development. Immunology and disease were

also shown to be greatly affected by breastfeeding and its ability to help lessen an infant's

likelihood of getting sick or developing a chronic illness like asthma. Furthermore,

breastfeeding displayed benefits for motor function development especially in a child’s later

years of growth. Also, studies show emotional development of an infant is connected to

breastfeeding due to the physical bond that breastfeeding achieves between mother and baby.

Overall, the research showed that there are definite advantages to breastfeeding but the depth of

those benefits in research studies varies. However, it is evident that when possible, breastfeeding

appears to be the best choice for a child.

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Effects of Breastfeeding versus Formula Feeding on Growth and Development from Infancy

through Childhood

Infants and children undoubtedly come in a variety of forms. All children have different

characteristics that help define who they are. Even siblings that have been raised in the same

environment and by the same parents display different qualities. Obviously, many variables may

influence this, but what about feeding method during infancy? Could method of feeding (breast,

formula, or a mix of the two) during infancy affect characteristics such as physical growth,

intellectual growth, motor development, immunological health, and emotional characteristics in

children? There is compelling evidence supporting this theory.

Literature Review

Introduction

In order to attempt to find answers about the controversial topic of breastfeeding,

information was acquired using Ebsco, Jsotr, and Cinahl Plus through Ohiolink. Three main

sources were used to identify the effects of breastfeeding versus formula feeding through

childhood. We specifically looked at weight, neurodevelopment, immunology and disease,

emotional development, and motor function and how each of these was affected by the mother’s

choice to breast or formula feed.

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Weight

There are many reasons why a mother decides to breastfeed or not to breastfeed. Some

of these things include how often they are away from their baby, milk supply, or over all comfort

such as nipple soreness. Either way they choose, breast milk and formula don’t have the same

contents and could affect the baby’s weight during infancy and a person later into their

adolescent years. In a study about helping women achieve their breastfeeding goals, many

mothers say that the reason they stopped breastfeeding is during their checkups, they realized

their babies were not gaining enough weight (Lushniak, Penine, 2014). This could be for a

multitude of reasons, including possibly they weren’t producing enough and just didn’t realize

the babies weren’t drinking enough. This caused the mothers to stop breastfeeding all together

and continue bottle feeding until at least six months of age.

In a study about breastfeeding, it is said the difference between formula and breast milk is

that formula milk is just a food whereas breast milk is a complex living nutritional fluid that

contains antibodies, enzymes and hormones all of which include health benefits (Hoddinott,

Tappin, Wright, 2008). These enzymes could improve gut health which would eventually cause

better absorption of nutrients and cause less incidents of diarrhea which causes fluid imbalances

and weight loss. Fluid loss for an infant is very dangerous due to their much higher volume of

fluid compared to adolescents. Infants contain about 80% fluid compared to their body surface

and adolescents contain about 50%. Therefore, when they lose fluid, it has more severe

consequences since they require more than older children or adults.

In the same study, it is stated that for each month of being breastfed, there is a 4% less

chance of being obese as a teen than if they were bottle fed (Hoddinott, 2008). This could affect
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their health for their whole lives because if they are obese as an adolescent, it is likely to

continue into adulthood. With obesity can come many health issues such as hypertension which

leads to many other things. Being obese can have a domino effect. This was conducted by a

meta- analysis of 33 mainly cohort or cross-sectional studies. It also stated that if the mother is

not able to breastfeed for any reason, the secondary choice is donor breast milk opposed to

formula for the baby due to its high volume of antibodies and enzymes. There was a downfall of

this study. The downfall being that when you assess studies from high income countries, they

usually have an educational and socio economic advantage compared to other low-income

countries. The areas of the world that this study looked at were Norway, UK, Central Eastern

Europe, sub Saharan Africa, Latin America, Middle East, North America, South and East Asia.

So, the study is an average including well educated and not as well-educated mothers.

The conclusion about how breastfeeding vs. bottle feeding effects a person’s weight is

not direct in the fact that it doesn’t just help because it has fat content. It is found that

breastfeeding is good for weight by helping prevent obesity in adolescent years. It also helps

babies keep their weight up by helping with absorption and preventing things that could cause

weight loss such as diarrhea. So, the decision to breastfeed a baby influences weight for their

whole lives.

Neurodevelopment

There is a substantial amount of information in the healthcare field that encourages and

promotes women to breastfeed their babies over formula feeding. Many health care

professionals claim that breastfeeding in the best choice for an infant’s neurological growth and

development. Therefore, there are various scientific studies that debate whether breastfeeding

versus formula feeding plays a significant role in the neurological development of an infant and
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how it affects their cognitive and brain growth in the first year of infancy and throughout

childhood. According to Herba, Hofman, Govaert, Jaddoe, Roza, and Verhulst (2013),

breastfeeding is the optimal choice when it comes to infant nutrition and that it has many

developmental benefits for the baby. In a study of 680 infants in the Netherlands it was shown

that breastfed infants had larger ganglio thalamic ovoid diameters and larger head

circumferences which is an indicator for overall brain development and growth. The study

concludes that greatest advantage amongst the participants were the infants that were exclusively

breastfed compared to those who were both bottle fed and breastfed and those that were never

breastfed. (Herba et al., 2013)

Outcomes of different studies of breastfeeding have shown various benefits to children’s

brain development. According to Herba et al. (2013) breastfeeding has shown remarkable

benefits to preterm or small for gestational age infants. Though there is some research that

argues that these benefits could be partially owed to other factors such as socioeconomic status

and genetics of the parents, so that must be taken into account when examining different studies.

“A recent study also demonstrated links between breast milk, cognitive development and white

matter volume among children aged 7-8 years, who were born prematurely. (Herba et al., 2013,

p. 333). Herba et al. (2013) notes that this link was particularly strong in premature boys and

that this connection makes sense because of the brain is in a critical stage of development after

birth and continues for the first two years of life. “Human breast milk contains long-chain

polyunsaturated fatty acids such as docosahexaenoic acid (DHA) and arachidonic acid (AA). The

rapid brain development just prior to birth and in the first 6-12 months after birth is associated

with an increased incorporation of these long-chain polyunsaturated fatty acids into the brain,

particularly the cerebral cortex and neural networks (Herba et al., 2013, p. 333).
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According to Tawaia, (2013) breastfeeding plays a significant role in the

neurodevelopment of infants and continues to affect them throughout childhood. Studies of the

brain, particular the white brain matter, shows that breastfed infants had considerable more white

brain matter than bottle fed infants. “White matter facilitates the rapid and synchronous brain

messaging required for higher-order cognitive functions” (Tawaia, 2013, p. 16). It was noted in

the research that the areas of the brain development that were affected the highest were language,

emotional function and cognition (Tawaia, 2013).

Another study showed that IQ is an area that is strongly affected by being breastfed. The

average IQ is raised by 5 points for individuals who are breastfed as infants. Therefore,

breastfeeding has shown to improve academic performance in school age children (Tawaia,

2013). Tawaia (2013) notes a study that “found being fed artificial baby formula milk as an

infant was associated with decreased school achievement by Brazilian adolescents – the shorter

time they had been breastfed, the less time they stay at school and the lower their academic

achievement” (p. 18). It is also noted in this study that socio-economic status did not play a part

in this study as all participants were in a similar social class (Tawaia, 2013).

Immunology and Disease

After a woman gives birth to her infant mother nature takes over instinctively to provide

for that newborn with a liquid called colostrum that will supplement that newborn until the

mother’s milk comes in a few days after birth. Mother’s milk has been studied by molecular

medicine to identify the properties that make up this natural food that is impossible to artificially

replicate in a lab. (Grzelak, 2014) A mother’s milk contains all the imaginable ingredients to

help that newborn develop and grow correctly. The number of the cellular components that

make up a mother’s breast milk is not uniform among every single mother. The components that
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make up one’s breast milk depends on the lactation period, the state of the mother's and child's

health, and genetic predisposition. (Grzelak, 2014) This means that the mother's body picks up

on the state of her infant and chemically changes and adapts her breast milk to help her infant

grow at that stage or help fight an infection within the infant.

The impact of breastfeeding on an infant is studied by the number of infections in the

infant and how long those infections last compared to an infant who is supplemented with

formula or strictly formula. Breastfed infants are shown to have a more developed respiratory

system and an increase in function and productiveness of the gastrointestinal tract. (Grzelak,

2014)

The recommended primary prevention of an allergic disease is to breastfeed your infant

for at least six months; this allows the intestinal mucosal barrier time to strengthen. (Grzelak,

2014) Rotavirus incidences are diminished in infants who are breastfed and typically occur after

six months compared to infants who are not breast are typically diagnosed within the first month.

(Grzelak, 2014)

Studies show that breast milk is the optimum source of nutrients required for construction

and development of the immature gastrointestinal tract, central nervous system and endocrine

and immune systems in infants, which determine the proper functioning of the whole body.

There are decreased incidences of allergies, type 1 diabetes, obesity in childhood and

long term decreased incidences of hypertension, atherosclerosis, Crohn’s disease and rheumatoid

arthritis. (Grzelak, 2014)

Studies have shown that breastfeeding your infant is one of the most modifiable risk

factor for the infant and yourself. It is highly recommended by The American College of
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Obstetricians and Gynecologists (ACOG) that all infants are exclusively breastfed for six months

for the most optimal protect and growth as an infant and in the years to follow. (Stuebe, 2009)

Breastfed infants are at a lower risk of infectious morbidity than formula fed infants since

a mother’s milk can adapt and provide protection against pathogens and infection.

Oligosaccharides and glycoproteins in a mother’s milk prevent the attachment and binding of

many pathogens such as Haemophilus influenzae, Streptococcus pneumoniae, Escherichia coli,

and rotavirus. Glycosaminoglycans reduce the risk of HIV transmission and human milk lipids

assist with immunity against Giardia lamblia, H influenzae, group B streptococci, S epidermidis,

respiratory syncytial virus (RSV), and herpes simplex virus type 1. (Stuebe, 2009)

With approximately forty-four percent of all infants having an incidence of otitis media

in their first year of life, the incidence among formula fed infants is nearly doubled compared to

infants who have been breast fed due to the human milk oligosaccharides and antibodies to

common respiratory pathogens found in a mother’s breast milk. (Stuebe, 2009)

Although there are many risk factors involved in Sudden Infant Death Syndrome, there

are increased odds with formula fed infants than breastfed infants even with changes in infant

sleeping position, smoke verses smoke-free, and socioeconomic status. (Stuebe, 2009)

Many studies have been conducted on asthma in infants with the breastfed versus formula fed

with results showing favor to each in different studies performed. It has not been proven either

way whether breastfeeding reduces the risk of developing asthma in later childhood. (Stuebe,

2009)

One last health benefit to the breastfed infant is the reduction of occurrence of childhood

cancer. Multiple studies have been conducted and show that infants breastfed for six months or
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more have reduced diagnosis of acute lymphoblastic leukemia and acute myeloid leukemia

versus an infant that has been formula fed. (Stuebe, 2009)

Emotional Development

There is convincing evidence that suggests a baby’s nutrition may impact their emotions

and temperament into childhood. According to a study conducted by Smith and Ellwood, there is

a significant correlation between maternal time spent on emotional care and the time spent

breastfeeding. The study states that exclusively breastfed infants receive frequent emotional care

from their mothers. For example, the study states that breastfed infants are held and fed for an

average of 7 times a day for 15 minutes each time. During this time, the infants are receiving

more emotional attention. (Smith and Ellwood, p.229). On the same page, the study discusses

infants once they start mixing milk with solid foods: “The formula-fed infants on solids and aged

3-9 months received and average of 3.8 hours of emotional care time a week compared to 7.0

hours among breastfeeding infants on solids. This relationship also holds for each age group of

infants.” The study goes on to conclude that the less an infant is breastfed, such as when they get

older and start to wean, the less time is spent on interactive feeding activities, which influences

the emotional care of the baby.

This study by Smith and Ellwood also considers that other forms of interactive childcare

may substitute for the close bonding associated with breastfeeding. The study, however,

concludes that other forms of interactive child care (such as method of carrying, holding, and

soothing the infant) do not compensate for breastfeeding when it comes to the emotional care of

the child. This study concludes that “the less exclusive the breastfeeding, and the older the infant,

the less time spent on childcare” (Smith, Ellwood, p.230), thus suggesting that there is a direct
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correlation between amount of time spent on childcare and positive emotional influences on the

infant, and that non-breastfed infants are at a disadvantage.

Maternal contact with the infant in the early postnatal period is important in developing

the mother-child relationship, providing the opportunity for the infant to shape maternal

behavior and interactions with the mother, with implications for developmental

outcomes. Breastfeeding obviously demands a degree of maternal-infant proximity and

maternal investment that is not necessary for formula feeding. We suggest that contact

and time with the mother as the infant becomes older may also be important to the

formation of attachment, and to cognitive development through physiological and

psychological mechanisms (Smith, Ellwood, p.231).

So, while the chemical makeup of the breast milk versus formula may not be the

difference in emotional development of infants, the time spent with direct maternal- infant

bonding is probably the reason for the difference in feeding methods and the effect on

attachment.

Another study by Bogumila Kielbratowska, Maria Kazmierczak, Justyna Michalek, and

Krzysztof Preis focused on a child’s temperament in response to feeding method. This study

focused on nine basic temperament dimensions; activity level, regularity of biological functions,

approach or withdrawal from new stimuli, adaptability, sensory threshold, intensity of reaction,

predominant quality of mood, distractibility and attention span. They used these dimensions of

temperament to distinguish children as having an easy, difficult, or slow-to-warm temperament.

This study concluded that “the temperamental traits are related to the feeding method

(breastfeeding vs. bottle-feeding): Breastfed children obtain higher scores on the vigor scale,
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which includes activity and initial reaction. Bottle-fed Children can be characterized as having

higher regularity” (Kielbratowska et al, p. 248).

Motor Function

When mothers make the important decision to either breastfeed, or bottle-feed, it is

obvious that they would like to make the best choice to ensure a healthy development of their

children. Deficits in the development of motor function attribute to a number of different health

disorders, and often lead to difficult treatments and expensive medications. To ensure that their

children have the best chance to develop proper motor function, mothers should be informed

about the benefits and risks of specific feeding methods.

In a study (Deoni et al., 2013), 133 children between the ages of 10-months-old, and 4-

years-old, were subjected to a number of different tests to assess multiple physical attributes. The

subjects were then categorized into three separate groups, which were exclusively breastfed,

exclusively bottle-fed, and a combination of breastfeeding and bottle-feeding. MRI scans were

used to view white matter structure in the brain, and children were assessed using the Mullen

Scales of Early Learning in the study. When analyzing the Mullen gross motor raw score results,

breast feeding had a very slight advantage over bottle-feeding, but the combination of breast and

bottle-feeding had the highest score (Deoni et al., 2013, p.83). These results were somewhat

surprising, because it was expected that the breastfeeding group would have significantly better

results than the bottle-feeding group. Breastfeeding is the most commonly recommended option

in the medical field, with a lot of data to support it. Using the combination of both breastfeeding,

and bottle-feeding is not the most common method of feeding, but it could have some advantages

of its own.
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In the same study (Deoni et al., 2013), there were also significant advantages of

exclusively breastfeeding shown, and the results were not close. “We have also shown extended

breastfeeding is positively associated with increased VFM in somatosensory, auditory and

language areas and, in turn, with increased language performance, visual reception and motor

control performance” (p.83). These results were much more aligned with the preferences and

recommendations commonly given in the medical field. With a positive correlation between

breastfeeding and motor function, this is an overwhelming advantage for the method of

exclusively breastfeeding. Along with more impressive results in other categories like speech, it

would be difficult to make an argument that exclusively bottle-feeding would be the superior

method of feeding, in regards to motor function development.

Furthermore, the same study also showed advantages to breastfeeding in the later stages

of development. “Our results show infant breastfeeding is associated with improved

developmental growth in late maturing white matter association regions” (Deoni et al., 2013,

p.85). It might be predictable that breastfeeding has advantages during the time period, when the

child consumes the breast milk. Although, it is shown that these benefits might possibly last to

the later stages of development.

Motor function is a major developmental consideration when viewing the overall health

status of a child, and mothers could possibly improve the chances of a normal developmental

process by selecting the right feeding method. It seems as though breastfeeding certainly has

more solid data backing it as the better method of feeding, when considering the benefits it has

on motor function development. Including the possibility that there could also be long-term

developmental advantages associated with exclusively breastfeeding, it is easy to see why

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breastfeeding is largely considered to be very advantageous, as well as a part of the natural

birthing process by many medical professionals.

Conclusion

When addressing the debate of breastfeeding versus formula-feeding, the majority of the

data favors the side of breastfeeding as the most advantageous method of feeding. After

reviewing multiple studies, breastfeeding shows a wide-range of benefits. It is shown that

breastfeeding can improve gut health, as well lower the chances of obesity. Furthermore,

breastfeeding has shown a number of advantages in regards to neurodevelopment, improving IQ

and helping brain development. Also, infants who are breastfed commonly have a better

development of the respiratory system. Exclusively breastfed infants also receive valuable

bonding time and emotional care from their mothers, compared infants who are formula-fed.

When taking multiple developmental considerations into account, breastfeeding seems like the

more beneficial method of feeding, when compared to formula-feeding.

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& Dirks, H. (2010). Breastfeeding and early white matter development: A cross-sectional

study. Neuroimage, 82, 77-86. Retrieved from

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Herba, Catherine M.; Hofman, Albert; Govaert, Paul; Roza, Sabine; Tiemeier, Henning;

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WVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=107924908&db=rz