Optimal Nutrition for Newborns

Abstract

For a long time, it has been disputed whether breastfeeding has any impacts on the cognitive development of an individual and to what extent these impacts are significant in the life course of the individual.

This essay will address the question ‘Does early infant breastfeeding improve cognition throughout the life course?’ In the introduction of the essay, the key terms will be defined, thus enabling the reader to understand the topic of discussion better. The essay will then use studies and analyses (primarily those done in high- income countries such as United Kingdom) to illustrate the different theories that have been proposed so far. Also, the life course perspective in relation to breastfeeding and cognitive development will be explored.

Introduction

Studies suggest that new-born babies need to be fed frequently thus the best and readily available source of nutrition is breast milk (Girad, Doyle, & Tremblay, 2017). Throughout the first six months of a new-born's life, it is recommended that breast milk should be the main source of nutrition for the infant. After the completion of the six months, it is suggested that the infant should be familiarised with complementary foods and that the infant should continue with their breast milk diet for the next two or more years of their life (Eidelman & Schanler, 2012).

Scholars argue that breastfeeding has numerous health advantages for both the infant and the mother (Horta & Victora, 2013). It has short term health advantages for the infant, there is an overall reduction in morbidity from infectious diseases and childhood mortality. Furthermore studies indicate that breastfeeding beneficial in reducing childhood illnesses such as obesity (Metzger & McDade, 2010), diabetes and respiratory tract infections (Bachrach & Schwarz, 2003).

Further studies show that breast milk is known to contain two long-chain polyunsaturated fatty acids, which are docosahexaenoic (DHA) and arachidonic acid (Brenna, et al., 2007) .These nutrients are known to influence the cognitive development of the infant, by promoting both visual and neural development, which are cognitive abilities that are related to problem-solving (McCann and Ames, 2005).

Cognitive development is defined as the ability to form a concept, through making decisions, memory and problem-solving, by looking at an individual’s life course (from childhood all through to adulthood) (Gottfredson, 1994). Academic accomplishments, the ability to adapt to unique social situations and work-related achievements can be anticipated by looking at the cognitive abilities gained during childhood (Ferguson, Horwood & Rider 2005).

Studies show that cognitive development in the first two years of the infant’s life is vital, it is the point at which fundamental systems (perceptual and sensory) that emphasise socio-emotional behaviour and language are shaped (Knickmeyer, et al., 2008).

Historically, cognitive development was measured in different ways. The most common structure is performed through an intelligent test. In the early 1900s, Alfred Binet was the first individual to construct a scientific test to measure intelligence. He endeavoured to measure children’s intellectual potential by studying their way of reasoning and thought process (Binet, 1905). Later on, Binet and Simon (1916) went on to create the Binet-Simon scale which was used to identify special needs students. An American psychologist Lewis Terman (1916) adopted this scale, ultimately releasing the ‘Stanford Revision of Binet-Simon Scale’ which is also known as the ‘Stanford-Binet’. This scale used four psychological factors; visual/abstract, verbal, and quantitative reasoning to measure intelligence. Terman’s scale led to a comprehensive score that he called an ‘intelligence quotient (IQ)’.

Currently, the scale used is the Wechsler Intelligence Scale for children, fourth edition (WISC-IV) test is employed to administer IQ test for children. It was initially developed by David Wechsler (1974) and was later revised in 2003 (Wechsler, 2003).The test measures two broad cognitive factors (verbal and performance IQ) as well as general intelligence.

Cognitive development changes all through an individual’s life course, thus the life course theory concerning early infant breastfeeding and the improvement in psychological will be explored during the course of this essay. The life course theory (also known as the life course perspective) is an interdisciplinary model that studies people lives in terms of structural contexts, and social change, from birth until death. The theory studies changes in an individual‘s and the alterations brought by these changes (Hendricks, 2012). This perspective incorporates interpretations and thoughts from a variety of areas, namely; geographical, sociological, biological areas and historical area.

As a concept, it is also defined as “a sequence of socially defined events and roles that the individual enacts over time” (Giele & Elder Jr 1998, p.22). There are five principles which govern the life course perspective, these are; the lives of people tend to be linked in one way or another, people tend to in control to some extent of the course of their lives (agency), life span development, a historical setting does govern birth cohorts and timing (Elder Jr & Johnson, 2003).

The principle of linked lives and shared connections emphasizes that the family and its complex system of shared interactions link both individual and societal experiences (Giele & Elder Jr, 1998). For example, it will be observed that families who experience bereavement of one of their members, will likely exhibit forms of stress and vulnerability. Or in other cases, resilience will be displayed.

According to the life course theory, when looking at the principle of human agency as well as personal control it can be seen that decision making and goal setting that shape social structure is influenced by individuals (Elder Jr, 1999). Individuals are also capable of being mindful when making choices that involve their social interactions and institutional contributions (Clausen, 1998).

The principle of life span development emphasizes that the experiences that are observed in the earlier stages of life need to considered for us to understand the choices an individual’s makes as well as the behaviour that they demonstrate (Elder Jr, et al. 2003).

Sociohistorical and geographical location; the area in which individual lives (geographical location) and the events that are taking place at the particular time (historical setting) impacts an individual’s life in one way or another (Elder Jr, 1999). For example economical progressions such as depressions and geographical events such as natural disasters.

Historical, individual and generational time are the three forms of time that are key in the life course analysis. (Price, Price & McKenry. 2000) Sociohistorical or critical events such as technological advancements, both economic and political advancements that affect individuals and their families, is known as historical time. Chronological age is referred to as an individual (or ontogenetic) time. This period is founded on cultural definitions of age (childhood, adolescence and adulthood) which influence the social roles and rights found in society (Hagestad & Neugarten, 1985).

To understand the role of infant breastfeeding and cognitive development throughout the life course, this essay will first address the keywords that make up the framework of the essay questions, which has been demonstrated in the introduction. It will then clarify the different studies that have been conducted, limitations observed and the conclusions reached. Next, it will closely examine the five principles of the life course concerning infant breastfeeding and cognitive development.

MAIN BODY

Studies and Analyses

Von Stumm and Plomin (2015) conducted study titled ‘Breastfeeding and IQ growth from Toddlerhood through Adolescence’, their study aimed to justify the benefits of breastfeeding for psychological development through empirical evidence. They observed the relationship between infant (both boys and girls) breastfeeding and the progression of the Intelligence Quotient (IQ) using the method of a latent growth curve modelling. This approach enabled them to differentiate the alteration in the IQ gains that would be observed later in childhood and adolescence and the IQ observed at the early childhood stage. The model was adjusted for other factors that affect cognitive development such as the mother’s age at birth (maternal age), her gestational stage and the mother’s socioeconomic factor. The data used for the study was obtained from the Twins Early Development Study (TEDS), which is a study that assessed twins born between the period of 1994 and 1996 in the United Kingdom. (von Stumm & Plomin, 2015) They were assessed nine times between the two years of age and sixteen years of age.

Results obtained from the study conducted only provided partial support. It was found that after adjusting for the other factors, at the age of two years boys who had been breastfed scored comparatively higher in the IQ test as compared to girls who hadn’t been breastfed. Contrastingly, the results collected from the boys were not sufficient and the observed effect wasn’t seen. It was also noted that other factors that coexist with breastfeeding such as maternal age, her gestational stage and the mother’s socioeconomic factor, influence long-term cognitive development.

The study done by von Stumm and Plomin (2015) had many strengths; the nature and size of the sample, the number of assessments done and the duration of time that the study was done. However, since the assessment was carried out using different approaches i.e. some test was conducted by the parents (this means that parents oversaw the issuing of the assessment i.e. giving of the instructions), while others were conducted through phone or a website. It can be found that the different approaches may have reduced the accuracy of the test. For example it is not known to what extent the parent may have assisted the child while issuing the assessment.

Von Stumm and Plomin (2015) argued that in a model made up of a large sample of British children, IQ increments from the period of early childhood to adolescence were not a result of breastfeeding. Early infant breastfeeding improved cognition mainly in the early childhood, however, later on in the life course cognitive development is associated with other factors such as the socioeconomic factor, the mothers IQ, genetics etc.

Gibson-Davis & Brooks-Gunn (2006) studied 1645 children from 15 states located in the United States of America. These children came from a total of 2 cities and from families where the parents were not married. The Peabody Picture Vocabulary test-III (also known as the PPVT-III) was employed to conduct the IQ test, the results indicated that the points scored by children who were breastfed were higher by 6.6points compared those who had not breastfed. After controlling for variables such as demographics, socioeconomic status etc. the difference in points recorded between children who had been breastfed and those that hadn’t been breast decreased top 1.72points. This assertion is supported by scholars such as Clark, Castillo & Calatroni (2006) who had researched this area. They too observed that children who had been breastfed scored highly as compared to those who hadn’t been breastfed. However, they introduced another angle on this debate, which suggested that the duration of breastfeeding also affects cognition. Using the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) to examine the children’s mental intelligence. They observed that there was a 1.0point difference between infants who had been breastfed for longer than eight months compared to those who had been breastfed for less than two months.

Horta and Victoria (2013) observed the long-term effects of breastfeeding on the cognitive development of an individual. They found that individuals who were breastfeed performed better in the assessments that they were given as compared to those who hadn’t been breastfed. Similar to the study conducted by von Stumm and Plomin (2015), Horta and Victoria (2013) acknowledged that maternal IQ plays a role in cognitive development. This analysis illustrated that the area (theses were primarily high-income socioeconomic status) where the studies were conducted, maternal IQ played a role in the length of the period in which the infant was breastfed as well as the cognitive development over time. Moreover, Brion, Lawlor, & Matijasevich, 2008, conducted a study where it was noted that there was a positive correlation between the period in which the infant was breastfed and the socioeconomic status. They observed that in high-income countries such as the United Kingdom, infants were breastfed more compared to middle-income areas such as Brazil (Pelotas). Yet, in spite of reporting similar results to other scholars (von Stumm and Plomin (2015); Horta and Victoria (2013)) there were no adjustments made for the household situation, thus study could not be included as it had some biases.

Furthermore, (Horta & Victora, 2013) expounded on the effect of maternal IQ, they maintained that even though this variable played a significant role in the cognitive development during a given life course, early childhood breastfeeding was linked with an extra 2.19 points on the IQ scale. Thereby, concurring with the theory that early infant breastfeeding does improve cognition through the life course.

About 8000 families from the Growing Up in Ireland longitudinal infant Cohort participated in a population study conducted by Girad, Doyle, & Tremblay (2017). The children’s data was collected at the ages of three and five years, with the main source of this data being from the accounts given by the guardians and teachers as well as intelligence tests. When analysis of the data collected was done, it was found that there was no substantial difference between the cognitive development of groups who had been breastfed for a period of thirty-one days and those who hadn’t at three and five years of age. Also, when the duration of breastfeeding was increased to between thirty-two and one hundred and eighty days, there was still no substantial difference between the groups who had been breastfed and those who hadn’t been breastfed. This observation disagreed with the observation made by Clark et al. (2006). When the children were breastfed for more than six months, there was a significant difference in the cognitive development in the infants who were breastfed and those who had not been breastfed. Suggesting that perhaps there were was a difference of approach when conducting the study. After amendments were done for other variables that affect psychological development such socioeconomic factors, demographics etc. it was found that for children who had been breastfed for at least six months and those who had not been breastfed for the given duration, there was no significant difference in their cognitive development. (Girad, Doyle, & Tremblay, 2017) However, not all research agrees with the above results, some authors (Gibson-Davis & Brooks-Gunn (2006); Horta and Victoria (2013)) that still used the same approach but had both a different analytical and delivery approach reported different results.

Horta, de Mola & Victora(2015) gathered data that linked breastfeeding and cognitive development. The data was first collected from collected Medline, LILACS, SCIELO, after which it was reviewed systematically. In the seventeen studies with eighteen estimates used it was noted that there was some biased in the publications identified, thus identifying a positive correlation between breastfeeding and cognitive development was difficult. Also, the effect that breastfeeding has had on cognitive development has been reported to be very insignificant in studies where the mother’s IQ was taken into consideration and also in individuals belonging to the adolescence stage (ten to nineteen years) (Horta & Victora, 2013). This implies that the impact that breastfeeding has on cognitive development is significant at early childhood. However, later on in the course other factors such as environment and the interactions between mother and child affect cognition (Walker et al. 2007).

In the study done by Wigg et al. (1998), it was noted that children who had been breastfed exclusively for at least six months had a higher IQ at twelve years of age compared to those who hadn’t been breastfed exclusively. Similarly, Eickman et al. (2007) observed that children who performed well in assessment test were those who had been breastfed in their first month of life.

Breastfeeding in the Life course

Scholars argue that compared to other common models of predicting breastfeeding behaviours, i.e. social-epidemiological perspective, the life course theory is very different (Marmot et al., 2008). According to the course theory, an individual cannot be studied without studying their environment. They are not only a product of their environment but also a product of their socio-historical location. Therefore, when their behaviour is being studied, it is important that they are not isolated from both temporal and ecological context (Elder Jr et al., 2003). The life course theory is the study of the interaction between an individual and the events that take place in their life course. Both the individual and societal outcomes as well as the time and place that the events occur are important. The psychological, biological and social changes that come with age, as well as the social structure and historical change constitute the behaviour of an individual (Elder Jr et al., 2003) .

Studies suggest that the connection between parents and their children is significant as peoples’ lives are interdependent (Elder Jr et al., 2003). More often than not, events in a life course are experienced in chronological order. And the current conditions seen in an individual’s life are as a result of the build-up of factors and conditions in an individual’s life (Fine & Kotel- chuck, 2010). Therefore, when studying the impact of breastfeeding on cognition the intergenerational transfer of behaviour from parents to children; the distribution of health care resources, policies, and laws; factors such as intention and confidence need to be considered.

A disadvantage of using the life course theory to study breastfeeding is that the theory is a conceptual framework rather than a series of testable premises (Sallis, Owen, & Fisher, 2008). To mitigate the disadvantage scholars (Whipps, Yoshikawa, & Godfrey ., 2018) suggest the use of a more testable method: the breastfeeding in a life course context (BILCC) model (see Figure 1).

The principle of human agency as well as personal control it can be seen that individuals play a big role in their decision making and goal setting that shape their life course. (Elder Jr, 1999)

Whipps et al. (2018) defined breastfeeding self-efficacy as the confidence an individual has when it comes to breastfeeding. Studies have shown that confidence is one of the strongest indicator of breastfeeding continuation; mothers who have high confidence are three to five more times more likely to continue breastfeeding after a certain point as compared to mothers with low confidence (Dennis, 1999). Intentions are defined as “indications of how hard people are willing to try, of how much of an effort they are planning to exert, in order to perform the behaviour” (Ajzen, 1991, p. 181). Therefore scholars (Donath & Amir, 2003) observed that stronger breastfeeding intention will lead to a longer duration of breastfeeding and breastfeeding initiation. This suggests that an increase in cognition will be seen in childhood, as observed by Horta, de Mola & Victora(2016) in their study.

Furthermore, breastfeeding can be measured and explained as behavioural trajectories (Elder Jr et al., 2003). In the USA, a trajectory that is seen often is an optimal trajectory; which is conforming to biological and societal norms that have been established (Hinde & Milligan, 2011). Studies have shown that choices an individual makes are dependent on the location that an individual is in as well as their background. The particular location will avail the individual with certain opportunities and limitations that will allow the individual to make his/ her own choices regarding the course of their life. For example, in high income countries there a lot of women who have joined the workforce (this is due the increase in literacy rates among women and an increase in the demand for labour). The former is an opportunity for women however, the limitation comes in when the women don’t have adequate parental leave.

It is a biological norm for humans to breastfeed their young, however studies have shown that it is almost physically impossible for women with a high- income status, with full-time employment to engage in optimal breastfeeding (Galtry, 2003). Estimates have shown that, even though 60% of mothers are aware of the WHO breastfeeding recommendations, only a few of them want to meet the goals set (Wen, Simpson, Rissel, & Baur, 2012).

Future breastfeeding patterns of a mother are as a result of direct impact of the events observed in the maternal life course, as well as indirect impacts on the social network and family (Whipps, et al., 2018). For instance, the relationship that a breastfeeding mother forms towards breastfeeding is based on intention, confidence and the reality of having a healthy child. These outcomes will, to some extent, become events in the mothers life span devlopment, they will impact infant breastfeeding for the second child born to that particular mother. Conversely, if the mothers experience was negative; being forced to appear to as ‘good mother’ by abandoning her career, pressure, lack of choice, these too will form events in the mother’s life course and impact the infant feeding decision for subsequent children (Whipps, et al., 2018). Research has shown that breastfeeding patterns differ from sibling to sibling. Breastfeeding is more likely to be initiated by first time mothers, whereas mothers who have had children before are less likely to intiate breastfeeding. However, if they do intiate breastfeeding they will do it for a longer period (Li et al., 2002). Studies have shown that psychological factors influence breastfeeding and therefore the feeding decisions made for the subsequent child born to that mother (Victora et al. 2016)

The breastfeeding outcomes of one generation and the life course events of the next generation are based on the life course principle of linked lives. Studies have proved what many practitioners have been hypothesizing: that infant breast feeding is, to some extent, ‘transferred’ from one generation to the next generation (Di Manno, Macdonald, & Knight, 2015). Thulier & Mercer (2009); Victoria et al. (2015) observed that fully breastfed children my result in higher academic achievement, thus increasing the likelihood of her breastfeeding her own children in the future.

Knowledge on breastfeeding passed from generation to the next may impact breastfeeding patterns through cultural and social pathways as well as the already existing biological pathways. Some maternal natures can be learnt from the different interactions that an individual has had with other individuals who are already mothers in their lives (I.e. from their nuclear family; mother, grandmother or from their extended family). These individuals will give the new mother-to-be advice on what is to be expected and how to handle breastfeeding thereby, shaping their perspective on breastfeeding. A systematic review revealed that if a grandmother had a positive attitude toward breastfeeding, breastfeeding would be perceived positively by the next generation (Negin, et al. 2016). Conversely, new studies have shown that in Britain, there are other pathways by which support may influence breastfeeding. For example, emotional support may increase the likelihood of breastfeeding, while practical support (i.e. child care) may reduce the likelihood of breastfeeding (Emmott & Mace, 2015)

CONCLUSION

Several conclusions have emerged from this analysis. It is evident that prolonged breastfeeding does have a positive effect on the cognitive development seen early childhood. Children aged between three and ten years who had been breastfed for the first six months of their lives and onwards, performed better in assessments that measured mental intelligence as compared to children who hadn’t been breastfed or who had been fed formula milk. (Girad, et al. 2017; Horta et al. 2015)

The association of breastfeeding and cognitive development is seen significantly in early childhood. However when the individual moves on to other stages of their life span (i.e. in adolescence, adulthood) the correlation become less significant. This can suggest that early infant breastfeeding does not improve cognition throughout the life course but rather breastfeeding only improves cognition in early childhood (Von Stumm & Plomin, 2015).

A lot of variables such as socioeconomic status, demographics and maternal IQ affect cognitive development in individuals. The positive correlation was seen that breastfeeding and cognitive development could be because of the family setting. Also, mothers with high IQs and socioeconomic status tend to create an atmosphere that encourages cognitive development (Horta and Victora, 2013).

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