Breastfeeding beyond infancy supports

Authors: CRIMMINS, MEGHAN - Arkansas Children'S Nutrition Research Center (ACNC); SIMS, CLARK - Arkansas Children'S Nutrition Research Center (ACNC); WILLIAMS, DAVID - Arkansas Children'S Nutrition Research Center (ACNC); ANDRES, ALINE - Arkansas Children'S Nutrition Research Center (ACNC); SOBIK, SARAH - Arkansas Children'S Nutrition Research Center (ACNC)

Submitted to: Pediatric Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/28/2025
Publication Date: 5/14/2025
Citation: Crimmins, M.R., Sims, C.R., Williams, D.K., Andres, A., Sobik, S. 2025. Breastfeeding beyond infancy supports. Pediatric Research. https://doi.org/10.1038/s41390-025-04111-z.
DOI: https://doi.org/10.1038/s41390-025-04111-z

Interpretive Summary: Breastfeeding is considered best for babies worldwide. The American Academy of Pediatrics and World Health Organization both recommend exclusive breastfeeding (EBF) for the first 6 months of life – and encourage continued breastfeeding once foods are introduced. Less is known about the long-term effects of breastfeeding beyond the first year of life. The objective of this study was to examine the associations of breastfeeding beyond the first year of life on toddler growth, development, and diet. In this prospective longitudinal study, 185 participants were categorized into 3 groups: formula fed (N = 22), breastfed up to 12 months (BF, N = 108), and prolonged breastfed up to 24 months (PBF, N = 55). Investigators collected information about participant demographics, anthropometrics, toddler Healthy Eating Index, Child Feeding Questionnaire, and Bayley scales of infant and toddler development. Statistical analysis showed that at age 24 months, PBF children had lower weight-for-length z-scores compared to both formula fed and BF children. Using Healthy Eating Index scores, analysis showed that formula fed infants had lower total fruit scores compared to BF and PBF infants, but PBF infants had higher seafood scores. Feeding responsibility was lower in parents of the BF group compared to parents who formula fed. Restriction was lower in BF and formula fed groups compared to PBF, and pressure feeding was less common in PBF. No significant differences were shown with developmental testing between the three groups. These results strengthen evidence that breastfeeding beyond the first year of life supports childhood growth, nutritional status, and development, but more research is needed to describe effects on health status in childhood.

Technical Abstract: BACKGROUNDANDOBJECTIVE: Theobjective of this study was to examine the associations of breastfeeding beyond infancy (BBI, >1 year) on toddler growth, development, and diet. METHODS: Participants (n =185) of a prospective longitudinal study were categorized into 3 groups: formula fed (FF, N=22), breastfed up to 12 months (BF, N=108), and breastfed up to 24 months (PBF, N=55). Data collected included demographics, anthropometrics, toddler Healthy Eating Index (HEI), Child Feeding Questionnaire (CFQ), and Bayley scales of infant and toddler development (BSID). RESULTS: At age 24 months, linear modeling showed PBF children had lower weight-for-length z-scores in comparison to both FF and BF children. FF infants had lower HEI scores for total fruit compared to BF and PBF infants, whereas PBF infants had higher seafood HEI scores. Feeding responsibility was lower in BF parents than FF parents. Restriction was lower in BF and FF groups compared to PBF, and pressure feeding was less common in PBF. Developmental testing revealed no significant differences between the three groups. CONCLUSION: These results strengthen evidence that BBI supports adequate childhood growth, nutritional status, and development. Further studies are needed to evaluate the effect of BBI on health status in childhood.