Does breastfeeding protect against substantiated child abuse and neglect? A 15-year cohort study.

This study utilized prospective data from a large national sample of Australian women to examine the effect of breastfeeding on substantiated child maltreatment 15 years later. The authors concluded that breastfeeding protects against child maltreatment, particularly events perpetrated by mothers.

The researchers examined duration of breastfeeding as a potential protective factor against child abuse and neglect. Maternal-relevant information (e.g. parenting attitudes, stress, anxiety) and breastfeeding data were collected from 7223 mother-child dyads around the time of birth. Case information from child protection agency reports on substantiated child abuse and neglect was obtained 15 years after birth. The researchers found that, as breastfeeding duration decreased, the odds of a child being maltreated by his/her mother within the next 15 years significantly increased. After adjusting for various potential confounding variables and modifying analyses to test for the robustness of findings, the researchers concluded that breastfeeding may act as a protective factor against child maltreatment. The prospective data collection allowed the researchers to make the simple yet elegant conclusion that breastfeeding potentially prevents child abuse and neglect. The use of a large sample also strengthens the generalizability of the findings. One drawback is that the authors asked participants to answer questions that appeared to have face validity but without additional validity or reliability. A replication using measures with established psychometric properties would be a significant contribution. The authors suggest that one potential explanatory mechanism for their finding is through the release of the neuropeptide oxytocin, which may help to elevate maternal mood and reduce maternal anxiety and stress. This finding is also consistent with animal models where oxytocin appears to influence maternal behavior. Although the physiological underpinnings of the findings were not tested directly in the current study, future research should continue to examine this important mechanism. The physiology for maternal bonding and breastfeeding behavior may lead to new ways of understanding attachment and subsequent outcomes. Another explanation for the findings, as suggested by the authors, concerns the self-selection of mothers who breastfeed. Mothers who decide to breastfeed may be more emotionally invested in motherhood and in their child; in turn, these mothers may be less likely to neglect or abuse their child. Since the authors could not ethically conduct a randomized design to test this potential confound, their findings may be the closest approximation to understanding the association between breastfeeding and prospective child maltreatment. Yet, it remains important to consider these influential third variables.

Acknowledgements: I would like to thank Ann Chu for their assistance in the preparation of this evaluation.