The connection between breastfeeding and brain development

 
During the first 1 000 days of life (from conception to two years of age), brain development is rapid. ^[1] Between 24 weeks of gestation and two years of age, humans acquire 90% of their brain size. “During this period, a series of neuro-anatomical developmental processes must take place in a time-coordinated fashion if complex behavioural, cognitive and motor circuits are to develop normally”.²

Nutrition is especially important during this period. Consider that a professional athlete will consume approximately 100 kcal/kg/day, to sustain athletic performance and health. An infant in NICU, on the other hand, must consume between 120 and 130 kcal/kg/day, simply to support the rapid brain development that is typical of this early life stage (especially so, for pre-term infants). ^[2]

A nutritional deficiency during these 1 000 days affects brain development as well as cognitive and emotional development (with lasting effects). ² Therefore, it is critical that we adopt interventions that prevent nutritional deficiencies, to enhance early brain development.

The link between breastmilk and healthy brain development

It’s a fact that breastfeeding is highly beneficial for infants. The World Health Organisation (WHO) states that breastfeeding “one of the most effective ways to ensure child health and survival”, as the antibodies in breastmilk provide babies with protection against common childhood illnesses. In addition, there is evidence of a link between breastfeeding and a reduced incidence of obesity in children. A further key benefit of breastfeeding is that it appears to boost neurological and cognitive development. ^{[3] [4] [5]} Children who have been breastfed show higher verbal IQ, performance IQ and overall IQ.  ^[6]

Breastmilk contains essential macronutrients (lactose, proteins and lipids), as well as: ^[7]

• bioactive components (e.g. antimicrobials and growth modulators),
• miRNAs that boost immunity and healthy development
• choline, a deficiency of which causes cognitive and memory deficits
• various minerals including calcium, zinc, iron and folate
• iodine, which is necessary for healthy thyroid function; a deficiency causes retardation in infants
• human milk oligosaccharides (HMOs), which are found to play a significant role in the development of memory and learning capabilities
• Sialic acid, which is involved in the development of the corpus callosum, the prefrontal cortex and the hippocampus
• vitamins B6, B12, C and D, all of which play a role in the formation of myelin and neurons.

 
Breastmilk also contains the omega-3 fatty acid, DHA, which is vital for the development and maintenance of healthy brain tissue. ^[8]

Promoting exclusive breastfeeding, for healthy cognitive development

Exclusive breastfeeding (EBF) is shown to boost cognitive development, as well as lowering rates of infant/child mortality and disease. It’s not surprising that EBF has been identified to improve infant and child nutrition. The United Nations (UN) and WHO have set a target, to increase EBF to at least 50% by 2025. ^[9]

However, researchers are finding that many African countries will not meet these targets. According to The Breastfeeding Collective (a breastfeeding advocacy and interest group) between 2013 and 2018, only 48% of newborns initiated breastfeeding within the first hour after birth (the ‘Golden Hour’). Furthermore,  only 44% of infants (under six months of age) are exclusively breastfed.  ⁹

The Breastfeeding Collective’s 2021 Scorecard has found that the global healthcare community is facing a number of challenges, in the protection and promotion of EBF. This includes a lack of funding and political support for EBF programmes; inadequate legislative support of the International Code of Marketing of Breast-Milk Substitutes (BMS); inadequate maternity protection in the workplace; low adoption of the baby friendly hospital; low access to breastfeeding counselling and education; a lack of community support programmes to support and protect EBF; and inadequate monitoring of these initiatives. ⁹

In a systematic review of EBF policy and practices in South Africa between 1980 and 2018, researchers found that there are additional factors which influence the adoption of EBF in the country. Among the findings of the review, the following emerged: ^[10]

• The HIV pandemic has influenced feeding practices; HIV-positive mothers may have been encouraged to use complementary feeding or to feed formula instead of breastmilk, to reduce the risk of transmission.

• Age and employment status: young mothers might abandon EBF, as they return to school or find work.
• Family dynamics: young women in patriarchal families are often pressured by elder family members to adopt mixed feeding or formula feeding. “The most consistent reasons for complying with family pressure related to seeking to quiet a crying baby or fulfilling expectations about what an infant ‘needs.’ Common beliefs about milk being insufficient also played a strong role at both household and community levels, reflecting and influencing mixed feeding norms”.
• Breastfeeding is not always convenient or easy: sleepless nights, pain and discomfort (as well as body image concerns) sometimes prevent the adoption of EBF.
• Health: Mental health, in particular, was found to be a barrier to EBF.
• Postnatal services that encourage breastfeeding were found to have a positive effect.

 
In Africa, EBF programmes should consider African traditional values systems and cultural practices that are passed on among Africans. For example, “Extended family members and the grandmothers have significant roles in childcare, and they have a powerful influence on innovation decision-making about exclusive breastfeeding. We recommend that the opinions of these adopters be considered when planning exclusive breastfeeding programs”.  Furthermore  the use of medicinal herbs and other practices should be integrated into these programs, and recommendations in this regard should be based on science.

Healthcare professionals play a role

It is interesting to note the findings of a study, that “the adoption of exclusive breastfeeding requires more of socio-cultural processes rather than technical processes”. ^[11]

Healthcare professionals (HCPs) have a role to play in these socio-cultural processes, by supplying their patients with accurate information about the benefits of breastmilk and EBF, as well as supporting the adoption of breastfeeding. The WHO and UNICEF have made the following recommendations: ^[12] “that children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first six months of life – meaning no other foods or liquids are provided, including water. Infants should be breastfed on demand – that is as often as the child wants, day and night. No bottles, teats or pacifiers should be used. From the age of six months, children should begin eating safe and adequate complementary foods while continuing to breastfeed for up to two years and beyond.”

HCPs, with their understanding of local cultural norms and attitudes, are also well-positioned to influence their patient communities favourably, while also making recommendations for an EBF programme that will fit in with local cultural norms.

As stated by The Breastfeeding Collective, there is “a unique opportunity for countries to announce bold commitments on the protection, promotion, and support of breastfeeding. The time to act is now”.  ^[13]