Breastmilk and Neurodevelopment
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Article Summary: The Science of Breastfeeding and Brain Development (Belfort, 2017)
Overview
This review summarizes the evidence that breastfeeding—particularly exclusive and longer-duration breastfeeding—supports brain development and cognitive outcomes in both term and preterm infants. The author reviews observational studies, randomized trials, and research in NICU populations to explain what is currently known and where questions remain.
Key Findings
1. Breastfeeding is associated with improved cognitive outcomes
Research consistently shows that children who are breastfed tend to have higher IQ scores, especially in verbal intelligence.
The strongest evidence supports improvements in cognition, rather than behavior, emotional development, or executive function.
2. Longer and more exclusive breastfeeding matters
In the Project Viva study, each additional month of exclusive breastfeeding was associated with approximately a 0.8-point increase in verbal IQ at school age.
Six months of exclusive breastfeeding could translate to an average gain of nearly 5 IQ points after accounting for maternal IQ, socioeconomic status, education, and home environment.
3. Randomized trial evidence strengthens the findings
Because breastfeeding studies are often observational, researchers worry about confounding factors (for example, families who breastfeed may differ in many other ways).
The PROBIT trial, a large randomized breastfeeding promotion study, found that children in hospitals promoting breastfeeding had:
Higher rates of exclusive breastfeeding.
About a 7.5-point advantage in verbal IQ at age 6.5 years.
Like other studies, it found no significant improvement in behavior or social-emotional outcomes.
What about premature infants?
Preterm infants have unique nutritional needs and are at higher risk for developmental delays, making human milk especially important.
Research reviewed in the article found that:
Greater intake of mother's own milk during the NICU stay was associated with:
Higher IQ at age 7
Better working memory
Better mathematical skills
Larger volumes of important brain structures (including the thalamus and hippocampus) on MRI
Benefits were not always detectable at age 2 but became more apparent by school age.
Mother's milk vs. donor milk
The review discusses the DoMINO trial, which compared donor human milk with preterm formula when a mother's own milk was insufficient.
Findings included:
Donor milk lowered the risk of necrotizing enterocolitis (NEC).
However, donor milk did not improve neurodevelopment compared with formula at 18 months and was associated with a higher proportion of children with cognitive impairment than the formula-supplemented group.
This suggests that mother's own milk may provide unique developmental benefits that donor milk does not fully replicate.
Why might breastfeeding benefit the brain?
The exact mechanism is not fully understood. The article suggests several possibilities:
Nutritional factors unique to human milk
Bioactive substances that support brain growth
The close interactions between mother and infant during breastfeeding, which may enhance development through responsive caregiving and bonding
The author notes that researchers have not yet identified a single nutrient responsible for the observed cognitive benefits.
Clinical Implications
The evidence supports current recommendations that:
Healthy term infants should be exclusively breastfed for about six months when possible.
Hospitalized preterm infants should receive fortified mother's own milk whenever available.
Supporting mothers to provide their own milk should be a priority in the NICU because of both short-term health benefits and potential long-term neurodevelopmental advantages.
Take-Home Messages for NICU Families
For families with premature infants:
Every drop of a mother's own milk may contribute to healthier brain development.
The greatest benefits appear with higher amounts and longer duration of maternal milk feeding.
If a baby cannot feed directly at the breast yet, providing expressed milk through a feeding tube still supports brain development.
Human milk is one part of a baby's developmental care; growth, medical stability, nurturing interactions, and therapy also play important roles.
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