May 2011

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


OBJECTIVE: To examine the relationship between child’s health needs, as represented by having special health care needs or being at high risk of developmental, behavioral or social delay, and both breastfeeding initiation and six month duration for those who were ever breastfed among children age 0-5 years in the United States. BACKGROUND: Breastfeeding has substantial health benefits for both infants and their mothers. Breastfed babies are less likely to be obese and to have otitis media, eczema, asthma, lower respiratory tract infections, type 2 diabetes and leukemia than non-breastfed babies.[superscript 1,2] Studies have found that children who were never breastfed were significantly more likely to have special health care needs than children who were ever breastfed.[superscript 3] Despite the extensive health benefits of breastfeeding, for babies born in 2007 less than 80% of mothers initiated breastfeeding and only 43% did so for 6 months.[superscript 1] Previously identified barriers to breastfeeding include social norms, inadequate support, infant admission into the intensive care unit (ICU), separation of infant and mother in the hospital and infant becoming sick and unable to breastfeed.[superscript 1,4] METHODS: This study uses data from the 2007 National Survey of Children’s Health. Chi-squared tests were used to investigate the social, demographic and geographic factors that are independently associated with special health care needs or high risk of developmental, behavioral or social delays (SHCN/DBSD) and each breastfeeding outcome independently. Multivariate logistic regression was used to estimate the odds of ever breastfeeding for SHCN/DBSD compared to non-SHCN/DBSD children and the odds of six month duration of breastfeeding for SHCN/DBSD compared to non-SHCN/DBSD children among only children who were ever breastfed. RESULTS: For children under six years living in the United States, increased health needs are negatively associated with both initiation and six month duration of breastfeeding. The multivariate-adjusted odds that children with special health care needs or at high risk of developmental, behavioral or social delays were breastfed were 18% lower than the odds for other children (95% CI: 3‐30%). Of children who were ever breastfeed, the multivariate-adjusted odds that those with special health care needs or high risk of delays stopped breastfeeding prior to six months of age were 26% higher than the odds for other children (95% CI: 10‐40%). Other factors associated with breastfeeding initiation and continuation for at least six months after initiation were income, mother’s health status, region of the United States, family structure, household tobacco use, child’s birth position, mother’s education and race/ethnicity. CONCLUSION: These results show that children with increased health needs have mothers who face greater barriers in starting and continuing to breastfeed. This identifies the need for increased support for the mothers and families of these children so that infants who have or are at increased risk for special health care needs can be exposed to the proven health benefits of breast milk. Breastfeeding is also less common for children with other vulnerabilities such as living below the federal poverty level or being exposed to tobacco inside the home, indicating that in many cases children who were not breastfed optimally are also exposed to other factors that can negatively affect health.




School of Medicine



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