Effects of Breastfeeding on Child Cognition

The Effect of Breastfeeding on
Children’s Cognition
Alghamdi
Comparative Analysis
Research Question what are the effects of breastfeeding on
children’s cognition?
This analysis is intended to summarize the two studies of
interest and attempt to answer the research question.
Study one: Breastfeeding and child cognitive outcomes
Study two: The effect of breastfeeding on child development at
5 years: A cohort study
Article #1 Summary
Conducted by: Jiang, M., Foster, E., & Gibson-Davis
Purpose: To investigate the the effects of breastfeeding duration
and initiation on children’s cognition (perception).
This study took into account previous studies, and it intended to
discover the deficiencies that other studies have on the same
topic area.
This study focused on confounding variables that can intervene
with results.
Article # 1 Summary(Methodology)
Design
The method used is correlational study since it studied the
relationship between breastfeeding and cognition. There were

3,271 participants selected from The Child Development
Supplement(CDS).
Materials
Tests
1-Woodcock Johnson Psycho-Educational Battery-Revised(WJ-
R), which examines cognitive abilities in different areas, such
as present progress position and proficiency in math and
literacy(Reading).
2-Wechsler Intelligence Scale for Children-Revised (WISC-R)
tests, which examines children’s capability to deal with
information in memory( working memory).
Article # 1 Summary(Methodology)
Materials(Continue)
The Child Development Supplement(CDS)
is a part of The Panel Study of Income Dynamics (PSID). The
participants and their families where selected from CDS. Also,
CDS provides information concerning children and their
families, such as cognitive abilities, children’s families and
neighborhood conditions (Health).
1997 CDS interviews
Previous literature
CDS Data
Article # 1 (Methodology)
Data collection procedures
Variables
1-Cognition data were collected from tests mentioned.

2-Breastfeeding initiation and period are the independent
variables and were collected from 1997 CDS interviews.
Breastfeeding can be divided into four groups: not once
breastfeed, less that 6 months, between 7 months and year and
more than a year.
3- Confounding variables were collected from lit review, CDS
and PSID. There are three groups of confounding variables:
A-Children confounding variables
B-Mothers confounding variables, such as IQ scores taken from
1997 CDS, education and age.
C-Family confounding variables, such as income since the child
birth.
Note: there are many confounding variables that had been
investigated. However, there is no space to mention them here.
Data analysis Procedures
Propensity Score Matching is ,According to Jiang et al. ( 2011)
,“ the conditional probability of assignment to treatment given a
set of covariates” Calculating Propensity Score for
breastfeeding initiation.
Calculating Propensity Score for breastfeeding period
Used Imbens method to investigate the relation between
breastfeeding and cognition.
Using a multinomial logic model to calculate propensity of each
group period of time.

Ordinary regression is used.
This study is based on interviews. However, there were multiple
incidents that data was missing
The procedures used is
Imputations(MI)
IQ measures taken from 1972 PSID interview.
Article # 1 Summary
Results
Data was collected on the sample from the1997 Interviews.
Children
Ages: range from 4 months- 15 years. Average age is
Seven and half years old.
Gender: 50% females.
Ethnic Group: 40% were African American.
Order: 8% were the first child
15% were born preterm.
Article#1Summary
Results(continue)
Children who breastfed achieved high scores on the tests(WJ-R
and WISC-R).
Children were white, less likely to be born preterm.
Mothers who breastfed tended to be older than mothers did not
breastfeed, achieved high scores on IQ and education.
Mothers who breastfed are more likely to be married. Also,
their income is higher comparing to never have breastfed.
Article#1Summary

Results
The effect of breastfeeding initiation.
Children who were breastfed achieved higher scores on
tests(2002).
Children achieved higher scores on “applied problems” than
those who had not been breastfed.
Article#1Summary
Results
The effect of breast feeding period
The study analysis indicated that there was not a linear
correlation between children’s cognitive abilities and
breastfeeding period.
Children who were breastfed for 1-6 months showed the same
results as children who were breastfed more than 6 months.
Children who were breastfed for 1-6 months achieved higher
scores only on ”applied problems” compared to children who
were never breastfed.
Example: Concerning comprehension, children who were never
berstfed achieved 98.1 and children who were breastfed for 12
months achieved 96.7
Article#1Discussion
Literature review showed children who were breastfed achieved
higher scores on cognitive tests than children who drank milk
formula. However, higher scores on cognitive tests can result
from other factors, such as the mother’s traits.
A study claimed that there is no big difference between children
who were breastfed longer than children who were never

breastfed. In fact, the study claimed that children who were
breastfed more that six months, their outcomes did not have
significant effect.
Higher cognitive abilities are best seen when children are
breastfed during the first six months. After six months passed,
breastfeeding is less associated with high cognitive scores.
Article#1 Discussion
Limitations
1-Data collected regarding breastfeeding was mostly dependent
on the memory of mothers.
2-when conducting supplemental analysis, investigators found
almost identical effects.
3-Investigators were unable to eliminate mothers’ bias in
recalling on breastfeeding
4-The study is considered not exclusive since its based on
observational data. For instance, some studies stated that some
children are still breastfed after 6 months.
Discussion
Limitation (continue)
Since it is an observational study, random assignment was not
applicable in this study. In fact, the study may be affected by
selection effect. Thus, regression was used. However, it is
restricted on some aspects. In this case, score propensity was
used.
Propensity score was used to regulate the confounding
variables. The study claimed that it considered a broad range of
covariates based on previous lit review.

Discussion
Furthermore, some cognition results, such as applied problems,
are very strong in relation to breastfeeding. However, other
results, such as WISC test, are based on sensitive analysis,
which means the tests results are sensitive. When using other
correction methods, the the latter results were not important.
Even though there are a lot of advantages of breastfeeding on
children and their mothers alike, mothers should not be treated
like they do not care about their children’s cognition
development. In fact, mothers should be allowed to breastfeed
whenever they want if needed.
Discussion
The study stated that public health considered the breastfeeding
is less significant than other aspects that can affect children’s
cognitive abilities, such as penury. As a result, in order to
improve children’s cognitive development, it is more important
to focus on other factors that may result in putting children in
danger.
Quality Criteria
Objectivity : The study had been done by a group of
researchers. So bias would be considered of no relevance. Also,
the study took into account different confounding variables that
may falsely attribute the relationship between the variables of
main interests.
Reliability: Reliability means the results will be the same if the
same instruments were used. In this case, I believe the results
may vary based on the confounding variables that are of most
concern to the researchers.
Validity : Had the study measured what it was supposed to
measure? In fact, the research question was if there was a

relationship between breastfeeding duration and initiation on
children’s cognition development. After the conduction of the
study, it was apparent that there was no significant effect of
breastfeeding duration and initiation on children’s cognition.
Quality Criteria(continue)
Representative sampling
The sample chosen in this study was taken from a Child
Development Supplement(CDS), which selected participants
randomly.
Replication
Any study that cannot be replicated is of no value. In this case,
the study can be replicated by using different people and
examining the same variables. In this case, to replicate the
results , a researcher can select another group of participants
and examine the same variables: confounding variables stated
in the study, breastfeeding period and initiation as independent
variables and children cognition.
Theoretical perspective
The theoretical perspective of this study is cognitive
developmental theory.
The cognitive theory is concerned with cognitive development
in cognition with biological and social factors
Cognitive development applies to this study for the reason
below:
This study is intended to measure cognitive development in
children by duration and initiation of breastfeeding. In other
words, how children develop cognitively.

Article #2: The effect of breastfeeding on child development at
5 years: A cohort study
Summary
Conducted by: Pj Quinn, M O’callghan, GM William, Jim
Najman, MJ Anderson and W Bor.
Hypotheses is, according to Quinn and et al.(2001), “duration of
breastfeeding would have direct beneficial effects on child
development at 5 years and that this effect would be
independent of social and family influences.”
Design
The study is correlational because it studies the relationship
between breastfeeding, which is an independent variable, and
another variable is cognition development.
Participants
3880 children (1842 females and 2038 males).
Materials
Questioners
Peabody Pictures Vocabulary Test Revised(PPVT-R) is
Standardized test to measure oral intelligence.
Rand health survey -Follow up surveys

Methodology
Data collection techniques
When the babies were age 6 months, questioners were given to
the mothers, which includes questions about the mothers’ social
and psychological aspects and were inquired for how long they
had breastfed according to 6 group periods.
Confounding variables
Mothers’ relationships with their children. For instance, if they
had talked and played with them. Also, if they has smoked
during pregnancy.
Mothers experiencing anxiety and depression during 6 months
and 5 years questionnaires and after delivery.
Methodology
At 5 years
Children were asked to take the PPVTR-R test. Children with
diseases concerning the neuron system were eliminated.
Confounding variables at 5 years Follow up:
Biological confounding variables were collected, such as
gender of the child, age, weight at birth, surgery history ..etc.
Other confounding variables regarding children’s mothers, such
as whether they are married or not, speak English, their first
experiences and knowledge of pregnancy, if they had
smoked…etc.
Note: there are other confounding variables that had been

addressed.
Methodology
Data analysis
Analysis of Variance was used to investigate the variation in
PPVT-R results in each period of breastfeeding.
Confounding variables were addressed for each child and and
also PPVT-R results.
Linear regression was used if the variables in PPVTR results
are (P<0.05).
Females and males data were analyzed independently.
results
Results
Children’s mothers not assessed with PPVT-R were
Probably unmarried
Diagnosis with anxiety and depression
Short period of breastfeeding
Children not assessed were
Weight at birth is less than assessed.
Mothers’ knowledge of pregnancy is considered unimportant
Results (continue)
Generally, after taking PPVT-R, children who were breastfed
for more than six months had higher scores(103.6) than those

were never breastfed(94.2).
Males and females were investigated independently and the
results were that females had higher scores than males.
Moreover, females and males who were breastfed more than six
months had higher scores than children who never breastfed.
There was a tendency to increase in PPVT-R scores in
accordance with increasing in period of breastfeeding.
Results
After taking cofounding variables into consideration, linear
regression is used, such as birth weight, poverty and others
which called is the adjusted model.
After using adjusted model for males and females, the results
were:
Males’ and females’ PPVT-R scores decreased. However,
children’s tests scores increased in accordance with increasing
in period of breastfeeding.
Conclusion
The duration of breastfeeding is important. Mothers should
breastfeed their children for 6 months and more due to the
strong effect on children’s cognitive development.
Discussion
This study is related to other studies regarding considering
confounding variables.
Other studies suggested that cognition development is related to
other factors rather than breastfeeding such as maternal
characteristics and environment that children live in.
Other studies suggested that breastfeeding has no relationship
with children social behaviors later in life. Thus, these studies
draw the conclusion that the relationships between
breastfeeding and cognitive development has no connection

with other factors such as social factors.
The relationship between breastfeeding and cognitive
development is said to be due to the milk characteristics . In
fact, breast milk have some elements that is related to the
development of children cognitive abilities.
Quality criteria
Objectivity : The study had been done by a group of researches.
So bias would be considered of no relevance. Also, study took
into account different confounding variables that may falsely
attribute the relationship between the variables of main
interests.
Reliability: Reliability means that the results will be the same if
the same instruments were used. In this case, I believe the
results may vary based on the confounding variables that are of
most concern to the researches.
Validity : Had the study measured what it was supposed to
measure? In fact, the research hypothesis was if there was a
relationship between breastfeeding duration on children
cognition development. After the conduction of the study, it was
apparent that there was significant effects of breastfeeding
duration on children’s cognition.
Quality Criteria
Representative Sampling
In this study, the representative sample is 3880 children (1842
females and 2038 males) selected from from Queensland study
of pregnancy (MUSP) project. It is considered represent the
children population.
Replication
Any study that cannot be replicated is of no value. In this case,

the study can be replicated by using different people and
examining the same variables. In this case, to replicate the
study, a researcher can select another group of participants and
examine the same variables: confounding variables stated in the
study, breastfeeding period as independent variables and
children cognition.
Theoretical perspective
The theoretical perspective of this study is cognitive
development theory.
This theory emphasized cognitive development according to
stages and in accordance to social and biological forces
This theory applies to the study to the reasons below:
This study concerns cognitive development in children which
is strongly emphasized in Piaget theory which was shown in the
study hypothesis.
Take Home Message
Study one contradicted study in regard to the effectiveness of
breastfeeding period on children cognition. In fact, study one
stated that there is not a linear correlation between
breastfeeding and cognition whereas the second indicated that
there was a correlational relationship between breastfeeding
period
According to the studies, Scientifically, first study is more
accurate since it took into account the multiple confounding
variables. However, most previous research were in agreement
with study two.
Take home Message

Limitation: In order to judge the validity of research on a single
research topic, investigators should not draw conclusions based
on one or two studies. There must be multiple research studies
that have the same results.
Confounding variables are very tricky and can sometimes be
conceivable.
Future research
Replication of the two studies
Participants can be chosen from countries other than USA.
Considering other confounding variables
References
Jiang, M., Foster, E., & Gibson-Davis, C. M. (2011).
Breastfeeding and the child
cognitive outcomes: A propensity score matching
approach. Maternal and
Child Health Journal, 15(8), 1296-1307.
doi:10.1007/s10995-010-0677-5
Quinn, P. J., O'Callaghan, M. M., Williams, G. M., Najman, J.
M., Andersen, M. J., &
Bor, W. W. (2001). The effect of breastfeeding on child
development at 5 years: A
cohort study. Journal of Paediatrics and Child Health,
37(5), 465-469.
doi:10.1046/j.1440-1754.2001.00702.x
Rubric
Total Assignment = 100 pts (=23% of course grade)
10 pts -- Your research question/ appropriate selection of
articles and presentation length--total presentation should be no

shorter than 20 and no longer than 40 slides
45 pts -- Summary of each study; please include for each study
the following.
a. Purpose of Study--what are the study's research questions? (6
pts)
b. Design --First, answer this question: is this study
experimental?, quasi-experimental?, or correlational?
Experimental=are there randomly assigned groups that were
treated differently?, Quasi-Experimental--are there groups that
naturally occurred--e.g., smokers vs. non-smokers--that were
treated differently by the researcher?, Correlational--a group is
described and the results show differences among the group
members? Second, IF the study has a developmental focus,
analyze the developmental design: cross-sectional, longitudinal,
or sequential. (6 pts)
c. Methods--include participants, materials/instruments, data
collection techniques, and data analysis techniques. After
summarizing the methods, analyze what the researchers did in
terms of the criteria of 1) objectivity, 2) reliability, 3) validity,
4) representative sampling, and 5) replication. (21 pts)
Rubric
c. Methods--include participants, materials/instruments, data
collection techniques, and data analysis techniques. After
summarizing the methods, analyze what the researchers did in
terms of the criteria of 1) objectivity, 2) reliability, 3) validity,
4) representative sampling, and 5) replication. (21 pts)
d. Findings--look for information indicating significant
differences--connect the findings back to the research
hypotheses. The findings should be contained in the Results
section of the paper (6 pts)

e. Conclusions--summary of authors' interpretations from
Discussion section (6 pts)
Rubric
15 pts--Theoretical Perspective--what are the researchers'
(probably implicit) perspectives on human development?--
defend your decisions for each study with reasons (from the
purpose, design, data collection and analysis, results, and
interpretation); you should 1) identify (2 pts), 2) explain (5 pts),
and 3) defend (8 pts) whether the perspective of each study is
organismic, cognitive-developmental, cognitive-learning,
behavioral, psychodynamic, contextual, or humanistic. If
possible to determine the specific theory being tested by the
study, further analyze the origins of the developmental approach
being used. Be sure to defend your point of view.
15 pts -- Take Home Message--having read these two studies
(notice this is a comparative analysis), what do you now
believe? (=conclusions, 5 pts) What other questions do you
have? (=future research questions, 5 pts) What can you not
know for sure? (=limitations, 5 pts)
Instructions of Intervention Plan
· Intervention Plan
Students are asked to read several of the research presentations
and respond to ONE of them by creating a lesson plan or plan
for intervention to assist individuals with the problems
described in the research presentation.
· This assignment addresses the teaching goal of identifying
strategies for facilitating the development of people. For

example, if your classmate's presentation concerns adolescent
identity in the face of parental divorce, create a plan for
intervention or treatment to help those adolescents that is based
on the conclusions of the research presentation.
· If your classmate's presentation concerns caregivers' health
problems in the face of a family member with Alzheimer's,
create a plan for intervention or treatment to help those
caregivers that is based on the results of the studies summarized
in the presentation.
· If your classmate's presentation concerns college student
grades in the face of extracurricular involvement in athletics,
create a lesson plan or intervention plan to help college students
that is based on the results of the studies.
· If your classmate's presentation concerns the effects of silent
reading on middle schoolers' comprehension skills, create a
lesson plan to help middle schoolers that is based on the results
of the studies.
· Convince me that your plan is based on the results of the
studies.
· Please create your OWN intervention--do not borrow one used
in your school district or found in another study.
· Think CREATIVELY about what you might do, why it should
work, and exactly how you would implement it. Think through
the steps of implementation.
The plan should identify a target audience, and a target frame of
duration, and contain an objective, a summary of skills to be
developed, and specific techniques for reaching the objective
and developing the skills. Be sure to identify the research
presentation that you are responding to and explain how your
intervention addresses the issues explained in your classmate’s
research presentation.
Please note that in your References section you should not
include any article that you yourself have not read.
Your classmate’s research presentation will list both of the

studies your classmate read to produce the research
presentation. I encourage you to work from the summaries
produced by your classmate. Unless you have read those
original studies yourself, you may not ethically cite those
studies. If you use other sources in preparing your IP, you
should cite those sources faithfully.
I prefer that you write your IP in Word. Please attach the rubric
(available under the purple button "Course Documents") to the
end of your plan.
The IP will be evaluated according to the rubric under Course
Documents and is worth 7% of your course grade. Please send
the IP (in a Microsoft Word format) to me as an email
attachment with the rubric copied into the last pages no later
than the date listed in the Calendar.
· Intervention Plan Rubric
· YOU MUST FOLLOW THIS RUBRIC PLEASE
__of 1 point Identification of Research Presentation to which
your plan is in response
__ of 3 points Explain how the research presentation
findings motivated your intervention--be specific
__of 1 point Target Audience
__of 1 point Target Frame of Duration
__of 1 point Objective
__ of 4 points Skills to be developed
__ of 4 points Specific Techniques
__of 2 points Originality of Student's Intervention
__of 3 points Style--grammar, spelling, rhetorical structure, and
proper citation of any sources used, including your classmate's
research presentation--make a separate References page
__ of 20 points Total

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