Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study

OBJECTIVES. We explored whether breastfeeding was protective against maternally perpetrated child maltreatment. METHODS. A total of 7223 Australian mother-infant pairs were monitored prospectively over 15 years. In 6621 (91.7%) cases, the duration of breastfeeding was analyzed with respect to child maltreatment (including neglect, physical abuse, and emotional abuse), on the basis of substantiated child protection agency reports. Multinomial logistic regression was used to compare no maltreatment with nonmaternal and maternally perpetrated maltreatment and to adjust for confounding in 5890 cases with complete data (81.5%). Potential confounders included sociodemographic factors, pregnancy wantedness, substance abuse during pregnancy, postpartum employment, attitudes regarding infant caregiving, and symptoms of anxiety or depression. RESULTS. Of 512 children with substantiated maltreatment reports, >60% experienced >= 1 episode of maternally perpetrated abuse or neglect (4.3% of the cohort). The odds ratio for maternal maltreatment increased as breastfeeding duration decreased, with the odds of maternal maltreatment for nonbreastfed children being 4.8 times the odds for children breastfed for >= 4 months. After adjustment for confounding, the odds for nonbreastfed infants remained 2.6 times higher, with no association seen between breastfeeding and nonmaternal maltreatment. Maternal neglect was the only maltreatment subtype associated independently with breastfeeding duration. CONCLUSION. Among other factors, breastfeeding may help to protect against maternally perpetrated child maltreatment, particularly child neglect. Pediatrics 2009; 123: 483-493