Infants Receiving Informal Daycare Less Likely to be Breast-Fed

From Medscape Medical News
Pauline Anderson

June 24, 2010 — Infants cared for by grandparents, other relatives, or friends are less likely to be breast-fed than those looked after by their mother. Also, infants who attend formal daycare are less likely to be breast-fed if they are from a more advantaged family and are in daycare full time, according to a new study.

"[O]ur findings imply that, while informal childcare has a detrimental affect on breastfeeding in all social groups, only mothers from the highest socioeconomic groups were less likely to breastfeed if they used formal childcare," said the study authors.

The study, carried out by researchers at the Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, United Kingdom, appears online in the Archives of Disease in Childhood.

On the basis of data from the UK Millennium Cohort Study, a longitudinal study of children born in 2000-2002, the analysis included 18,050 infants. They were considered to be breast-fed if they were given any breast milk for at least 4 months.

For the study, informal childcare was defined as care provided by a grandparent or other relative, friend, or unregistered child minder that lasted at least 10 hours a week and began before the child turned 4 months. Formal care was that provided in a nursery or childcare center or by a registered child minder or nanny.

The researchers stratified the mother's social class (managerial and professional, intermediate, and routine and manual occupations) and education and distinguished "lone" parent from those who were part of a couple. They also adjusted for confounders, including ethnicity, parity, age at first live birth, and paid employment in the first 4 months of the infant's life.

About a third of infants (5360) were breast-fed for at least 4 months. The proportion of mothers who breast-fed was consistently lower in the less advantaged groups and across all childcare types.

Before the age of 4 months, 7% of infants were cared for in informal childcare for at least 10 hours a week, mostly by grandparents. The proportion of infants in any kind of care before the age of 4 months was low (9%).

Infants in both part-time (10 – 30 hours a week) and full-time (>30 hours a week) informal childcare were less likely to be breast-fed than those cared for by a parent (relative risk [RR], 0.51; 95% confidence interval [CI], 0.43 – 0.59). This reduced likelihood of breast-feeding was seen in all socioeconomic groups. "Therefore breastfeeding campaigns in the UK might be aimed at all members of society, as well as targeting disadvantaged current and future mothers," wrote the study authors.

Formal childcare was also associated with lower likelihood of breast-feeding but only for full-time care (RR, 0.68; 95% CI, 0.51 – 0.92) and for mothers with managerial and professional backgrounds (RR, 0.76; 95% CI, 0.62 – 0.94), a higher education (RR, 0.71; 95% CI, 0.58 – 0.86), or a partner (RR, 0.79; 95% CI, 0.66 – 0.94). In contrast, lone mothers were almost twice as likely to breast-feed if the infant was cared for in formal childcare.

"Compared to those cared for only by a parent (or in childcare for less than 10 hours a week), infants were less likely to be breast-fed (at all), if they were cared for in informal childcare (both part-time and full time) and in formal childcare (after adjustment and for full time care only) before the age of 4 months," wrote the study authors.

Infant Feeding Advice

Because many mothers get infant feeding advice from their own mothers who provide most informal daycare, information about breast-feeding might be targeted to grandparents through such channels as a recently launched UK website aimed at grandparents. "The move by the UK government in the 2009 budget to provide grandparents with National Insurance credits for caring for grandchildren may also provide a vehicle for health promotion," noted the study authors.

Breast-feeding could also be promoted at childcare centers by, for example, allowing moms to store expressed milk, they added. "Greater support during pregnancy and after birth may help mothers when making decisions about infant feeding, employment, and childcare, enabling them to consider all possible options."

What Other Factors Influence Decision for Breast-Feeding?

Adjusting for maternal employment did not change the association between childcare and breast-feeding. However, childcare did not necessarily precede cessation of breast-feeding before the age of 4 months. "It is likely that, for many mothers, it is not childcare use in isolation that influences the decision to breastfeed but a chain of antenatal decision about infant feeding, childcare, and employment."

The World Health Organization recommends that infants be exclusively breast-fed for 6 months. In 2005, only 25% of mothers living in the United Kingdom breast-fed for this length of time, and mothers from lower socioeconomic backgrounds were less likely to breast-feed.

The study was conducted by the Public Health Research Consortium, which is funded by the Department of Health Policy Research Programme. Additional funding support for the study was provided by the Medical Research Council Centre of Epidemiology for Child Health. One author is supported by a Medical Research Council Career Development Award in Biostatistics. The other authors have disclosed no relevant financial relationships.

Arch Dis Child. Published online June 24, 2010.