How Important is Breast Feeding for The Development of Preterm Infants?

Myriam Al Bcherraoui
· 5 min read

The question as to whether breastfeeding holds greater benefits over bottle-feeding is one of the most controversial issue among scientists. In fact, there has been many debates over the years on the long-lasting impact of breastfeeding on children’s development. While some studies have found that breastfed infants score higher on IQ tests in childhood and adolescence, other studies have argued that the reason behind this is not due to breastfeeding per se, instead it is due to the fact that mothers who breastfeed are generally older, more educated, and enjoy a more supportive environment compared to mothers who do not breastfeed. Nevertheless, several studies have shown that breast milk includes nutritional benefits which directly impact infants’ neural and cognitive functioning. Not only does breastfeeding influence cognitive development, but also produces positive effects on the mother-child relationship, which indirectly supports cognitive development.

For pre-term infants, breast milk poses more definite positive effects in terms of cognitive development. Breast milk is beneficial for premature infants for several reasons:

· It provides the optimal nutritional components including adequate amounts of proteins, enzymes, lipids, fatty acids, and other micronutrients; all of which are important factors for growth and development.
· It supports premature infants by decreasing the possibility of infection and improving gastrointestinal function and the absorption of nutrients.

Responsive image

With premature infants, mothers generally face greater difficulties in bonding with their child. As a matter of fact, the mother-infant relationship is strained by multiple factors. The initial separation, medical problems, uncertain survival, a shorter pregnancy, disruption in the mother’s preparation for birth and motherhood all interfere with the ability of the mother to develop desirable maternal behaviors. Mothers of premature infants show increased levels of anxiety and depression, which additionally hinder the development of the mother-infant relationship. Moreover, increased levels of intrusiveness and decreased levels of sensitivity are seen among mothers of premature infants, thus, leading to significantly less skin-to-skin contact. Intervention programs that improve maternal-infant contact during the neonatal period were found to be effective by increasing maternal adaptation and infant alertness; in turn, better cognitive outcomes are observed. Breastfeeding is one of these important bonding experiences that can strengthen maternal-infant contact, increase maternal responsiveness to infant cues, and improve infant interaction, which may lead to better cognitive outcomes.

Breast milk not only poses psychological benefits for mothers, but also psychobiological. Prolactin and oxytocin, the hormones released during breastfeeding, have been found to play a role in stress management and maternal behavior, and the reduction of depression and anxiety.

In this study, Feldman & Eidelman (2003) examined the role of breast milk in premature infants’ cognitive and neurobehavioral development. They tested 86 premature infants and classified them into three groups according to the amount of breast-milk consumed during the hospitalization period:

· First group are those receiving minimal (less than 25% of nutrition) amounts of breast milk.
· Second group are those receiving intermediate (between 25-75%) amounts of breast milk.
· Third group are those receiving substantial (more than 75%) amounts of breast milk.

At 37 weeks gestational age, mother-infant interactions were video-taped, maternal depression was self-reported, and neurobehavioral maturation was assessed by the Neonatal Behavior Assessment Seale. Once infants reached 6 months of age, they were assessed on a combination of early cognitive skills using the Bayley II Mental Developmental Index (MDI). Results indicated that infants who received substantial amounts of breast milk presented better neurodevelopmental profiles, were more alert during social interactions, exhibited higher mental and psychomotor skills at 6 months, and enjoyed greater affectionate touch by their mothers. Moreover, only those receiving substantial amounts of breast milk displayed higher cognitive skills, indicating that a specific amount of breast milk must be supplied for premature infants in order to have a long-lasting impact on their development. Therefore, breast milk may have enhanced infants’ attention and arousal regulation, which lead to better cognitive development.

Breast milk was also associated with enhanced mother-infant interactions, increased maternal affectionate touch, and lower maternal depression. In contrast, higher maternal depression was associated with the groups receiving lower amounts of breast milk. High maternal depression was also related to reduced maternal affectionate touch and lower infant cognitive skills. Thus, the amount of breast milk indirectly contributes to the cognitive development of premature infants whereby higher amounts of breast milk is associated with better maternal mood and enhanced interactive behavior.


Feldman, R., & Eidelman, A. I. (2003). Direct and indirect effects of breast milk on the neurobehavioral and cognitive development of premature infants. Developmental Psychobiology: The Journal of the International Society for Developmental Psychobiology, 43(2), 109-119.