Evidence supporting the association between breastfeeding patterns and autism is inconsistent. This study examined sociodemographic and birth factors related to breastfeeding duration and subsequent autism spectrum disorder (autism) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, compared to a neurotypically developing cohort, based on electronic health records. Demographics, feeding preferences, and breastfeeding duration as reported by parents during routine baby wellness visits were analyzed for a cohort of 11,766 (1.9%) children with autism spectrum disorder diagnosis and a random subsample of 12,000 (2.03%) neurotypically developing children. Autism spectrum disorder diagnosis was based on a national autism registry and assigned after electronic health records were completed. Preterm, very low birth weight, multiple births, and complex medical comorbidities were excluded. Infants subsequently diagnosed with autism were breastfed for an average of 5.0 months, 1.5 months shorter than neurotypically developing. Fewer autism spectrum disorder infants were exclusively breastfed in the first year of life. Two-way analysis of variance indicated a significant effect of socioeconomic status and autism spectrum disorder on breastfeeding duration, and a significant interaction of socioeconomic status with autism spectrum disorder. Shorter breastfeeding duration among infants with subsequent autism spectrum disorder was confirmed, calling for closer monitoring for autism traits in infants with breastfeeding difficulties. These challenges were independent of birth parameters; however, they were influenced by socioeconomic factors.
Lay Abstract
This study found that infants later diagnosed with autism were breastfed for a shorter duration than their typically developing peers, with differences influenced by socioeconomic status. These findings highlight the importance of monitoring breastfeeding challenges as a potential early indicator of autism, particularly in families of mid-range socioeconomic status.
Abd ElmaksoudM. S.AlyO.Abd ElfatahM.MahfouzA. (2022). Breastfeeding and autism spectrum disorder: A cross-sectional study from Egypt. Alexandria Journal of Pediatrics, 35(1), 59–66. https://doi.org/10.4103/ajop.ajop_10_22
2.
Al-FarsiY. M.Al-SharbatiM. M.WalyM. I.Al-FarsiO. A.Al-ShafaeeM. A.Al-KhaduriM. M.TrivediM. S.DethR. C. (2012). Effect of suboptimal breast-feeding on occurrence of autism: A case–control study. Nutrition, 28(7–8), e27–e32. https://doi.org/10.1016/j.nut.2012.01.007
3.
AllenL.Leon-AttiaO.ShahamM.SheferS.GabisL. V. (2020). Autism risk linked to prematurity is more accentuated in girls. PLOS ONE, 15(8), 1–12. https://doi.org/10.1371/journal.pone.0236994
4.
AloufiH. R.AlotaibiF. F.ZamzamiL. Z.AlmadaniR. M. (2022). Breastfeeding and its relation with autism spectrum disorder in children. Egyptian Journal of Hospital Medicine, 87(1), 1092–1096. https://doi.org/10.21608/ejhm.2022.221663
5.
AnderssonY.HammarströmM. L.LönnerdalB.GraverholtG.FältH.HernellO. (2009). Formula feeding skews immune cell composition toward adaptive immunity compared to breastfeeding. Journal of Immunology, 183(7), 4322–4328.
6.
AustinD. W.BusijaL.BrownC. M. (2014). Observable essential fatty acid deficiency markers and autism spectrum disorder. Breastfeeding Review, 22(2), 21–26.
7.
BenetouV.TavoulariE.-F.GryparisA.LinosA. (2019). Reducing Caesarean sections and smoking after delivery could help to tackle shorter exclusive breastfeeding duration. Acta Paediatrica, 108(11), 2107–2108. https://doi.org/10.1111/apa.14927
8.
Ben-SassonA.GuedaliaJ.IlanK.ShahamM.SheferG.CohenR.TamirY.GabisL. V. (2024). Predicting autism traits from baby wellness records: A machine learning approach. Autism: The International Journal of Research and Practice, 28(12), 3063–3077. https://doi.org/10.1177/13623613241253311
9.
Ben-SassonA.GuedaliaJ.NativL.IlanK.ShahamM.GabisL. V. (2024). A prediction model of autism spectrum diagnosis from well-baby electronic data using machine learning. Children, 11(4), 429. https://doi.org/10.3390/children11040429
10.
BerthozS.LalanneC.CraneL.HillE. L. (2013). Investigating emotional impairments in adults with autism spectrum disorders and the broader autism phenotype. Psychiatry Research, 208(3), 257–264. https://doi.org/10.1016/j.psychres.2013.05.014
11.
BrianJ. A.BrysonS. E.ZwaigenbaumL. (2015). Autism spectrum disorder in infancy: Developmental considerations in treatment targets. Current Opinion in Neurology, 28(2), 117–123. https://doi.org/10.1097/WCO.0000000000000182
CoxJ. L.HoldenJ. M.SagovskyR. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786. https://doi.org/10.1192/bjp.150.6.782
15.
da SilvaV. B.AlvesF. D.CezarI. A. M.BandeiraL. V. S.OliveiraS. L. N.de RezendeL. F.de Araújo SaegerV. S.FreireR. S.SilveiraM. F. (2024). Breastfeeding and autism spectrum disorder: Case-control study. Revista Brasileira de Saúde Materno Infantil, 24, Article e0000340. https://doi.org/10.1590/1806-9304202400000340-en
16.
EidelmanA. I. (2022). Challenges to the autistic mother who wishes to breastfeed. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 17(12), 979–980. https://doi.org/10.1089/bfm.2022.29228.editorial
17.
ElbedourL.BalaumR.AlhozyelE.MeiriG.ZigdonD.MichaelovskiA.KerubO.MenasheI. (2024). Breastfeeding patterns in infants are associated with a later diagnosis of autism spectrum disorder. Autism Research, 17(8), 1696–1704. https://doi.org/10.1002/aur.3211
18.
EshraghiR. S.DethR. C.MittalR.ArankeM.KayS.-I. S.MoshireeB.EshraghiA. A. (2018). Early disruption of the microbiome leading to decreased antioxidant capacity and epigenetic changes: Implications for the rise in autism. Frontiers in Cellular Neuroscience, 12, 256. https://doi.org/10.3389/fncel.2018.00256
19.
GabayZ. P.GondweK. W.TopazM. (2022). Predicting risk for early breastfeeding cessation in Israel. Maternal & Child Health Journal, 26(6), 1261–1272. https://doi.org/10.1007/s10995-021-03292-3
20.
GabisL. V.ShahamM.Leon AttiaO.SheferS.RosenanR.GabisT.DaloyaM. (2021). The weak link: Hypotonia in infancy and autism early identification. Frontiers in Neurology, 12, Article 612674. https://doi.org/10.3389/fneur.2021.612674
21.
GhozyS.TranL.NaveedS.QuynhT. T. H.Helmy ZayanA.WaqasA.SayedA. K. H.KarimzadehS.HirayamaK.HuyN. T. (2020). Association of breastfeeding status with risk of autism spectrum disorder: A systematic review, dose-response analysis and meta-analysis. Asian Journal of Psychiatry, 48, 101916. https://doi.org/10.1016/j.ajp.2019.101916
22.
GrantA.JonesS.WilliamsK.LeighJ.BrownA. (2022). Autistic women’s views and experiences of infant feeding: A systematic review of qualitative evidence. Autism: The International Journal of Research and Practice, 26(6), 1341–1352. https://doi.org/10.1177/13623613221089374
23.
HendersonJ. J.EvansS. F.StratonJ. A.PriestS. R.HaganR. (2003). Impact of postnatal depression on breastfeeding duration. Birth (Berkeley, Calif.), 30(3), 175–180. https://doi.org/10.1046/j.1523-536x.2003.00242.x
24.
HuangS.WangX.SunT.YuH.LiaoY.CaoM.CaiL.LiX.LinL.SuX.JingJ. (2021). Association of breastfeeding for the first six months of life and autism spectrum disorders: A national multi-center study in China. Nutrients, 14(1), 45. https://doi.org/10.3390/nu14010045
25.
HuskJ. S.KeimS. A. (2015). Breastfeeding and autism spectrum disorder in the National Survey of Children’s Health. Epidemiology, 26(4), 451–457. https://doi.org/10.1097/EDE.0000000000000290
26.
IngersollB.HambrickD. Z. (2011). The relationship between the broader autism phenotype, child severity, and stress and depression in parents of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 337–344. https://doi.org/10.1016/j.rasd.2010.04.017
27.
Israeli Ministry of Health. (2017). Guidelines for promotion, protection, and support of breastfeeding in well-baby clinics (Tipat Halav). https://www.gov.il/he/pages/bz06-2017
28.
Israel Ministry of Health. (2023). MABAT Infant 2: Second national survey on the health and nutritional status of infants aged 9–11 months in Israel, 2019–2020. Israel Center for Disease Control. https://www.gov.il/he/pages/mabat-infant2
JenabiE.BashirianS.SalehiA. M.KhazaeiS. (2022). Not breastfeeding and risk of autism spectrum disorders among children: A meta-analysis. Clinical and Experimental Pediatrics, 66(1), 28–31. https://doi.org/10.3345/cep.2021.01872
31.
KaraT.AlpganÖ. (2020). Nursing personality and features in children with autism spectrum disorder aged 0–2: An exploratory case-control study. Nutritional Neuroscience, 25(6), 1200–1208. https://doi.org/10.1080/1028415X.2020.1843891
32.
KolevzonA.GrossR.ReichenbergA. (2007). Prenatal and perinatal risk factors for autism: A review and integration of findings. Archives of Pediatrics & Adolescent Medicine, 161(4), 326–333. https://doi.org/10.1001/archpedi.161.4.326
33.
KrolK. M.MonakhovM.San LaiP.EbsteinR. P.GrossmannT. (2015). Genetic variation in CD38 and breastfeeding experience interact to impact infants’ attention to social eye cues. Proceedings of the National Academy of Sciences of the United States of America, 112(39), E5434–E5442. https://doi.org/10.1073/pnas.1506352112
34.
LemckeS.ParnerE. T.BjerrumM.ThomsenP. E. R. H.LauritsenM. B. (2018). Early regulation in children who are later diagnosed with autism spectrum disorder. A longitudinal study within the Danish national birth cohort. Infant Mental Health Journal, 39(2), 170–182. https://doi.org/10.1002/imhj.21701
35.
LimperopoulosC. (2009). Autism spectrum disorders in survivors of extreme prematurity. Clinics in Perinatology, 36(4), 791–805. https://doi.org/10.1016/j.clp.2009.07.010
36.
LinA. E.Brunetti-PierriN.LindsayM. E.SchimmentiL. A.StarrL. J. (2017/2024). Myhre syndrome. In AdamM. P.FeldmanJ.MirzaaG. M.PagonR. A.WallaceS. E.AmemiyaA. [Eds.], GeneReviews® [Internet] (pp. 1993–2025). University of Washington.
37.
LucasR. F.CutlerA. (2015). Dysregulated breastfeeding behaviors in children later diagnosed with autism. Journal of Perinatal Education, 24(3), 171–180. https://doi.org/10.1891/1058-1243.24.3.171
38.
ManoharH.PravallikaM.KandasamyP.ChandrasekaranV.RajkumarR. P. (2018). Role of exclusive breastfeeding in conferring protection in children at-risk for autism spectrum disorder: Results from a sibling case–control study. Journal of Neurosciences in Rural Practice, 9(1), 132.
39.
NascimentoM. B. R. D.IsslerH. (2004). Breastfeeding in premature infants: In-hospital clinical management. Jornal de Pediatria, 80, s163–s172. https://doi.org/10.2223/1250
PeriesM.DuhrF.PicotM. C.HeudeB.BernardJ. Y.BaghdadliA. (2023). Breastfeeding is not a risk factor for clinical severity in autism spectrum disorder in children from the ELENA cohort. Scientific Reports, 13(1), 816. https://doi.org/10.1038/s41598-022-27040-x
42.
PunatarR.AngkustsiriK.KairL. R.TancrediD. J.HarveyD. J.SchmidtR. J. (2024). Association of breastfeeding duration with neurodevelopmental outcomes in an enriched familial likelihood cohort for autism spectrum disorder. Child Psychiatry and Human Development. Advance online publication. https://doi.org/10.1007/s10578-024-01700-7
43.
ReynoldsR.KingslandM.DalyJ.LicataM.TullyB.DohertyE.FarragherE.DesmetC.LecathelinaisC.WiggersJ.HollisJ.McKieJ.WilliamsM. (2023). Breastfeeding practices and associations with pregnancy, maternal and infant characteristics in Australia: A cross-sectional study. International Breastfeeding Journal, 18(1), 8. https://doi.org/10.1186/s13006-023-00545-5
44.
SaighM. (2025). Influence of early-life gut microbiota on neurodevelopmental disorders: Aspirations for breastfeeding interventions. Frontiers in Neuroscience, 19, Article 101123. https://doi.org/10.3389/fnins.2025.101123
45.
SauerwaldT.DemmelmairH.KoletzkoB. (2001). Long-chain polyunsaturated fatty acids in early neurodevelopment. European Journal of Pediatrics, 160(2), 72–74. https://doi.org/10.1007/s004310000537
46.
SayG. N.BabadağıZ.KarabekiroğluK. (2015). Breastfeeding history in children with autism and attention deficit hyperactivity disorder. Breastfeeding Medicine, 10(5), 283–284. https://doi.org/10.1089/bfm.2015.0033
47.
SchamsD. (1994). Growth factors in milk. Endocrine Regulations, 28(1), 3–8.
48.
SchultzS. T.Klonoff-CohenH. S.WingardD. L.AkshoomoffN. A.MaceraC. A.JiM.BacherC. (2006). Breastfeeding, infant formula supplementation, and Autistic Disorder: The results of a parent survey. International Breastfeeding Journal, 1, 16–17. https://doi.org/10.1186/1746-4358-1-16
49.
ShafaiT.MustafaM.HildT.MulariJ.CurtisA. (2014). The association of early weaning and formula feeding with autism spectrum disorders. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 9(5), 275–276. https://doi.org/10.1089/bfm.2013.0104
SokeG. N.MaennerM.SchieveL. A.WindhamG.MoodyE.KaczaniukJ.DiGuiseppiC. (2019). Association between breastfeeding initiation and duration and autism spectrum disorder in preschool children enrolled in the study to explore early development. Autism Research, 12(5), 816–829. https://doi.org/10.1002/aur.2091
52.
SpyrakouE.MagriplisE.BenetouV.ZampelasA. (2022). Factors associated with breastfeeding initiation and duration in Greece: Data from the Hellenic National Nutrition and Health Survey. Children, 9(11), 1773. https://doi.org/10.3390/children9111773
53.
SteinmanG.MankutaD. (2013). Breastfeeding as a possible deterrent to autism–A clinical perspective. Medical Hypotheses, 81(6), 999–1001.
54.
TsengP.-T.ChenY.-W.StubbsB.CarvalhoA. F.WhiteleyP.TangC.-H.YangW.-C.ChenT.-Y.LiD.-J.ChuC.-S.YangW.-C.LiangH.-Y.WuC.-K.YenC.-F.LinP.-Y. (2019). Maternal breastfeeding and autism spectrum disorder in children: A systematic review and meta-analysis. Nutritional Neuroscience, 22(5), 354–362. https://doi.org/10.1080/1028415X.2017.1388598
55.
van ‘t HofM.EsterW. A.SerdarevicF.van Berckelaer-OnnesI.HillegersM. H. J.TiemeierH.HoekH. W.JansenP. W. (2020). The sex-specific association between autistic traits and eating behavior in childhood: An exploratory study in the general population. Appetite, 147, 104519. https://doi.org/10.1016/j.appet.2019.104519
56.
VarmaC.de SouzaN. (2023). Feeding behaviours in infancy of children later diagnosed with autism spectrum disorder. International Journal of Contemporary Pediatrics, 10(8), 1280–1286. https://doi.org/10.18203/2349-3291.ijcp20232249
57.
VictoraC. G.BahlR.BarrosA. J. D.FrançaG. V. A.HortonS.KrasevecJ.MurchS.SankarM. J.WalkerN.RollinsN. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7
58.
VrbinC. M. (2022). Parametric or nonparametric statistical tests: Considerations when choosing the most appropriate option for your data. Cytopathology, 33(6), 663–667.
WilsonJ. C.AndrassyB. (2022). Breastfeeding experiences of autistic women. MCN: The American Journal of Maternal/Child Nursing, 47(1), 19–24. https://doi.org/10.1097/NMC.0000000000000779
61.
WozniakR. H.LeezenbaumN. B.NorthrupJ. B.WestK. L.IversonJ. M. (2017). The development of autism spectrum disorders: Variability and causal complexity. Wiley interdisciplinary reviews. Cognitive Science, 8(1–2). https://doi.org/10.1002/wcs.1426
62.
XiangX.YangT.ChenJ.ChenL.DaiY.LiT.ZhangJ.LiL.JiaF.WuL.HaoY.KeX.YiM.HongQ.ChenJ.FangS.WangY.WangQ.JinC. (2023). Association of feeding patterns in infancy with later autism symptoms and neurodevelopment: A national multicentre survey. BMC Psychiatry, 23(1), Article 174. https://doi.org/10.1186/s12888-023-04667-2
63.
ZhanX.-L.PanN.KaratelaS.ShiL.WangX.LiuZ.-Y.JingJ.LiX.-H.CaiL.LinL.-Z. (2023). Infant feeding practices and autism spectrum disorder in US children aged 2–5 years: The national survey of children’s health (NSCH) 2016–2020. International Breastfeeding Journal, 18(1), 1–12. https://doi.org/10.1186/s13006-023-00580-2
64.
ZimmermanD. R.KaplanM.ShoobH.FreisthlerM.ToledanoM.Stein-ZamirC. (2022). Breastfeeding challenges and support in a high initiation population. Israel Journal of Health Policy Research, 11(1), 1–10. https://doi.org/10.1186/s13584-022-00538-5
65.
ZwaigenbaumL.BrysonS.GaronN. (2013). Early identification of autism spectrum disorders. Behavioural Brain Research, 251, 133–146. https://doi.org/10.1016/j.bbr.2013.04.004
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