Breastfeeding, Gut Health, and Mental Health in Children: A Correlational Study
Purpose of the Study
Various studies surrounding the gut microbiome and mental health suggest that there is a potential link between gut health and mental health through the gut-brain axis. There is growing evidence that serotonin, which acts as a key bi-directional neurotransmitter of the microbiome-gut-brain axis, regulates, emotions, stress response, behaviors, and cerebellar regulation is altered with intestinal inflammation (Sandgren & Brummer, 2018). This same bi-directional function allows the brain to influence intestinal activities and the gut to influence mood, cognition, and mental health (Appleton, 2018). Diaz (2016) suggests that there is a direct connection between the complex gut microbiome and the regulation of the nervous system.
Experiments conducted both on laboratory mice and children with ASD demonstrate promising findings. A 2004 study on mice showed that mice who were wiped of their gut microbiome experienced elevated levels of stress hormones and anxiety until their guts were reconstituted with healthy bacteria and Bifidobacterium. The younger mice demonstrated a better recovery than older mice, implying “there is a critical period during which young brains are more susceptible to influence from the gut, making it especially relevant to child psychiatry” (Rouse, 2018, p. 5). A study on 18 children with ASD demonstrated a drastic improvement in behavioral autism symptoms after a fecal transplant (Kang, et as., 2017)
During infancy, breast milk-derived microbes compose nearly one-third of the infant gut microbiome, which acts to “seed” the gut with the proper balance of beneficial bacteria known to play a role in immunity, metabolism, brain development, and behavior (Newmark, 2017). Infants who were exclusively breastfed at least five to six months demonstrated higher test results, better mental concentration, and short term memory than their non-breastfed counterparts (Bahrami, Hezaveh, Tanha, & Vafa, 2018). Reynolds, Hennessy, & Polek (2013) concluded “being breastfed remained a significant predictor of child mental well-being when child obesity was controlled for, indicating that being breastfed, independent of child obesity, is a predictor of child mental well-being” (p. 882). Thus, breast milk remains a key factor in overall health, including the healthy development of the brain, nervous system, and behavior.
Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are childhood mental health conditions that affect all racial, ethnic, and socioeconomic groups at ever-increasing rates. From 2004 to 2014 the incidence of ASD has increased by 10% while ADHD has increased 7.8% for children ages four to seventeen and more than 50% in children from 2007 to 2012 (Centers, for Disease Control, 2019). The interventions and treatments for these diagnoses that have been estimated to cost over a billion dollars per year in health care costs, behavioral treatments, and educational support (Abright, 2012). Aside from the financial impact of these conditions, caregivers for those with ASD and ADHD experience greater degrees of depression and anxiety due to the chronic stress and psychological strain over long periods of time (Schulz & Sherwood, 2008)
During the first year of life, a child’s gut microbiome is established largely by the consumption of either breastmilk or a breastmilk alternative such as formula. Recent research has shown that infants who are breastfed have a healthier gut microbiome, which plays a major role in mood, neurological development, and behavior (Lucas, 2018). Thus, breastmilk may provide a protective mechanism against childhood mental health disorders.
The purpose of this study is to examine a correlation between breastfeeding in infancy and a reduction in the diagnoses of ASD and ADHD in children.
At this time, research points to a direct correlation between an optimal gut microbiome and healthy neurological development in children. A correlational study examining the feeding methods and mental health outcomes in children is indicated.
What is the current impact of ADHD and ASD on today’s pediatric population?
How does the gut microbiome impact overall mental health?
How does breast milk impact the development of the gut microbiome?
Although this study is promising in what is has to offer for the future of mental health, there are limitations to the research and methodology. Participants may answer questions based on what they desire their child to be like instead of their true abilities and deficits (Meyers & Hansen, 2012). Test fatigue may result in incorrect or inaccurate responses from the participants as they are the caregivers for young children and have many responsibilities that limit their free time (Shivers, Krizova, & Lee, 2017).
Other limitations include family history, genetic factors influencing mental health, and the ways in which children are aided or disadvantaged based on the level of involvement from their caregivers. Participants who speak a foreign language or move from their home may create additional barriers to data collection.
250 families across five states: California, Texas, Minnesota, Florida, and New York
Families will be offered an opportunity to participate in the study while in the hospital after the birth of their child.
One-tailed longitudinal study
Quantitative factorial design
Data gathered through surveys
Expected to last five years
Informed Consent paperwork (start of study)
Demographic Survey (at start of study)
Health History Survey (each interval)
Parents’ Evaluation of Developmental Status (PEDS) (years zero to five)
PEDS: Developmental Milestones (PEDS: DM) (years zero to five) (PEDS Test, 2019)
Early Childhood Inventory-4 (years three to five)
M-CHAT-R (years three to five) (Overgaard et al., 2019)
Families will be placed into one of three groups:
Exclusively breastfed group (group one)
Exclusively formula-fed group (control group)
Mixed feeding group (group two)
Families will be surveyed at the following intervals:
Three months of age
Six months of age
Nine months of age
One year of age
Two years of age
Three years of age
Four years of age
Five years of age
Ethical considerations include the following:
The safety, welfare, and well-being of all participants involved
Protection of parental decision making
Respect for communities where infant feeding is a cultural choice
Protecting patient confidentiality
HIPAA violations, should a medical evaluation be suggested
Adherence to strict APA ethical guidelines
Protection of paper data as well as digital data
Abright, A. (2012). Estimating the costs of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 987–989.
Appleton, J. (2018). The gut-brain axis: influence of microbiota on mood and mental health. Integrative Medicine: A Clinician’s Journal, 17(4), 28–32.
Bahrami, L., Hezaveh, Z., Tanha, K., & Vafa, M. (2018). The relationship between exclusive breastfeeding and mental concentration in first and second grade primary school children of Mashhad. Journal of Nutrition and Food Security, (2), 65-69.
Centers for Disease Control. (2018). Autism prevalence slightly higher in CDC's ADDM Network | CDC Online Newsroom | CDC. Retrieved from https://www.cdc.gov/media/releases/2018/p0426-autism-prevalence.html
Diaz Heijtz, R. (2016). Fetal, neonatal, and infant microbiome: Perturbations and subsequent effects on brain development and behavior. Seminars in Fetal and Neonatal Medicine, 21(6), 410–417.
Kang, D.-W., Adams, J. B., Gregory, A. C., Borody, T., Chittick, L., Fasano, A., … Krajmalnik-Brown, R. (2017). Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-l abel study. Microbiome, 5(10), 1-16
Lucas, G. (2018). Gut thinking: the gut microbiome and mental health beyond the head. Microbial Ecology in Health and Disease, 29(2), 2-6
Newmark, L. (2017). Mother's Milk Microbes. Retrieved from http://milkgenomics.org/article/mothers-milk-microbes
Overgaard, K. R., Oerbeck, B., Friis, S., Biele, G., Pripp, A. H., Aase, H., & Zeiner, P. (2019). Screening with an ADHD-specific rating scale in preschoolers: A cross-cultural comparison of the Early Childhood Inventory-4. Psychological Assessment, 31(8), 985–994.
PEDS Test. (2019). PEDS Test. Retrieved from https://pedstest.com
Reynolds, D., Hennessy, E., & Polek, E. (2014). Is breastfeeding in infancy predictive of child mental well-being and protective against obesity at 9 years of age? Child: Care, Health & Development, 40(6), 882–890.
Rouse, A. (2018). Gut feelings: The microbiome and children’s mental health. Brown University Child & Adolescent Behavior Letter, 34(11), 1–5.
Sandgren, A. M., & Brummer, R. J. M. (2018). ADHD-originating in the gut? The emergence of a new explanatory model. Medical Hypotheses, 120, 135– 145.
Schulz, R., & Sherwood, P. R. (2008). Physical and mental health effects of family caregiving. Journal of Social Work Education, 44(3), 105-113.
Shivers, C. M., Krizova, K., & Lee, G. K. (2017). Types of strain among family members of individuals with autism spectrum disorder across the lifespan. Research in Developmental Disabilities, 68, 42–51.
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