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BRIEF RESEARCH REPORT article

Front. Public Health

Sec. Children and Health

This article is part of the Research TopicEmbracing Human Milk Feeding ChallengesView all 6 articles

Breastfeeding Moderates the Association between Family Socioeconomic Status and Child Behaviour Scores

Provisionally accepted
Sarah E TurnerSarah E Turner1,2,3*Leslie E RoosLeslie E Roos2,4Nathan C NickelNathan C Nickel1,2,3,5,6Jacqueline PeiJacqueline Pei7Sukhpreeet K TamanaSukhpreeet K Tamana8Theo MoraesTheo Moraes9Stuart TurveyStuart Turvey8Elinor SimonsElinor Simons10,2,3Padmaja SubbaraoPadmaja Subbarao11Piushkumar MandhanePiushkumar Mandhane12,13Meghan B AzadMeghan B Azad1,10,2,3
  • 1Manitoba Interdisciplinary Lactation Centre, Winnipeg, Canada
  • 2University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
  • 3University of Manitoba Department of Community Health Sciences, Winnipeg, Canada
  • 4University of Manitoba Department of Psychology, Winnipeg, Canada
  • 5University of Manitoba Faculty of Kinesiology and Recreation Management, Winnipeg, Canada
  • 6University of Manitoba Manitoba Centre for Health Policy, Winnipeg, Canada
  • 7School and Clinical Child Psychology Program, University of Alberta, Edmonton, Canada
  • 8The University of British Columbia Department of Pediatrics, Vancouver, Canada
  • 9The Hospital for Sick Children Department of Pediatrics University of Toronto, Toronto, Canada
  • 10University of Manitoba Department of Pediatrics and Child Health, Winnipeg, Canada
  • 11Department of Pediatrics, Physiology and Dalla Lana School of Public Health, The Hospital for Sick Children, University of Toronto, Toronto, Canada
  • 12University of Alberta Department of Pediatrics, Edmonton, Canada
  • 13UCSI University Faculty of Medicine and Health Sciences, Federal Territory of Kuala Lumpur, Malaysia

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Abstract Background: Children living in low socioeconomic status (SES) environments are more likely to develop behaviour problems. Breastfeeding is one behaviour that has been positively linked to mental health throughout childhood. We investigated whether breastfeeding modifies the association between low SES and behaviour problems. Methods: We studied a subset of the Canadian CHILD cohort (N=2,342). Lower SES (n=592) was defined as one or more of: 1) low income based on family size, 2) single parenthood or 3) maternal education below a post-secondary degree. Breastfeeding was reported by caregivers from birth to two years. The Child Behaviour Checklist (mean 50, SD [10], comprising internalizing, externalizing and total behaviour scores), was administered at five years. We tested main effects and interactions between SES and breastfeeding on child behaviour, adjusting for several maternal and child characteristics. Results: Lower SES was related to higher (worse) behaviour scores (B=2.06 [95%CI: 1.06, 3.07] for total behaviour scores), while longer and more exclusive breastfeeding was related to lower (better) behaviour scores (B=-2.43 [95% CI:-3.74, -1.11] for exclusive breastfeeding at six months, compared to no breastfeeding, for total behaviour scores). We observed significant interactions between longer and more exclusive breastfeeding and family SES on internalizing and total behaviour scores, indicating that the "socioeconomic gap" in behaviour scores becomes smaller with more exclusive and longer breastfeeding. Conclusion: This study provides new evidence that breastfeeding may be one factor that can help reduce socioeconomic inequities in child behaviour scores.

Keywords: breastfeeding, Child behaviour check list (CBCL), Family socioeconomic status, cohort, Interaction

Received: 24 Jun 2025; Accepted: 24 Nov 2025.

Copyright: © 2025 Turner, Roos, Nickel, Pei, Tamana, Moraes, Turvey, Simons, Subbarao, Mandhane and Azad. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Sarah E Turner

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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