Modes of Infant Feeding and the Risk of Childhood Asthma: A Prospective Birth Cohort Study

Annika Klopp, Lorena Vehling, Allan Becker, Padmaja Subbarao, Piushkumar J. Mandhane, Stuart Turvey, Diana L. Lefebvre, Malcolm Sears, Denise Daley, Frances Silverman, Kent Hayglass, Michael Kobor, Tobias Kollmann, Jeff Brook, Clare Ramsey, Joseph Macri, Andrew Sandford, Peter Pare, Scott Tebbutt, Michael BrauerJudah Denburg, Michael Cyr, Anita Kozyrskyj, Edith Chen, Tim Takaro, Felix Ratjen, Hartmut Grasemann, Sharon Dell, Teresa To, Theo Moraes, Linn Holness, A. Dean Befus, James Scott, Richard Hegele, Wendy Lou, Sonia Anand, Elinor Simons, Meghan Azad, Thomas Eiwegger, Qingling Duan, Perry Hystad

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Objective To determine whether different modes of infant feeding are associated with childhood asthma, including differentiating between direct breastfeeding and expressed breast milk. Study design We studied 3296 children in the Canadian Healthy Infant Longitudinal Development birth cohort. The primary exposure was infant feeding mode at 3 months, reported by mothers and categorized as direct breastfeeding only, breastfeeding with some expressed breast milk, breast milk and formula, or formula only. The primary outcome was asthma at 3 years of age, diagnosed by trained healthcare professionals. Results At 3 months of age, the distribution of feeding modes was 27% direct breastfeeding, 32% breastfeeding with some expressed breast milk, 26% breast milk and formula, and 15% formula only. At 3 years of age, 12% of children were diagnosed with possible or probable asthma. Compared with direct breastfeeding, any other mode of infant feeding was associated with an increased risk of asthma. These associations persisted after adjusting for maternal asthma, ethnicity, method of birth, infant sex, gestational age, and daycare attendance (some expressed breast milk: aOR, 1.64, 95% CI, 1.12-2.39; breast milk and formula, aOR, 1.73, 95% CI, 1.17-2.57; formula only: aOR, 2.14, 95% CI, 1.37-3.35). Results were similar after further adjustment for total breastfeeding duration and respiratory infections. Conclusions Modes of infant feeding are associated with asthma development. Direct breastfeeding is most protective compared with formula feeding; indirect breast milk confers intermediate protection. Policies that facilitate and promote direct breastfeeding could have impact on the primary prevention of asthma.

Original languageEnglish (US)
Pages (from-to)192-199.e2
JournalJournal of Pediatrics
StatePublished - Nov 1 2017


  • asthma
  • breastfeeding
  • pumped breast milk

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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