“Breast is best,” is a saying many of us have heard. But is breast milk really best for babies with autism spectrum disorder (ASD)? Is there any connection between breastfeeding and the development of autism? And is it advisable for autistic mothers to breastfeed their babies?
It seems any article about breastfeeding needs to be introduced with great sensitivity, a disclaimer or two, and even then there may be enough reason for accusations of being a “nipple nazi” or alternatively pushing the agenda of formula feeding by manufacturing companies.
Maybe it’s better to acknowledge, right off the bat, that there are no clear answers. Plenty of research still needs to be conducted, and most importantly, for moms with autistic children, no one should be adding any more pressure to the (possibly) already boiling pot.
Instead, mothers at higher risk of having autistic children may need more information about the suggested role of breast milk in autism prevention or symptom management. Mothers with children with ASD may require information about prolonged breastfeeding and, finally, autistic mothers may be interested to learn more about the influence of neurodivergence when it comes to breastfeeding a baby.
Autism spectrum disorder and breastfeeding
Definitive answers about the link between autism prevention and breastfeeding are difficult to provide. There are so many variables, making it difficult for scientists to provide definite conclusions. However, research does suggest a correlation between reduced risk of ASD when breastfeeding.
Factors complicating research include things like gestational age and socioeconomic status of mothers. These two factors may influence whether a baby is likely to be breastfed, and it may also influence autism risk. There are, however, some suggestions from recent studies and research about the influence of breastfeeding on autism.
Can breastfeeding reduce the risk of autism?
A recent meta-analysis—a statistical analysis combining results of multiple scientific studies—reviewed the association of breastfeeding status with the risk of autism (Ghozy et al., 2020). The authors shared the following:
- According to their dose-response meta-analysis, breastfeeding a baby for six months was linked to a 54% reduction in risk
- In the conventional meta-analysis, the greatest reduction in the risk of autism spectrum condition was associated with prolonged breastfeeding of young children, between 12 to 24 months
The conclusion of the authors highlights the importance of breastfeeding to reduce the risk of autism. This may be a sound conclusion, reached after a meticulous meta-analysis, but for many women it may feel like a scientific reprimand. A recommendation from the ivory labs where babies don’t latch on incorrectly, inflicting the pain of a crazed piranha intent on destroying human flesh (or at least that’s the downplayed version of my first lactation attempt).
For some women, breastfeeding is painful, impractical and demoralizing. For others, circumstances just don’t allow the time and commitment needed to breastfeed. If I didn’t have a village of support, I probably would’ve quit after the first week, where I ended up crying more than my baby.
The difficulty and the emotional controversy do not take away from the miracle. Most women recognize the benefits of breastfeeding, many women want to breastfeed for a long time, but most mothers’ preconceived notions of parenting turn out to be comic in its Pollyanna-like positivity.
The missing ingredient in breastmilk
I saw doctors, pediatricians, and nurses in many hospitals and clinics, on more than one continent; and yet, not a single one thought it necessary to tell me there is something an exclusively breastfed baby may be missing: Vitamin D, the so-called sunshine vitamin. In Europe more than 40% of the population may be deficient (Cashmen et al., 2016).
The fetus (and newborn baby) will be affected by maternal vitamin D concentrations, a mother who is deficient will be breastfeeding from a depleted level and, without supplementation, the baby will also be deficient in this vital vitamin. This may be especially concerning for parents of autistic children, or mothers with a higher genetic risk of having a baby with autism.
Results from a recent study (Lee et al., 2021) seemed to confirm an increasing body of evidence suggesting early childhood concentrations of vitamin D may be involved in an increased risk of neurodevelopmental conditions like autism spectrum disorder.
A review (Cannell, 2017) discussed the results from open trial studies where about 75% of children showed improvement in core autism symptoms with high dose vitamin D. The connection between vitamin D deficiency and autism will need further investigation and more research, but mothers should be made aware of the risks and vulnerable groups may need to be advised about supplementation.
An autistic mother may already have a vitamin D deficiency, her baby may be born deficient and this deficiency may be exacerbated if exclusive breastfeeding is not supplemented appropriately.
Breastfeeding on the spectrum
The thoughts above bring me to a different route of discussion for this article. For neurotypical women, breastfeeding may be challenging because of biology, postpartum depression, isolation, needy siblings, and many other reasons. For an autistic woman, the regular challenges may be amplified; risk factors interfering with successful breastfeeding may include sensory difficulties, anxiety, and a lack of support.
Many women on the spectrum are only diagnosed later in life, often as they go through the process of seeking a diagnosis for their own children. Autism is underdiagnosed in females, with research suggesting some autistic females may be missed by the current diagnostic procedures (Ratto et al., 2018).
So how would breastfeeding be different for autistic mothers, especially those who are not diagnosed? It’s dangerous and unfair to generalize, but there seems to be two distinct ways mothers on the spectrum approach breastfeeding.
Some autistic mothers view their children as their “special interest”. They focus every ounce of energy on their newborn; their knowledge of the benefits of breast milk means they breastfeed, even when it is a daily struggle. I spoke to a neurodivergent mother who was still breastfeeding her 15-month old daughter every two hours, every single night. She was exhausted, worryingly underweight, but her black and white outlook meant prolonged breastfeeding was nonnegotiable.
For others, extreme sensory differences could mean the sensation of breastfeeding is impossible to bear. For someone with tactile hypersensitivity, breastfeeding may not be the dream of a beautiful skin on skin experience portrayed in commercials.
Even highly sensitive neurotypical mothers reveal the overwhelm of breastfeeding. They whisper, in fear of judgment, about the respite of handing the baby to dad for bottle feeding. This may be an important coping mechanism, for some new moms, especially those with mental conditions, a break for self-care may be vital.
The ideal of a perfect mother, with a beautiful smile on her face, breastfeeding her quiet baby is the reason so many women struggle in silence through the first few months. Maybe if breastfeeding became known for the possibly challenging experience it is, women would be more open to accepting and asking for help.
Final thoughts: the complicated benefits of breast milk
The evidence of how beneficial breast milk may be for babies on the spectrum is overwhelming. There are even suggestions of protection against gastrointestinal symptoms associated with exclusive breastfeeding and late weaning (Penn et al., 2016). For women’s health, breastfeeding may offer a protective effect against ovarian cancer, breast cancer, osteoporosis, and other conditions. But breastfeeding is complicated and, for many women, it’s associated with pain, discomfort, and emotional upset.
Women need more encouragement, information, and a realistic view of just how tough breastfeeding may be. Pregnant women should be evaluated for deficiencies, and when considering breastfeeding, the importance of vitamin D should be emphasized especially for women in vulnerable groups. Committing to breastfeeding, and succeeding against all odds, will make it even tougher to hear the baby may be deficient in one of the vitamins with a possible link to autism.
Women struggling with breastfeeding may feel discouraged when reading the research about the benefits of breastmilk, especially when they feel formula feeding may be better for their situation. No one should be judging, everyone should be encouraging, because, for many women breastfeeding only becomes manageable with a strong support network.
Cannell J. J. (2017). Vitamin D and autism, what’s new?. Reviews in endocrine & metabolic disorders, 18(2), 183–193. https://doi.org/10.1007/s11154-017-9409-0.
Cashman, K. D., Dowling, K. G., Škrabáková, Z., Gonzalez-Gross, M., Valtueña, J., De Henauw, S., Moreno, L., Damsgaard, C. T., Michaelsen, K. F., Mølgaard, C., Jorde, R., Grimnes, G., Moschonis, G., Mavrogianni, C., Manios, Y., Thamm, M., Mensink, G. B., Rabenberg, M., Busch, M. A., Cox, L., … Kiely, M. (2016). Vitamin D deficiency in Europe: pandemic?. The American journal of clinical nutrition, 103(4), 1033–1044. https://doi.org/10.3945/ajcn.115.120873.
Ghozy, S., Tran, L., Naveed, S., Quynh, T., Helmy Zayan, A., Waqas, A., Sayed, A., Karimzadeh, S., Hirayama, K., & Huy, N. 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.
Lee, B. K., Eyles, D. W., Magnusson, C., Newschaffer, C. J., McGrath, J. J., Kvaskoff, D., Ko, P., Dalman, C., Karlsson, H., & Gardner, R. M. (2021). Developmental vitamin D and autism spectrum disorders: findings from the Stockholm Youth Cohort. Molecular psychiatry, 26(5), 1578–1588. https://doi.org/10.1038/s41380-019-0578-y.
Penn, A. H., Carver, L. J., Herbert, C. A., Lai, T. S., McIntire, M. J., Howard, J. T., Taylor, S. F., Schmid-Schönbein, G. W., & Dobkins, K. R. (2016). Breast Milk Protects Against Gastrointestinal Symptoms in Infants at High Risk for Autism During Early Development. Journal of pediatric gastroenterology and nutrition, 62(2), 317–327. https://doi.org/10.1097/MPG.0000000000000907.
Ratto, A. B., Kenworthy, L., Yerys, B. E., Bascom, J., Wieckowski, A. T., White, S. W., Wallace, G. L., Pugliese, C., Schultz, R. T., Ollendick, T. H., Scarpa, A., Seese, S., Register-Brown, K., Martin, A., & Anthony, L. G. (2018). What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills. Journal of autism and developmental disorders, 48(5), 1698–1711. https://doi.org/10.1007/s10803-017-3413-9.