Published: July/August 2013, MedPageToday.com


By Michael Smith, North American Correspondent, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner




Action Points

  • Longer breastfeeding duration in infancy was associated with a higher vocabulary test score at age
  • Longer breastfeeding was also associated with higher intelligence testing at age 7.


Longer breastfeeding over the first year of life was linked to better understanding of language at 3 and better verbal and nonverbal intelligence at 7, researchers reported.

Also, any breastfeeding — as opposed to none — was associated with better verbal intelligence at 7, according to Mandy Belfort, MD, of Boston Children’s Hospital, and colleagues.

The findings, from a prospective cohort study, support a causal link between breastfeeding and later intelligence, Belfort and colleagues argued online in JAMA Pediatrics.

Taken with other research, Belfort and colleagues said, the study supports national and international recommendations in favor of exclusive breastfeeding through 6 months and at least some breastfeeding in the rest of the first year.

Indeed, the possible impact on cognition might be the factor that increases breastfeeding in the U.S., commented Dimitri Christakis, MD, of the Seattle Children’s Hospital Research Institute.

In an accompanying editorial, he noted that breastfeeding is known to reduce the incidence of such things as gastroenteritis, otitis media, and atopic eczema, but those outcomes, while desirable, do not have “dramatic public health consequences.”

Children’s cognitive function might be “the force that tilts the scale” and prompts a range of changes in policy and public opinion on breastfeeding, Christakis argued.

He also noted that many women start breastfeeding, but fail to sustain it; after 6 months only 35% of women overall and 20% of black women still breastfeed their infants.

Belfort and colleagues studied 1,312 mothers and children in Project Viva, a study that enrolled pregnant women and followed them and their children until the children were 7.

When children were 3, the researchers measured language understanding with the Peabody Picture Vocabulary Test and motor skills with the Wide Range Assessment of Visual Motor Abilities.

When they were 7, Belfort and colleagues measured verbal and nonverbal intelligence with the Kaufman Brief Intelligence Test, and also looked again at motor skills with the Wide Range Assessment of Visual Motor Abilities.

All the tests have a 100-point scale, where higher scores indicate a better result.

Analysis controlled for such things as age and sex of the children, their health, and socioeconomic factors, as well as maternal intelligence and the home environment.

In a fully adjusted regression analysis, Belfort and colleagues reported, longer breastfeeding was associated with a higher Peabody Picture Vocabulary Test score at age 3 — an increase of 0.21 points per month of breastfeeding.

Longer breastfeeding was also associated with higher intelligence on the Kaufman Brief Intelligence Test at 7 — increases of 0.35 points per month on the verbal scale and 0.29 points per month on the nonverbal scale.

There were no links between breastfeeding and the motor skills test, Belfort and colleagues reported.

Put another way, Christakis commented, breastfeeding an infant for the first year of life would be expected to increase his or her IQ by about 4 points.

Because most other studies have had a dichotomous endpoint — breastfeeding or not — the researchers also analysed their data that way and found that 7-year-old breastfed children scored 3.75 points higher on the Kaufman test than those who were not breastfed.

They were also higher on the Peabody test at 3 but not significantly so.

Belfort and colleagues cautioned that the study was observational, so that unmeasured factors might have affected the outcomes. And, although the main outcomes were statistically significant, the lower bounds of the 95% confidence intervals include “values with little clinical importance,” they noted.



The study was supported by the NIH. The journal said the authors made no disclosures.

Christakis is co-chair of the Excellence in Paediatrics Global Breastfeeding Initiative.

Primary source: JAMA Pediatrics
Source reference: Belfort MB, et al “Infant feeding and childhood cognition at ages 3 and 7 years: Effects of breastfeeding duration and exclusivity” JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.455.

Additional source: JAMA Pediatrics
Source reference:Dimitri A. Christakis “Breastfeeding and cognition: Can IQ tip the scale?”JAMA Pediatr 2013; DOI: 10.1001/jamapediatrics.2013.470.




By John Gever, Deputy Managing Editor, MedPage Today, August 1, 2013


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SILVER SPRING, Md. — Acetaminophen is associated with rare but severe and sometimes fatal skin reactions at usual doses, the FDA said Thursday.

The agency cited three published reports in which individuals developed Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), or acute generalized exanthematous pustulosis (AGEP) following administration of acetaminophen, and later showed skin reactions when rechallenged with the drug.

Additional reports of these syndromes following acetaminophen, but without rechallenge to confirm causality, have been published as well, the FDA noted. In most of the reported cases, acetaminophen was the only drug taken.

Also, a search of adverse event reports submitted to the FDA yielded 91 cases of Stevens-Johnson syndrome or TEN and another 16 cases of AGEP that were linked to acetaminophen. Twelve of those cases were fatal and 67 involved hospitalization.

The FDA said it would order a new warning for labels on all prescription products containing acetaminophen indicating a risk for severe skin reactions, and will request that manufacturers of over-the-counter products add such warnings.

It urged that patients developing skin reactions while taking acetaminophen or any other pain reliever or fever reducer to stop the drug and seek medical attention immediately. Patients who previously experienced such reactions after using acetaminophen should avoid the drug in the future, the FDA said.

The three cases of severe reactions confirmed with rechallenge involved two children and an elderly man who each had to be hospitalized. Symptoms included an erythematous rash diagnosed as TEN over the buttocks and legs in a 7-year-old girl, erosive hemorrhagic lesions in an 11-year-old boy consistent with Stevens-Johnson syndrome, and hundreds of nonfollicular pustules and a rash in an 83-year-old man diagnosed as AGEP.

In each case, a later exposure to acetaminophen (or, in the case of the older man, an acetaminophen prodrug, propacetamol) led to development of erythematous rashes.