Investigation of the long-term effects of breastfeeding with school readyness test scores

Introduction: Breast milk is the optimal source of nutrition for almost all infants. Breastfeeding provides numerous benefits for both children and mothers, and these effects are dose-dependent. Breastfeeding offers direct health benefits to the baby during the nursing period, some of which continue even after weaning. While the short-term benefits of breastfeeding are well established, evidence demonstrating its long-term advantages is primarily based on longitudinal cohort studies and thus remains limited. Additionally, inadequate control of confounding factors related to both breastfeeding and health outcomes in studies contributes to confusion. Objective: The aim of this study is to investigate the long-term effects of breastfeeding through our demographic information survey and the results of the Marmara School Readiness Scale (MİHÖ). Materials and Methods: Our study included students and their mothers who received parental consent and were about to start first grade at a private primary school between 2019 and 2023. Exclusion criteria included preterm birth, congenital anomalies, chronic illnesses affecting development, a history of asphyxia, and incomplete vaccinations. A survey was administered to mothers to collect demographic information about the children and themselves, and school readiness test results (MİHÖ) were obtained from the school. Test results and demographic data were analyzed according to breastfeeding duration. Results: A total of 149 children, comprising 74 girls (49.7%) and 75 boys (50%), participated in the study, with 124 students' MİHÖ test results available (65 girls (52%) and 59 boys (47%)). All children had attended at least one year of vi preschool education. It was observed that 98% of students had received breast milk for varying durations, while 1.3% had never been breastfed. The average duration of exclusive breastfeeding was 5.33±1.44 months, and the total breastfeeding duration was 17.86±8.93 months. Children who were breastfed for more than one year had significantly higher scores in mathematics (p=0.010), science skills (p=0.003), phonological awareness (p=0.001), line work (p=0.015), labyrinth tests (p=0.002), and total scores (p<0.001) compared to children breastfed for one year or less. As breastfeeding duration increased, total test scores, mathematics scores, and phonological awareness scores also increased linearly. Children diagnosed with asthma had significantly shorter breastfeeding durations than those without asthma, while no association was found between breastfeeding duration and other allergic diseases. A positive correlation was observed between breastfeeding duration and children's attention levels. No statistically significant relationship was found between breastfeeding and BMI, infection frequency, dental caries, or orthodontic issues. Conclusion: According to our study, breastfeeding has significant positive effects on children's cognitive and general health status in the long term. These positive effects show a linear correlation with breastfeeding duration, becoming more pronounced in children who were breastfed for more than one year. To further demonstrate the long-term effects of breastfeeding, there is a need for multicenter, well-designed, randomized studies. Keywords: Breast milk, Breastfeeding, MİHÖ, Cognitive development