Disparities in breastfeeding practices by children's health needs in the United States

Background: Breastfeeding is accepted as the best possible feeding for infants; however the prevalence remains well below national goals. Previously identified barriers include social norms, inadequate support, infant admission into intensive care, hospital policy and practices, and infant becoming sick. Methods: Data source is the 2007 National Survey of Children's Health for children age 0-5 years (n=37,374). Chi-squared tests were used to establish associations between demographic factors and special health care needs or high risk of developmental, behavioral or social delays (SHCN/DBSD) and breastfeeding initiation and duration. Multivariate logistic regression was used to obtain adjusted odds ratios. Results: The odds of breastfeeding among SHCN/DBSD children were 18% lower than for other children (95% CI: 3-30%). Among children who were ever breastfed, the odds that SHCN/DBSD children stopped prior to six months were 26% higher than for other children (95% CI: 10-40%). Other factors associated with breastfeeding were income, mother's health status, geographical region, family structure, household tobacco use, child's birth position, mother's education and race/ethnicity. Conclusions: Results suggest that mothers of children with increased health needs face more barriers to breastfeeding. Understanding barriers is vital to providing support and reducing this disparity faced by CSHCN. Breastfeeding is also less common for children living below the federal poverty level and those exposed to tobacco inside the home, indicating often children who were not breastfed optimally are also exposed to other negative health risk factors.