Breastfeeding Duration and Reported Child Maltreatment in a Population-based Alaskan Birth Cohort

Abstract

Research suggests that breastfeeding may reduce child maltreatment risk. Alaska has high rates of both breastfeeding initiation and maltreatment reports to Child Protective Services (CPS). The present study assessed any and exclusive breastfeeding duration and child maltreatment reports to CPS among Alaskan mother-infant dyads, controlling for demographics and shared risk factors. We used a prospective, population-representative dataset linking 2009–2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) data with 2009–2016 Alaska CPS and administrative state data (n\u2009=\u20093,459). Breastfeeding duration was derived from PRAMS breastfeeding questions and categorized as never,\u2009<\u20091 weeks, 1—9 weeks, and\u2009≥\u200910 weeks. Age at first report of maltreatment to Alaska CPS included physical or sexual abuse, neglect, or mental injury. Hazard ratios and 95% confidence intervals (CI) were calculated using Cox proportional hazard models, adjusting for confounders. There was no increase in risk of maltreatment report among children never breastfed compared to those breastfed for\u2009≥\u200910 weeks. Risk of maltreatment report during the observation period was 1.7 times as high among children breastfed for\u2009<\u20091 week (CI: 1.06, 2.73), and 1.5 times as high among those breastfed for 1–9 weeks (CI: 1.17, 1.80), compared to those breastfed for\u2009≥\u200910 weeks. Estimates were attenuated for exclusive breastfeeding. Feeding method did not predict maltreatment reports in this population. Among mothers who initiated breastfeeding, shorter duration was associated with elevated risk of maltreatment reports. Addressing factors that facilitate or prohibit sustained breastfeeding may reduce risk of child maltreatment reports.