The association between breastfeeding and attachment: A systematic review
Midwifery
Report summary
What does research show about breastfeeding and child attachment security?
Four of seven child-attachment studies linked longer breastfeeding with greater attachment security after measured covariates. Studies did not find a significant security difference between breastfeeding and bottle-feeding, and breastfeeding immediately after birth was not associated with later child attachment.
Modern syntheses generally support attachment as a relationship-based developmental system while rejecting deterministic predictions from a single classification or experience.
Researchers' conclusions
The authors found some evidence of a possible positive contribution from breastfeeding, but said the effect was likely small and stronger prospective research was needed.
This is a plain-language summary of the researchers' conclusion. It is not advice for an individual family.
How the report was produced
Interpretation depends on how attachment and caregiving were measured, whether observations were relationship-specific, and whether samples represented ordinary, high-risk, clinical, or court-involved families.
What this paper supports
Reasonably supports
- Observing caregiving behaviour and relationship history carefully.
- Treating attachment security and disorganization as probabilistic, relationship-specific constructs.
- Supporting familiar, responsive, non-abusive caregiving and continuity of good-enough care.
- Recognizing networks of attachment relationships as normal and potentially protective.
Does not establish
- Assigning one caregiver permanent scientific priority solely because of gender or a parent label.
- Predicting an individual child’s future from one attachment classification.
- Using attachment theory alone to calculate nights, percentages, or a legal outcome.
- Treating separation, childcare, or transitions as equivalent to deprivation without examining care quality and context.
Important limitations
- Only 11 studies met the review criteria
- Most studies had measurement or sample-size limitations
- Association does not show that breastfeeding is necessary for secure attachment
- The review did not study post-separation schedules or father-child attachment
Evidence context and debate
Open the sections below for the wider research context, points of agreement, and areas that remain contested.
Why this question matters
Attachment theory moved from broad claims about separation and maternal care toward testable questions about caregiver behaviour, relationship-specific security, context, and probabilistic developmental pathways.
Attachment research describes how children organize help-seeking, proximity, exploration, and comfort within particular caregiving relationships. It does not divide children into permanently secure or insecure types. A classification is an observation under defined conditions, and its meaning depends on the relationship, measurement procedure, developmental stage, and context.
Ainsworth’s sensitivity hypothesis became one of the field’s most influential claims. De Wolff and van IJzendoorn’s meta-analysis supported a meaningful but moderate association, showing why sensitivity matters and why it cannot be the only explanation. Research on disorganization similarly identifies group-level risk without turning a classification into an inevitable future or an individual diagnosis.
The modern direction is both more evidence-based and more cautious than popular accounts. Researchers accept the value of attachment relationships while emphasizing multiple caregivers, ecological stress, culture, developmental change, resilience, and the limited sensitivity and specificity of attachment measures for high-stakes individual prediction.
Where researchers agree and disagree
Researchers broadly agree that familiar, responsive, non-abusive caregiving and continuity of good-enough care matter, and that attachment classifications describe relationship patterns rather than fixed child traits.
Debate remains about the strength of particular causal pathways, the transportability of measures across contexts, and how much individual prediction attachment assessments can support.
Comparison with other research
Bowlby’s foundational programme
Established the importance of enduring caregiving relationships, separation, loss, and the secure base. Later research retained these questions while revising simple monotropy and deprivation interpretations.
Ainsworth and colleagues
Made attachment behaviour observable and relationship-specific through intensive home observation and the Strange Situation, allowing claims to be tested rather than assumed.
De Wolff & van IJzendoorn, 1997
Quantified the sensitivity-security association and concluded that sensitivity is important but not exclusive, directing attention toward context and other caregiving dimensions.
van IJzendoorn et al., 1999
Synthesized disorganization research and reported meaningful risk associations while describing modest stability rather than inevitability.
Forslund et al., 2022
Translated the mature evidence base into supported court principles and explicit warnings against diagnostic or schedule-determining misuse.
How the evidence developed later
Researchers increasingly tested broad theories by combining measured results and examining which family conditions changed the pattern.
Father-child and multiple-caregiver research widened the unit of analysis beyond mother-child dyads.
Developmental psychopathology emphasized adaptation, cumulative risk, resilience, and changing pathways.
International consensus now distinguishes supported principles from forensic claims that attachment tools cannot validly make.
Read the paper and related research
This report
Katja Linde, Franziska Lehnig, Michaela Nagl & Anette Kersting (2020). The association between breastfeeding and attachment: A systematic review. Midwifery, 81, 102592. https://doi.org/10.1016/j.midw.2019.102592
Record checked against the linked scholarly source. Last editorial review: 22 July 2026, as part of a batch review of the current collection.