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.
Key limitation: Only 11 studies met the review criteria
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.
Read this conclusion within the population, research design and limitations described in this record.
How the report was produced
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.
Editorial interpretation of the wider topic
This section discusses the wider topic. Its statements are not all findings of this individual paper.
The review is relevant to breastfeeding and attachment. It did not compare custody schedules or father-child attachment.
Read the design and limitations of each included study before drawing a causal conclusion.
Questions the wider evidence informs
- Keeping feeding measures and attachment outcomes explicit.
Limits of the wider evidence
- Treating breastfeeding as a requirement for secure attachment.
- Prescribing a parenting schedule from this review.
Why this question matters
Feeding method and attachment security are different questions. This review examined their association.
The review distinguishes breastfeeding duration from comparisons of feeding methods. These exposures should not be treated as interchangeable.
Where researchers agree and disagree
The review found some positive associations with breastfeeding duration, with important limitations.
The findings varied between studies. They do not establish that breastfeeding is necessary for secure attachment.
Comparison with other research
Linde and colleagues, 2020
The review called for stronger prospective research. Its findings do not answer questions about father-child attachment or residential schedules.
How the evidence developed later
This record does not establish whether later research changed the review's conclusions.
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
Use the original publication to verify a claim before relying on it. Read the source-checking limits and correction record.