Link found between breastfeeding and autism but more research needed

the breast feeding of newborn

They say a picture is worth a thousand words and the image below is quite impressive. It’s the rate of autism over time compared to the rate of breastfeeding over time:

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Over the past 4 decades, there has been a shocking rise in the prevalence of autism. Antivax activists have pointed out that there has been an increase in the number of vaccines that infants receive and conclude that vaccines cause autism. But as this graph shows there has also been a dramatic increase in breastfeeding rates. Indeed the two seem to rise in concert over time demonstrating a link between breastfeeding and autism.

It is grossly irresponsible for any medical professional or organization to announce a link based on a temporal association.

Obviously more research is needed. We should be urgently investigating whether breastfeeding causes autism. We should reconsider recommendations designed to encourage breastfeeding and ask if we are ignoring the harmful effects. In the meantime, we should direct lactation consultants, La Leche League and the Baby Friendly Hospital Initiative to inform new mothers of the very clear association between breastfeeding and autism. How can women make an informed decision about breastfeeding if they don’t know about the link?

If you read this far you’re probably asking yourself what has happened to my reasoning abilities. Just because two phenomena rise in concert doesn’t make them linked. Sure, it raises the possibility, but it is grossly irresponsible for any medical professional or organization to announce a link based merely on a temporal association. I must be joking, right?

Yes, I am joking but the folks at Baby Friendly UK are not. Here’s a tweet they published this morning:

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Links also found between induction of labor and autism but more research needed #bfconf

The hashtag refers to the UNICEF/Baby Friendly Hospital Initiative conference now under way in Liverpool.

Correlation is not causation, though. Rising autism rates are correlated with rising induction rates AND rising breastfeeding rates. Unless the folks at the BFHI are willing to suggest that autism is linked with breastfeeding, they shouldn’t be suggesting that autism is linked with induction.

The above tweet was part of a series reporting on a lecture by lactation professional Karin Cadwell that demonized oxytocin and suggested that it interferes with breastfeeding.

Wait, what? A natural hormone produced in part to promote breastfeeding interferes with it? Well, sure, if you put it in an IV! Apparently the oxytocin knows where it came from no matter that it is chemically identical to the oxytocin produced by the mother’s body.

If the webpage is any indication, the lecture is an amalgam of the naturalistic fallacy (if it’s natural it must be good; if it’s technological it must be bad), the Panglossian paradigm (nothing can improve upon nature), and utter nonsense like this:

Then, one of our local hospitals hired a full time OB anesthesiologist and epidurals began. The nurses reported an immediate outbreak in flat nipples and babies who had trouble latching. One of the nurses told me that it was almost as though the baby didn’t know that the breast was there! Now, epidurals, labor induction and augmentation with synthetic oxytocin, operative deliveries and elective cesarean births are widespread with ubiquitous breastfeeding problems.

Prof. Cadwell appears to think this is what passes for “reasoning”:

I ask myself almost every day, how can something that is so fundamental to good health, in fact our survival as a species, be so difficult? How can it be that babies fail to latch when the characteristics of their mother’s Montgomery gland secretions are analogous to their unique amniotic fluid flavor? What has happened to otherwise healthy, full term babies in the process of being born that they would deny themselves the ultimate pleasure nursing?

It’s analogous to the “argument” that anti-vaxxers make about vaccines: Immunity is fundamental to good health and our survival as a species. Unvaccinated is the biological norm. Therefore, vaccines are unnecessary and possibly harmful.

It’s a ridiculous “argument” when made by anti-vaxxers and equally ridiculous when made by lactation professionals.

Unvaccinated may be the biological norm for infants and children but deaths from vaccine preventable diseases are also the biological norm. Natural immunity is indeed the product of hundreds of millions of years of evolution, but that didn’t make it perfect or even close to perfect.

Just because breastfeeding is the biological norm does NOT mean that all women produce enough breastmilk, that some women don’t have flat nipples, that some babies can’t latch. But, but, but if those things occurred in nature lots of babies would die! That’s right and until very recently, lots of babies DID die for precisely that reason. Human existence is perfectly compatible with massive rates of infant mortality.

So if correlation does not equal causation and natural is not necessarily best, how do we figure out if breastfeeding or induction causes autism.

To determine if Event A caused Disease B, we need to investigate whether it satisfies Hill’s Criteria. These are nine criteria, most of which much be satisfied before we can conclude that Event A is not merely correlated with Disease B, but Event A actually causes Disease B.

I’m not going to review all nine criteria here. I’ll highlight two that are most important in this setting.

Consistency: Have the findings that purport to show a relationship been replicated by other scientists, in other populations and at other times? If studies fail to consistently show the relationship, causation is very unlikely.

This is a critical point. One experiment or even a few studies is NOT enough to determine causation. A large number of studies that consistently show the same result is required.

And:

Consideration of alternative explanations: In the case of breastfeeding (or vaccines) and autism, there is a very simple alternative explanation. Autism cannot be diagnosed before the age of 2 and breastfeeding (and most vaccines) are given before the age of 2.

Similarly, as autism is almost certainly genetic, there may be differences in the pregnancies or fetuses affected by autism that lead to a need for oxytocin induction or augmentation in labor. For example, there is some evidence that autism leads to larger head size. Larger head size leads to greater need for interventions in labor. Therefore any association between oxytocin administration and autism may be a consequence not a cause.

The correlation between induction and autism is probably weaker than the correlation between breastfeeding and autism. Unless and until the folks at Baby Friendly are willing to suggest that breastfeeding causes autism, they have no business suggesting induction does.

  • rational thinker

    My 14 year old daughter is autistic. I do think autism is rare and is caused by genetics.my husbands half brother is autistic also. I did notice in the first week of her life something was wrong. I was induced and she was small but overdue but that had nothing to do with the autism, genetics did. I also think it is very over diagnosed and that is what we should be looking at.

  • StephanieJR

    I never want to hear the phrase ‘amniotic fluid flavor’ ever again.

  • Heidi

    I think there’s also a correlation with low birth weight and autism, and I was induced precisely for that. And yes, I do believe my son will be diagnosed with autism. But as I’ve mentioned here before, I have worked briefly in a group home that served some autistic individuals and one individual’s mother told me about some obvious differences that were perceptible right away. I’ve suspected this in my own child since early infancy. I never saw any dramatic change at 18 months because I already saw differences. My dad on the other hand believes everything seemed normal until recently. My dad thinks he babbled on time, but he did not. My dad wasn’t aware of the not so obvious signs.

  • demodocus

    Ludicrous. There’s just so much wrong with that even to my under educated eyes. Pitocin is given for a brief time, relatively speaking, and I haven’t heard that the autism rate in preemies is any different than in term babies but that it is inborn, so it probably happens earlier. They’re grasping at straws.

    • Azuran

      Considering that pitocin is exactly the same as oxytocin and the body cant make the difference. If pitocin causes autism, then it logically follows that natural labour does as well because of oxytocin.
      The longer your labour is, the more your baby is exposed and the more risks there are.
      Conclusion: pre-labour elective c-section is the best way to prevent autism.

  • Mel

    Did you know that the number of teenagers in gangs is correlated with the increasing literacy standards in the US? To end violence between gangs, we need to stop teaching children to read right now!

    • kilda

      that would also eliminate the problem of dyslexia!

  • Sarah

    Given that autism seems to be more commonly diagnosed in the children of older mothers and that older mothers are also more likely to be induced, it’s no great shock that children with an autism diagnosis are more likely to have mothers who were induced.

    • E.C.

      Older mothers are also more likely to have the time, job flexibility, and insurance coverage to get their autistic children diagnosed.

      • Heidi

        Thankfully, I don’t think you need health insurance in the U.S. to get diagnosed or to receive intervention. That being said, I have no doubt that systemic racism and classism doesn’t have a play in who receives diagnoses and intervention. With my son, we went to the doctor, expressed our concerns, he contacted the early intervention services, they came over to do an evaluation, and he is receiving services. Our neighbor’s best friend has a daughter who did not talk until she was 6 and she is 9 now and our neighbor was asking us if we liked our pediatrician as the current pediatrician for her friend’s daughter refuses to help at all. One would think the school system would have done something even. How is this person being allowed to fall through the cracks in such an epic manner?

        • Chi

          It is SO much harder to get girls an autism dx. A LOT of it is to do with the fact that the majority of criteria for diagnosing autism comes from studying boys, so typical patriarchal medicine saying that if boys are like that, then girls should be the same, right?

          As such girls are SO much more likely to be misdiagnosed with things like anxiety or OCD, or it’s likely to be attributed to something like poor vision or what have you.

          Not to mention that we STILL tend to socialize girls to be more social, more nurturing/caring etc, so they are capable of learning behaviours that ‘mask’ their symptoms. However if you know what you’re looking for, then autistic girls are still significantly behind neurotypical girls their age when it comes to social behaviour.

          My daughter is still standoffish with kids her age, though she’s getting better at letting kids join her in activities and she’s starting to join into other activities too. But she’s 4.5 years old and still mostly into parallel play – which she should have started around 2-3 years of age.

          I was lucky and got a wonderful pediatrician who knew what to look for, but if I hadn’t pushed it she may have fallen through the cracks too.

          • Heidi

            I have heard that. However, in this case, I suspect racism has more to do with it. One would think not talking until 6 years old is a not so subtle sign that early intervention services need to be contacted.

          • Gail Jiles

            Schools do not diagnose medical conditions of any kind. We encourage parents to visit their pediatricians if they have concerns and if they’re not satisfied, seek other medical personnel. It is against the law for schools to suggest to anyone that their child has autism, ADHD, or any related neurological condition. I think the story of “someone’s neighbor’s sister’s kid” is very incomplete. If the parents didn’t hear their 6-year-old speaking (for that matter a three-year-old!) THEY should have moved heaven and earth to get help for their child, not begin blaming everyone else or play the race/bad rich folks card. All states in the U.S.A have free medical care for children, especially poor children. Race is not a factor.
            Head Start and other national institutions provide special classes and help children overcome language delays. In my county, where many children don’t speak English, children receive an astounding amount of free services, one just has to look.

          • Chi

            Here in New Zealand, Early Childhood teachers are trained on general milestones for children and are pretty good at identifying which kids may be lagging behind their peers in certain areas. They can then recommend to the parents to go to the doctor for further investigation, and then if the doctor agrees a referral is then made for a pediatrician to do an assessment.

            However, getting to see a pediatrician through our public health system can involve a 3-18 month wait time depending on where you are in the country, how many pediatricians are available and how long the waiting list is.

            And even here there are a lot of services available, BUT for the most part you don’t get told about them. When my daughter was diagnosed with autism, she was SUPPOSED to be referred to our local health service, but the referral never arrived. It took me TWO years to figure out that they hadn’t gotten that referral, that I wasn’t on some massive wait list and that I could actually refer my daughter myself.

            And since I did, yes I’ve gotten access to a lot of services, like occupational therapists, behaviour specialist etc, respite care funding etc.

            But if you’re a parent who is dealing with the relatively new stress of finding out you have a child with special needs I can tell you from my own experience that it’s almost IMPOSSIBLE to know where to start looking for help.

          • Heidi

            I am not going to respond to Gail because I know the type, but yes, it can definitely be impossible to know where to start. Also I have no idea what I would do if I was still employed. I’ve never had a job that would have let me take off work 3 days a week to take my son to speech therapy and speech pathology. I have to be there for the entirety of the sessions. I also wonder if my pediatrician told me not to worry, if I wouldn’t have trusted him for a while. It’d be what I’d want to hear and I guess I’d trust his expertise for some period.

            I had our monthly meeting with the coordinator today and these free school programs aren’t a given. Even the paid ones aren’t a given.

          • Dinolindor

            Both of my kids are on the spectrum. It has felt impossible to figure out 1) who and what to ask for, 2) if what people tell us we need actually is helpful, 3) the hairy details of how to access those services, and 4) how to make sure they’re effective. (Oh, and of course, what does “effective” even mean!)

            We’re doing the best we can, and as parents we have virtually zero roadblocks in terms of our own education, acceptance of our family’s situation, a state that protects care through insurance and school, etc, etc, etc and IT IS HARD to figure this stuff out. I cannot imagine how much harder it would be if just one of those pieces suddenly dropped out from under us. And it panics me to think of what my kids would lose if that ever came to pass. I have complete sympathy with any family trying to figure this stuff out.

          • Chi

            Exactly! Because what’s ‘effective’ for one child might be COMPLETELY wrong for another child and make behavioural problems worse.

            To be fair though, once we’d accessed the child development services here, we had our choice of several things, including parenting courses, access to fund for respite care, occupational therapist assessments etc.

            But another family who has a child further up the spectrum might need speech therapy, behavioural experts to assess and help with problem behaviours etc.

            Luckily most of the support services here tend to work together fairly well, although you have to repeat back you child’s history EVERY SINGLE TIME you access a new service and that can get frustrating and repetitive. I agreed you could share my info between agencies, so WHY do I need to answer all the same questions all over again???

          • Chi

            Most definitely. But I can bet it was brushed off with multiple variations of ‘oh she’s just shy, she’ll grow out of it.’

          • rational thinker

            Autism is just less common in girls there are 4 autistic boys for every one autistic girl.I did have doctors tell me shes just a late bloomer. I put up with that until she was 18 months then demanded to see a neuro doc and she was on a waiting list to get a diagnosis from the neuro doc for 2 years. Luckily I contacted the school and they took her before she got the diagnosis. They were supposed to wait till she turned 3 but they took her a few months before her 3rd birthday.I do agree that things like class, racism have a lot to do with delayed diagnosis and especially falling through the cracks.

      • Ravens Starr

        My child was finally dxed with autism when he was nine. (Asperger’s then, but since they changed it to autism). I was frankly disbelieving because they told me the behavioral criteria on which he was diagnosed and I said to the team at school, “But he behaves just like me when I was a kid!” And they all stared at me, then told me it was genetic.
        I had my child young. He was not a preemie. My mom had me VERY young, and I was not a preemie either. We both had older fathers, though. People forget abut that.

      • Sarah

        In the US, yes absolutely. Hence talking about diagnosis not just prevalence. See also, rising rates of autism diagnosis in the Somali community since coming to America, being described as rising rates of autism without anyone stopping to think about how exactly one would seek a diagnosis during, say, the Battle of Mogadishu!

  • How about “Link found between refusing an unplanned section when the doctor tells you your kid’s head is stuck in your pelvis” linked to ADHD and Autism. Cause apparently it is. What’s a little Birth Asphyxia and Meconium Aspiration in the long run?

    • BeatriceC

      I do sometimes wonder if newborn starvation is actually contributing to some of the poor outcomes we’re seeing.

      • Cristina

        I wish they would do a study on both of those.

      • Merrie

        Either that or oxygen deprivation at prolonged births. Seems like every other kid on Mothering has some sort of “sensory issue” (diagnosed or not) or some other neurological problem.

        • kilda

          I think part of that is because it is the only socially acceptable reason for your child to be less than a genius.

      • WonderWoman

        I was thinking exactly the same thing , newborn starvation or problems at birth, maybe both. Arw there any studies on that?

        • BeatriceC

          There aren’t, and I honestly can’t think of a way to construct a study that would be able to tease out the effects of newborn starvation vs the dozens of other factors at play.

  • Madtowngirl

    Wow, BFUK. That’s got to be one of the biggest stretches in reasoning I’ve seen in a while. Also lmao Prof. Cadwell. My C-section caused my flat nipples? That’s quite a feat, since my flat nipples were noted at one of my pediatric visits, well before I was even sexually active.

    • space_upstairs

      Maybe they’d say it was your mother getting a C-section or an epidural or not breastfeeding you that caused your flat nipples.

  • BeatriceC

    Typo alert: “Correlation is not causation, though. Rising autism rates are correlated with rising autism rates AND rising induction rates.” I think it should read Correlation is not causation, though. Rising autism rates are correlated with rising breastfeeding rates AND rising induction rates.

    • BeatriceC

      Also it looks like you have the word my instead of by here. “It’s a ridiculous “argument” when made my anti-vaxxers and equally ridiculous when made by lactation professionals.”

      • Amy Tuteur, MD

        Thank you so much for catching these and pointing them out!