European Child & Adolescent Psychiatry

, Volume 28, Issue 1, pp 19–30 | Cite as

Maternal breastfeeding and attention-deficit/hyperactivity disorder in children: a meta-analysis

  • Ping-Tao Tseng
  • Cheng-Fang Yen
  • Yen-Wen Chen
  • Brendon Stubbs
  • Andre F. Carvalho
  • Paul Whiteley
  • Che-Sheng Chu
  • Dian-Jeng Li
  • Tien-Yu Chen
  • Wei-Cheng Yang
  • Chia-Hung Tang
  • Hsin-Yi Liang
  • Wei-Chieh Yang
  • Ching-Kuan Wu
  • Pao-Yen LinEmail author
Original Contribution


Previous studies have suggested environmental factors may contribute to the risk of attention-deficit/hyperactivity disorder (ADHD). The current meta-analysis examined (1) the difference in the duration of maternal breastfeeding between children with and without ADHD, and (2) the association between maternal breastfeeding and ADHD in children. The data of individual studies were synthesized with a random-effects model. Eleven articles were included in this meta-analysis. Children with ADHD had significantly less breastfeeding duration than controls (Hedges’ g = − 0.36, 95% confidence intervals (CIs) = − 0.61 to − 0.11, p = 0.005; difference in means: − 2.44 months, 95% CIs = − 3.17 to − 1.71, p < 0.001). In addition, the rates of non-exclusive breastfeeding in children with ADHD is significantly higher in “under 3 months” (odds ratio (OR) = 1.90, 95% CIs = 1.45 to 2.48, p < 0.001) but lower in “6 to 12 months” (OR = 0.69, 95% CIs = 0.49 to 0.98, p = 0.039) and “over 12 months” (OR = 0.58, 95% CIs = 0.35 to 0.97, p = 0.038) than controls. Children with ADHD received significantly higher rate of exclusive breastfeeding duration “under 3 months” (OR = 1.51, 95% CIs = 1.20 to 1.89, p < 0.001) but lower in “over 3 months” (OR = 0.52, 95% CIs = 0.29 to 0.95, p = 0.033) than controls. Furthermore, an association was found between non-breastfeeding and ADHD children (adjusted OR = 3.71, 95% CI = 1.94 to 7.11, p < 0.001). Our results suggest maternal breastfeeding is associated with a lower risk of ADHD in children. Future longitudinal research is required to confirm/refute these findings and to explore possible mechanisms underlying this association.


Attention-deficit/hyperactivity disorder Breastfeeding Meta-analysis Nutrition Risk 



Attention-deficit/hyperactivity disorder




Confidence interval


Conners’ Parent Rating Scale


Conners’ teacher rating form


Diagnostic and statistical manual of mental disorders, fifth edition


Diagnostic and statistical manual of mental disorders, fourth edition


Effect size


International statistical classification of diseases and related health problems 10th revision




Meta-analysis of observational studies in epidemiology


Not available


Newcastle–Ottawa scale


Odds ratio


Polyunsaturated fatty acids



The authors declare that there are no conflicts of interest or funding in relation to the subject of this study. This manuscript had been presented as the poster in the 55th Annual Meeting of Taiwanese Society of Psychiatry. We had contacted the authors Field S.S., Lemcke S., Ptacek R., Say G.N., and Turkoglu S. for inquiry of original data and we thank for their responding and help.

Compliance with ethical standards

Conflict of interest

The authors state that there are no any competing interests in the current literature.

Supplementary material

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Supplementary material 1 (TIFF 825 kb)
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Supplementary material 2 (DOCX 26 kb)
787_2018_1182_MOESM3_ESM.docx (18 kb)
Supplementary material 3 (DOCX 18 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ping-Tao Tseng
    • 1
    • 2
  • Cheng-Fang Yen
    • 3
    • 4
  • Yen-Wen Chen
    • 5
  • Brendon Stubbs
    • 6
    • 7
    • 8
  • Andre F. Carvalho
    • 9
    • 10
  • Paul Whiteley
    • 11
  • Che-Sheng Chu
    • 12
  • Dian-Jeng Li
    • 13
    • 14
  • Tien-Yu Chen
    • 15
  • Wei-Cheng Yang
    • 16
  • Chia-Hung Tang
    • 17
  • Hsin-Yi Liang
    • 18
  • Wei-Chieh Yang
    • 19
  • Ching-Kuan Wu
    • 1
  • Pao-Yen Lin
    • 20
    • 21
    Email author
  1. 1.Department of PsychiatryTsyr-Huey Mental Hospital, Kaohsiung Jen-Ai’s HomeKaohsiungTaiwan
  2. 2.WinShine Clinics in Specialty of PsychiatryKaohsiungTaiwan
  3. 3.Department of PsychiatryKaohsiung Medical University HospitalKaohsiungTaiwan
  4. 4.Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
  5. 5.Prospect Clinic for Otorhinolaryngology and NeurologyKaohsiungTaiwan
  6. 6.Physiotherapy DepartmentSouth London and Maudsley NHS Foundation TrustLondonUK
  7. 7.Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN)King’s College LondonLondonUK
  8. 8.Faculty of Health, Social Care and EducationAnglia Ruskin UniversityChelmsfordUK
  9. 9.Translational Psychiatry Research Group and Department of Clinical MedicineFederal University of CearáFortalezaBrazil
  10. 10.Department of Clinical Medicine, Faculty of MedicineFederal University of CearáFortalezaBrazil
  11. 11.ESPA ResearchSunderlandUK
  12. 12.Department of PsychiatryKaohsiung Veterans General HospitalKaohsiungTaiwan
  13. 13.Department of Addiction ScienceKaohsiung Municipal Kai-Syuan Psychiatric HospitalKaohsiungTaiwan
  14. 14.Graduate Institute of Medicine, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
  15. 15.Department of Psychiatry, Tri-Service General Hospital, School of MedicineNational Defense Medical CenterTaipeiTaiwan
  16. 16.Department of Adult PsychiatryKaohsiung Municipal Kai-Syuan Psychiatric HospitalKaohsiungTaiwan
  17. 17.Department of Psychiatry, Tainan HospitalMinistry of Health and WelfareTainanTaiwan
  18. 18.Department of Child PsychiatryChang Gung Memorial Hospital at Taoyuan and Chang Gung UniversityTaoyuanTaiwan
  19. 19.Department of PediatricsDA-AN Women and Children HospitalTainanTaiwan
  20. 20.Department of PsychiatryKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
  21. 21.Institute for Translational Research in Biomedical SciencesKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan

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