Infants considered medically high-risk at birth who were exclusively breastfed during their first six months grew somewhat faster in early infancy than their formula-fed peers, according to a retrospective study of 108 term infants followed at a single Chinese clinic. The differences were most pronounced at six months of age and largely faded as the children approached their first birthday, and no clear differences in early neurodevelopmental scores emerged among the feeding groups.
The study, published in Frontiers in Public Health, was conducted by researchers at the Department of Child Health Care of the Affiliated Maternity and Child Health Care Hospital of Nantong University in Jiangsu, China. It focused on a population that has received comparatively little attention in feeding research: infants born at term, meaning at 37 weeks of gestation or later, but who carried biological, maternal, or environmental risk factors that put them at elevated risk of impaired growth or developmental delay. Most existing evidence on infant feeding and growth comes from generally healthy populations, while studies of high-risk infants have often centered on those born preterm or with low birth weight.
The researchers reviewed records from 120 term high-risk infants who attended the hospital’s High-Risk Infant Clinic between February 2024 and February 2026. Twelve children who did not complete follow-up were excluded, leaving 108 infants in the final analysis, split evenly between 54 boys and 54 girls. Based on feeding histories documented at routine visits, the infants were grouped as exclusively breastfed (32 infants), mixed-fed with both breast milk and formula (45), or exclusively formula-fed (31). The high-risk conditions recorded in their charts included low birth weight, fetal distress, neonatal hyperbilirubinemia, neonatal hypoglycemia, neonatal pneumonia, neonatal sepsis, gestational diabetes in the mother, hypertensive disorders of pregnancy, maternal hypothyroidism, and advanced maternal age. Some infants carried more than one of these conditions.
Because the study was retrospective, the investigators extracted all data from existing electronic medical records rather than assigning feeding patterns prospectively. The infants were followed for at least 12 months, with visits scheduled every one to two months during the first half-year and every two to three months between seven and twelve months. At each visit, clinicians measured body weight, length, and head circumference, and the team converted these measurements into sex- and age-specific Z scores—weight-for-age (WAZ), length-for-age (LAZ), and head-circumference-for-age (HCZ)—using WHO Anthro software based on the WHO Child Growth Standards.
In the unadjusted comparisons, the exclusively breastfed group showed clear advantages at six months: their LAZ averaged 1.06 versus 0.31 in the formula group, and their WAZ averaged 1.21 versus 0.29. After Bonferroni correction for multiple pairwise comparisons, the exclusive breastfeeding group had significantly higher LAZ (mean difference 0.747) and WAZ (mean difference 0.924) than the formula group at that age. At eight months, the breastfed group had higher WAZ (mean difference 0.975) and HCZ (mean difference 0.752) than the formula group, and at twelve months only WAZ remained significantly different in the unadjusted analysis, with a mean difference of 0.676.
The picture became more nuanced once the researchers fitted linear mixed-effects models adjusted for sex, birth weight, fetal and neonatal risk factors, maternal risk factors, and advanced maternal age. These models, which use all repeated growth measurements and account for the fact that the same children were measured multiple times, found a significant feeding group by time interaction only for length-for-age (p = 0.004), not for weight-for-age (p = 0.265) or head-circumference-for-age (p = 0.168). In the adjusted pairwise comparisons, the exclusive breastfeeding group retained higher WAZ (adjusted mean difference 0.721) and LAZ (adjusted mean difference 0.602) than the formula group at six months, but no other between-group differences at eight or twelve months reached statistical significance. Notably, the mixed-feeding group did not differ significantly from either extreme at any time point.
The authors suggest several explanations for the pattern. Human milk contains a balance of macronutrients along with bioactive components such as growth factors, hormones, human milk oligosaccharides, and lactoferrin, which may support early growth through effects on intestinal development, gut microbiota, metabolism, and immune function. For infants already carrying perinatal risk factors, these biological properties might be particularly relevant, the researchers write. They also note that the growth differences appeared mainly between the exclusive breastfeeding and formula groups, echoing earlier reports that partially breastfed infants often occupy an intermediate position. As for the fading of differences after six months, the team points to the introduction of complementary foods around that age, which become increasingly important sources of energy and nutrients and may dilute the influence of early feeding patterns on later growth.
On the neurodevelopmental side, the researchers assessed children at eight and twelve months using the Developmental Screening Test (DST) for children aged zero to six years in China, administered by certified, standardized-trained physicians. Results were expressed as a developmental quotient (DQ), with scores of 85 or above considered normal, 70 to 84 indicating suspected delay, and below 70 indicating delay. The number of children with completed assessments was small: at eight months, DQ data were available for 9 exclusively breastfed, 17 mixed-fed, and 15 formula-fed infants, and at twelve months for 12, 18, and 10 respectively. No significant differences in DQ or developmental classification emerged among the feeding groups at either age. The authors caution that these limited sample sizes reduced the study’s ability to detect potential developmental differences, and they call for larger, multicenter studies with long-term follow-up to clarify any association between breastfeeding and neurodevelopment in this population.
The study also has structural limitations that shape how its findings should be read. The retrospective design means selection bias and residual confounding cannot be excluded; families who manage to sustain exclusive breastfeeding may differ from formula-feeding families in ways the available variables do not capture. Some baseline factors relevant to child development, such as the amount of breast milk actually consumed and the home-rearing environment, could not be quantified. The data themselves had gaps: mode of delivery was recorded for only 82 infants, birth weight for 105, and exact gestational age for just 44 of the 108 children, with the remainder documented only as more than 37 weeks. Mean birth weight was numerically higher in the exclusively breastfed group (about 3,421 grams) than in the formula group (about 3,094 grams), a difference that narrowly missed statistical significance at p = 0.051, although birth weight was included as a covariate in the adjusted models.
With those caveats in place, the authors conclude that exclusive breastfeeding during the first six months was associated with more favorable early growth patterns among term high-risk infants, while explicitly stating that the observational design means the findings should not be interpreted as evidence of a causal effect. The authors conclude that the results add observational evidence relevant to early nutritional management in term high-risk infants, and they call for larger, multicenter prospective studies with longer-term follow-up to further investigate the associations between early feeding patterns and growth and developmental outcomes in this population.
Subject of Research: Associations between early feeding patterns and physical growth and neurodevelopment in term high-risk infants
Article Title: Association of early feeding patterns with physical growth and neurodevelopment in term high-risk infants: a retrospective study
Article References: Zhang, C.-C., Xu, X.-J., Li, Y., & Wang, Y.-Y. (2026). Association of early feeding patterns with physical growth and neurodevelopment in term high-risk infants: a retrospective study. Frontiers in Public Health, 14, Article 1995315. https://doi.org/10.3389/fpubh.2026.1995315
Image Credits: AI Generated
DOI: 10.3389/fpubh.2026.1995315
Keywords: breastfeeding, formula feeding, mixed feeding, high-risk infants, infant growth, neurodevelopment, anthropometric Z scores, retrospective study, developmental screening, child health, WHO growth standards, perinatal risk factors
News Source: Harold Sullivan. (October 29, 2026). Breastfed high-risk infants show stronger early growth in retrospective study. Scienmag.
