Althea Vol 3 No 1 full text Final.indd


Althea Medical Journal. 2016;3(1)

79

Association between Exclusive Breastfeeding and Child Development

Ghaniyyatul Khudri,1 Eddy Fadlyana,2 Nova Sylviana3
1Faculty of Medicine, Universitas Padjadjaran, 2Departement of Child Health Faculty of Medicine, 

Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, 3Departement of 
Physiology, Faculty of Medicine, Universitas Padjadjaran

Abstract

Background: Child development highly correlates with child’s quality. The fastest child development period 
is during the first three  years, also called golden period. This research was aimed to discover correlation 
between exclussive breastfeeding and child development in Cipacing Village Jatinangor, district of Sumedang.
Methods: This research was conducted using cross-sectional method in thirteen Pos Pelayanan Terpadu 
(Posyandu) Cipacing Village in Jatinangor. One hundred and two children  aged 12−24 months with their 
caregiver were recruited as respondents by using cluster sampling method. Hist ory of exclusive breastfeeding 
was assessed with questionnaire  while child development status was assesed with Kuesioner Pra Skrining 
Perkembangan (KPSP) in September 2013 after informed consent was obtained. Chi-square test analysis 
was performed to determine correlation between exclusive breastfeeding and child development status.
Results: Overall, children in Cipacing Village had non-exclusive breastfeeding history (83.3%), and only 
16.7% respondents had exclusive breastfeeding history. Meanwhile, 89.2% of children had  normal 
development status, and 10.8% had  delayed development status. Statistic analysis using chi-square test in 
the level of 95% confidence between exclusive breastfeeding and child development showed p=0.686 and 
odds ratio 2.133.
Conclusions: There is no significant relationship between history of exclusive breastfeeding and child 
development status. [AMJ.2016;3(1):79–84]

Keywords: Child development, exclusive breastfeeding, one year old children

Correspondence: Ghaniyyatul Khudri, Faculty of Medicine, Universitas Padjadjaran, Jalan Raya Bandung-Sumedang 
Km.21, Jatinangor, Sumedang, Indonesia, Phone: +62 852 7492 5956  Email: ghaniyyatul.khudri@gmail.com

Introduction

Development is a result from interaction 
between matured central nervous system 
and effected organs, biological changes to 
control gross and fine muscles, psychological 
changes in sosial relationship, language, and 
personality.1 Delayed in this aspect indicates  
developmental  delay on children, that is still 
a problem in developing country, especially 
Indonesia. World Health Organization 
(WHO) in 2007 recorded that more than 
two hundreds million children in developing 
country did not reach complete development,2 
while in Indonesia about 12.8−28.5% 
children had delayed development.3 The 
only food source with complete nutrients 
that needed by children until six months is 
mother’s breastmilk. Nutrient deficieny on 
children under two years old may reduce 
brain cells about 15−20%,4 disruption in 

brain cell maturation processes, interupted 
nerve interaction for development process, 
such as physcomotoric, cognitive and sosial 
behavior. In Indonesia only 15.3% infants get 
exclusive breasfeeding.5 A survey on exclusive 
breastfeeding by World Breastfeeding Trends 
Initiative (WTBi) on March 2012, Indonesia 
ranked 3 of 81 countries.2 Locally, prevalence 
exclusive breastfeeding in 2012 based on data 
in Pusat Kesehatan Masyarakat (Puskesmas) 
Jatinangor is only 1.3%.

A case control research conducted in 
Lowokharu, Malang6 in 2007, stated that there 
was no difference in developmental status 
among children aged 1−2 years old with or 
without exclusive breatfeeding. Contrast to a 
prospective cohort study in Krakow, Poland7 
in 2011, that showed exclusive breastfeeding 
in early infancy improve cognitive children 
development. In accordance to explanation 
above, this research was aimed to discover 
correlation between exclusive breastfeeding 



Althea Medical Journal. 2016;3(1)

80     AMJ March 2016

and 12−24 months children development in 
Cipacing, Jatinangor.

Methods

This was a cross-sectional research conducted 
in Pos Pelayanan Terpadu (Posyandu) Cipacing 
Village, Jatinangor, in September 2013. After 
ethical clearance was approved by Health 
Research Ethics Committee, thirteen Posyandu 
were choosen from eighteen Posyandu in 
Cipacing Village. Samples were obtained 
by cluster sampling. Total respondents  in 
this study were  102 children included their 
mother or caregiver. Inclusion criteria was 
children aged one years old that registered 
in Posyandu, Cipacing Village, with complete 
gestational age or birth weight >2500 
grams, without congenital abnormality and 
chronic disease. Meanwhile, children without 
caregiver’s permission or ill children when 
data collection were  excluded.  

After caregivers were explained and 
understood about informed consent, they 
should sign the form. The instruments 
were validated questionnaires for exclusive 
breastfeeding history and Kuesioner Pra 
Skrining Perkembangan (KPSP) questionnare 
for children development. Caregivers would 
answer five questions for children history of 
breastfeeding and Makanan Pendamping ASI 
(MP-ASI) then children development status 
was observed using KPSP questionnaire. Four 

aspects assessed were gross motors, fine 
motors, language, and sosial behavior. 

After scoring KPSP scores, developmental 
status was divided into two groups, normal 
development (KPSP score nine to ten) and 
delayed development. Delayed development 
itself was divided into suspect developmental 
delay for KPSP score seven to eightand delayed 
development for KPSP score equal or less 
than six. The collected data were analyzed by 
using chi-square test to discover correlation 
between exclusive breastfeeding and children 
developmental status

Results

Most mother’s age were ranged in 24−34 
years old (52%), more than half of them did 
not complete senior high school (59.8%), and 
there were 74.5% respondents come from 
upper middle sosioeconomic status based on 
the regional minimum wage (Upah Minimum 
Regional/UMR) of Sumedang. Most of the 
mothers work as housewives (87.3%) (Table 
1).

According to gender of children, it was 
found that boys are more than girls about 
57.8%. Children with age group 12−17 months 
have highest percentage (60.2%) than other 
age ranges. There were 55.9% respondents 
who had siblings (Table 2).

Children in Cipacing Village had non-
exclusive breastfeeding history (83.3%), 

Table 1 Maternal Characteristics  

Variable Frequency Percentage (%)

Maternal Age (years old)
15−24 28 27.5
25−34 53 52
≥35 21 20.6
Mother’s Education Level
<senior high school 61 59.8
≥senior high school 41 40.2
Occupation
Housewife 89 87.3
Work 13 12.7
Sosioeconomic status
Below UMR 26 25.5
Upper middle UMR 76 74.5

Note: UMR= Upah Minimum Regional/ Regional Minimun Wage. UMR of Sumedang District Rp 1.300.000,−/month



Althea Medical Journal. 2016;3(1)

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and only 16.7% respondents had exclusive 
breastfeeding history. Meanwhile, 89.2% of 
children had normal development status, 
and 10.8% had delayed development status. 
Statistic analysis using chi-square test in the 
level of 95% confidence between exclusive 
breastfeeding and child development showed 
p=0.686 and odds ratio 2.133 (Table 3).

There are misconceptions on information 
about breastfeeding for children under six 
months old. Thus, misconceptions arise from 
local belief when their child cries, it means 
that breaskmilk is  not enough. Some mothers 
complained that there was no breastmilk 
is produced, that may be caused by wrong 

breastfeeding technique, and others got 
recommendation from medical staffs nearby 
that combining breastmilk and formula milk 
even before six months were good for children 
nutritional status.

Based on maternal age groups, the highest 
developmental delay are mothers in aged 
range 15−24 years old (45.5%). Statistically, 
there was no correlation between a mother’s 
age and the child’s development. (Table 4,5)

The occupational status of mothers 
showed no significant relationship (p=0.35) 
because all children with developmental 
disorders came from housewives who do 
not work. Number of sibling’s respondents 

Ghaniyyatul Khudri, Eddy Fadlyana, Nova Sylviana: Association between Exclusive Breastfeeding and Child 
Development

Table 3 Correlation between Exclusive Breastfeeding and Developmental Status

Exclusive Breastfeeding
Child Development

Total n(%) p OR
Good n(%) Delayed n(%)

No  75(88.2 %) 10 (11.8%) 85(83.3%) 0.686 2.133
Exclusive 16 (94.1%) 1 (5.9%) 17(16.7%) 

Total 91 (89.2%) 11(10.8%)
Note: OR= odds ratio

Table 2 Characteristics of Children 

Variable Frequency Percentage (%)

Sex
Boy 59 57.8
Girl 43 42.2
Children ages (month)
12−17 62 60.2
18−24 40 39.2
Number of Sibling
none 45 44.1
≥2 57 55.9
IMD
Yes 82 80.4
No 20 19.6
MP-ASI  
Appropriate by age 89 87.3
Not appropriate by age 13 12.7
Head Circumference
Appropriate by age 87 85.3
Not apprpriate by age 15 14.7

Note: IMD= Inisiasi Menyusu Dini/Early Initiation of Breastfeeding,MP-ASI= Makanan Pendamping ASI/Weaning Food 



Althea Medical Journal. 2016;3(1)

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showed no correlation with the child’s 
developmental status (p=1). Weaning food 
feeding also showed no relationship with 

child’s development. Therefore, none of the 
characteristics have a significant relationship 
with child development.

Table 4 Correlation between Developmental Status and Maternal Characteristics

Variable
Child Development

p OR
Good Delayed

Maternal Age (year)
15−24 23 5

0.20125−34 50 3
≥35 18 3
Mother’s Education Level
<senior high school 54 7

1 1.199
≥senior high school 37 4
Occupation
Housewife 78 11

0.351 1.167
Work 13 0
Sosioeconomic status
Below UMR 22 4

0.465 1.331
Upper middle UMR 69 7

Note: OR= odds ratio, UMR= Upah Minimum Regional/ Regional Minimun Wage. UMR of Sumedang District Rp 1.300.000,−/month

Table 5 Correlation between Developmental Status and Characteristics of Children

Variable
Child Development

p OR
Good Delayed

Sex
Boy 52 7

0.757 1.313
Girl 39 4
Children ages (month)
12−17 53 9

0.194 3.22
18−24 38 2
Number of Sibling
none 40 5

1 1.063
≥2 51 6
EarIMD
Yes 73 9

1 0.901
No 18 2
MP-ASI
Appropriate by age 81 8

0.146 0.329
Not appropriate by age 10 3
Head Circumference
Appropriate by age 77 10

1 0.55
Not appropriate by age 14 1

Note: OR= odds ratio, IMD= Inisiasi Menyusu Dini/ Early Initiation of Breastfeeding, MP-ASI= Makanan Pendamping ASI/Weaning Food 



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Discussion

Golden period is the most important phase for 
child development. Developmental distrubance 
in this phase affects worse than other period 
of time. Basic needs for child development 
includes care, affection, and stimulation.   
While, development itself depends on many 
factors such as nutrition, health,  genetic, 
race, and sex. There are internal factor and 
external factor. The internal factor consists of 
nutrition, endocrine, immunological, maternal 
pshycology, radiation and infection, while the 
external factor is chemical.1

In the development, brain cell grows 
continously until three years old,4 therefore 
besides exclusive breastfeeding, early 
initiation of breastfeeding and weaning food 
were assessed in this research to exlude the 
possibility of confounding factor that might 
arise.8 

Maternal breastmilk is the main nutrient 
for equal or less than six month old infant, 
and it was suggested to be continued until two 
years old. It is rich source of fatty acids and 
other bioactive components essential for the 
infant brain development. The breastmilk also 
contains docosahexaeoic acid and arachidonic 
acid that is not contained in cow’s milk.7 
Related to other studies that revealed infant 
who were breastfeed exclusively had better 
score in cognitive development test than non-
exclusively breastfeed infants.9

In this study, children with good 
development at the first year in exclusive 
breastfeeding group were 94.1% and in non-
exclusive breastfeeding group were 88.2%. 
Children with delayed development were 
higher in non-exclusive breastfeeding group 
(11.8%), Therefore, no correlation found 
between exclusive breastfeeding and child’s 
developmental status (p=0.686). It was 
similiar to the previous research that showed 
no significant correlation between exclusive 
breastfeeding and child’s developmental 
status, but there were higher risk possibilities 
of developmental disorders for non-exclusive 
breastfeeding infant than exclusive breastfeed 
infant.4,6,7 The correlation strengh parameter 
used to determine risk estimate in this 
research is odds ratio,10 which generates value 
about 2.133. The value was meant that the 
children with non-exclusive breastfeed had  
2.133 times more risk for developmental delay 
than exclusive breastfeeding child.

The percentage of developmental delays on 
children in Cipacing was slightly lower (16.7%) 
than the average of Indonesia developmental 

delays on children.3
Based on maternal age groups, the highest 

developmental delay are mothers in aged range 
15−24 years old (45.5%). Nevertheless, most 
mother’s age were ranged in 24−34 years old 
(52%), this result was in accordance with the 
age of pregnancy and childbirth in Indonesia.11 
However, there was no correlation between a 
mother’s age and the child’s development, but 
mothers who have children less than 20 years 
old have a higher risk for having children with  
disorder and psychological health.7

Maternal education is a significant predictor 
of child care. The education gives mothers 
more knowledge about what is needed for 
their children such as prenatal care, nutrition 
prenatal and postnatal, development stimulus, 
authoritative parenting, positive mother-child, 
and parental management that is important for 
child development.12 In this study, more than 
half of the mothers did not complete the nine 
years study program (59.8%), this data shows 
poor rate of maternal education in Cipacing. 

Most of the mothers work as housewives 
(87.3%). A profession as a housewive spends 
more time at home that gives more opportunity 
for interacting and caring their children, so her 
expectation provide a good stimulus for child 
development.13 

According to sosioeconomic status, there 
were 74.5% respondents come from upper 
middle sosioeconomic status based on the 
regional minimum wage (Upah Minimum 
Regional/UMR) of Sumedang, the recent 
study showed that sosioeconomic families 
were the external factors that could affect a 
child’s development.14 However there was no 
characteristic of respondent had significant 
correlation with children developmental 
status. Even though, continual poverty is 
more harmful on cognitive ability, intelligence 
quotient, and other enviromental factors that 
affect child development.15

In conclusion, there is no correlation 
between exclusive breastfeeding and child 
development status. Limitation for this study 
was insufficient number of respondents 
because it was restricted in one village area. 
Also, there were recalled bias because it 
depended on caregiver’s memory to retrive 
history foods eaten by child during last one 
year. Therefore, next research can be done 
using larger size sample and  prospective 
cohort as research design.

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Ghaniyyatul Khudri, Eddy Fadlyana, Nova Sylviana: Association between Exclusive Breastfeeding and Child 
Development



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