OBJECTIVEChildhood behavioral problems can predict future psychiatric disorders. Temperament development is important for a healthy personality in adulthood. This study investigated whether breastfeeding is associated with the occurrence of behavioral problems and the temperament development in preschool children.

METHODSA total of 737 children (399 boys and 338 girls) aged 4-5 years in Zibo City were recruited by stratified random cluster sampling. They were born at term with a birth weight of >/= 2.5 kg. The feeding patterns and the breastfeeding duration in infancy were collected. Behavioral and temperament developments were investigated by the Achenbach Child Behavior Checklist (CBCL), temperament questionnaire for 3-7-year-old children and a self-designed inventory questionnaire. The association of feeding patterns and the breastfeeding duration with behavioral problem occurrence and the temperament development in children were analyzed by a multivariate non-conditional logistic regression analysis and a multivariate stepwise regression analysis.

RESULTSAfter controlling for confounding variables, such as family income and parental education levels, it was found that a breastfeeding duration of >/= 9 months was a protective factor against behavioral problem occurrence in boys (OR=0.184). In girls, a breastfeeding duration of >/= 9 months was also a protective factor against behavioral problem occurrence (OR=0.165), while a mixed feeding with more breast milk and less formula milk was a risk factor (OR=2.203). The factors influencing temperament development consisted of exclusive formula feeding and the duration of breastfeeding (lasting for 4-6 months or 7-9 months) as well as a mixed feeding (with more formula milk and less breast milk, more breast milk and less formula milk, or equal amount of both).

CONCLUSIONSThe fewer amounts and the shorter duration of breastfeeding are risk factors for behavioral problems occurrence in children aged 4-5 years. Children's temperament development is correlated with the feeding patterns and the breastfeeding duration.