Breastfeeding Indicators and Gastrointestinal Outcomes in Chinese 0-23-Month-Old Infants and Young Children: a National Cross-Sectional Survey Finding

Optimal breastfeeding is critical for infant health. However, data on current breastfeeding status in China and associations between breastfeeding practices and gastrointestinal outcomes remain limited. This cross-sectional study enrolled 2,405 infants and children aged 0–23 months and their mothers from 10 provinces and cities across five regions of China (Southwest, East, Northeast, Northwest, and Central). A standardized questionnaire was used to collect data on breastfeeding practices, non-breast milk feeding status, complementary feeding practice, as well as sociodemographic and perinatal characteristics. Gastrointestinal symptom profiles, including numbers and severity, were assessed using the Infant Gastrointestinal Symptom Questionnaire. The WHO-recommended Infant and Young Child Feeding indicators were used as core indexes to assess breastfeeding practices. Multivariate logistic regression analysis was performed to assess the relationship between each breastfeeding indicator and gastrointestinal symptoms. Among 2,405 infants and children, 29.6%, 32.5%, and 37.9% were aged (0–5) months, (6–11) months, and (12–23) months, respectively. Ninety-five-point two percent (95.2%) had been breastfed, while 49.2% initiated breastfeeding within 1 hour of delivery. 44.5% of children received their first intake of non-breast milk fluids within the first 24 hours of life. For infants under six months, 53.9% were exclusively breastfed, 22.6% were fed mixed milk, and 10.7% were provided additional water while breastfeeding. Breastfeeding continuation rates were 44.7% of children at 1 year of age and 16.8% of those at 2 years of age. Multivariate logistic regression analysis revealed that early initiation of breastfeeding (within 1 hour), exclusive breastfeeding, delayed introduction of non-breast milk fluids (no less than 1 month), and continued breastfeeding (CBF) 6-11 months were significantly associated with fewer gastrointestinal (GI) symptoms and lower GI symptom scores (P < 0.05), after adjusting for all covariates, including complementary feeding indicators. No significant associations were observed between number of GI symptoms and GI symptom scores and CBF 12-23 months, age 1 year, or age 2 years (P > 0.05). China's breastfeeding status are improving, and the appropriate breastfeeding practices benefit infants’ gastrointestinal health. Efforts on supporting and guiding mothers to achieve optimal breastfeeding and research on the benefit of CBF in complex feeding conditions should be conducted in the future to better support child health.