consequences (Dykman and Casey, 2003). Other factors that may be more modifiable include knowledge about optimal food intake and content, which can be addressed with education.

Breastfeeding has been studied extensively concerning its relevance to emotional and behavioral health. On the one hand, mounting evidence suggests that breastfeeding can contribute to enhanced cognitive capabilities independently of confounding factors (Kramer, Aboud, et al., 2008). While the IQ effect is modest in most studies, intelligence is a protective factor for MEB disorders and related problems. On the other hand, the weight of evidence at this time does not support superior behavioral outcomes for children who have been breastfed (Kramer, 2008). Based on current information, breastfeeding should be promoted for many reasons, but prevention of MEB disorders in childhood or in later life is not one of them.

Avoidance of nutritional deficiencies is important for promotion of mental health. High on the list of critical nutritional elements is iron. Children shown to have severe chronic iron deficiency in infancy score lower on measures of mental and motor functioning and are rated by both parents and teachers after 10 years of follow-up as more problematic in the areas of anxiety, depression, social problems, and attention problems (Lozoff, Jimenez, et al., 2000). This study is one of several that suggests an important relationship between iron deficiency and subsequent behavior. A concern, of course, is that iron repletion does not reverse long-term adverse outcomes and that iron deficiency remains very common in the United States (e.g., Schneider, Fuji, et al., 2005). U.S. Hispanic children and overweight children are particularly vulnerable (Brotanek, Halterman, et al., 2005). Strategies for avoiding iron deficiency include iron supplementation of exclusively breastfed babies (Dallman, Siimes, and Steckel, 1980), avoidance of prolonged bottle feeding (Brotanek, Halterman, et al., 2005), and routine testing of certain populations of infants for iron deficiency in the course of medical care. Given the magnitude of potential adverse outcomes, systematic efforts to inform parents of childbearing age about the importance of adequate iron intake for both mother and child should be adopted and sustained at the national level.

Attention has been focused for the past decade or two on the omega-3 fatty acid content of prenatal maternal diets and diets for children postnatally. Low levels of DHA and EPA—omega-3 fatty acid products—and corresponding high levels of arachadonic acid have been shown in animal studies to be detrimental to brain development (Innis, 2008) and are related to indices of brain inflammation (Orr and Bazinet, 2008). Cognitive and some behavioral consequences of this imbalance have been described in animals and correlated with effects on cell membranes in the central nervous system (Mahieu, Denis, et al., 2008). In human studies, alterations in omega-3 fatty acid levels have been associated with cardiovascular disease;

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement