The impact of breastfeeding on facial appearance in adolescent children.

Evidence that breastfeeding impacts the facial features of children is conflicting. Most studies to date have focused on dental and skeletal malocclusion. It currently remains unclear whether such effects are of sufficient magnitude to be detectable on outward facial appearance. Here, we evaluate the extent to which maternally reported breastfeeding is associated with 3D facial shape in a large adolescent cohort. After extracting 3D facial surfaces from MR scans in 2275 9- and 10-year-old children and aligning the surfaces in dense correspondence, we analyzed the effect of breastfeeding on shape as a dichotomous (no/yes) and semi-quantitative (to assess duration in months) variable using partial least squares regression. Our results showed no effect (p = 0.532) when breastfeeding was dichotomized. However, when treated as a semi-quantitative variable, breastfeeding duration was associated with statistically significant changes in shape (p = 3.61x 10-4). The most prominent facial changes included relative retrusion of the central midface, zygomatic arches, and orbital regions along with relative protrusion of forehead, cheek, and mandible. The net effect was that as breastfeeding duration increased, the facial profile in children became flatter (less convex). The observed effects on the face, however, were subtle and likely not conspicuous enough to be noticed by most observers. This was true even when comparing the faces of children breastfed for 19-24 months to children with no reported breastfeeding. Thus, breastfeeding does appear to have detectable effect on outward facial appearance in adolescent children, but its practical impact appears to be minimal.