Association Between Infant Feeding Practices and Autism Spectrum Disorder: A Cross-Sectional Analytical Study Among Children Aged 3 to 10 Years in a Tertiary Care Hospital

Abstract

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition increasingly diagnosed during early childhood. Emerging evidence suggests that early-life exposures, particularly infant feeding practices, may influence neurodevelopmental outcomes. However, data from Indian settings remain limited.

Aim: To assess the association between infant feeding practices and the diagnosis of Autism Spectrum Disorder among children aged 3 to 10 years in a tertiary care hospital, and to identify maternal and child-related factors influencing suboptimal feeding.

Materials and Methods: A cross-sectional analytical study was conducted at the Department of Pediatrics, Sree Balaji Medical College and Hospital, Chennai, between January and June 2025. A total of 106 children (53 with ASD and 53 typically developing controls) aged 3–10 years were recruited using consecutive convenience sampling. Data on infant feeding practices were collected using a semi-structured questionnaire administered to caregivers. Multivariate logistic regression was performed to assess associations between feeding variables and ASD, with results expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results: Exclusive breastfeeding for ≥6 months was significantly lower in the ASD group (42.2%) compared to controls (75.6%) and was associated with reduced odds of ASD (aOR = 0.25; 95% CI: 0.13–0.48; P < 0.001). Early top feeding (aOR = 3.4), delayed initiation of breastfeeding (>1 hour) (aOR = 2.9), early complementary feeding (<6 months) (aOR = 2.6), and bottle feeding before six months (aOR = 2.2) were all significantly associated with increased odds of ASD. Commonly reported breastfeeding challenges among mothers of ASD children included poor oromotor coordination, weak bonding, and inadequate milk supply.

Conclusion: Suboptimal infant feeding practices—particularly lack of exclusive breastfeeding, early top feeding, and delayed breastfeeding initiation—are significantly associated with ASD. Exclusive breastfeeding emerges as a consistent protective factor. Public health strategies promoting optimal feeding practices and early maternal support may contribute to improved neurodevelopmental outcomes and potentially reduce ASD risk in early childhood.