ABSTRACT
<p><b>OBJECTIVE</b>Childhood 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.</p><p><b>METHODS</b>A 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.</p><p><b>RESULTS</b>After 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).</p><p><b>CONCLUSIONS</b>The 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.</p>