Association between Breastfeeding and Respiratory Tract Infections and Gastroenteritis in Children Aged 2–3 Years

Abstract

Breastfeeding supports childhood nutrition, growth, and immune protection, and WHO recommends exclusive breastfeeding for six months, with continued breastfeeding up to two years or beyond. Respiratory tract infections and gastroenteritis remain major causes of childhood morbidity and healthcare use. Evidence on the role of breastfeeding in children aged 2–3 years is still limited. This research sought to investigate the association between breastfeeding history and respiratory tract infections and gastroenteritis among children aged 2–3 years attending Misurata Medical Centre, Libya. A cross-sectional study was conducted from April 1 to May 1, 2026, including children aged 24–36 months. Information was gathered through face-to-face interviews with parents or caregivers using a self-developed questionnaire covering feeding practices, infection history, household exposures, vitamin supplementation, and vaccination status. Associations were assessed using the chi-square or Monte-Carlo exact test, and crude odds ratios were estimated by binary logistic regression. The data included 101 children (53 boys [52.5%] and 48 girls [47.5%]). The survey indicated that 88.1% of the children had been breastfed, while only 39.6% were exclusively breastfed during the first six months and 42.4% received complementary foods before six months. During the first two years of life, 87.0% had at least one upper respiratory tract infection, 54.0% had at least one lower respiratory tract infection, and 68.4% had at least one episode of gastroenteritis. Formula-fed children showed the highest frequency of every infection outcome (e.g., any lower respiratory tract infection 76.9% versus 51.3% in exclusively breastfed children), and longer breastfeeding was accompanied by fewer recurrent infections. However, no significant association (p≥0.05) was found between feeding pattern or breastfeeding duration and any infection outcome. Household cigarette smoke exposure was the only factor significantly associated with an outcome, with about three times the odds of lower respiratory tract infection (OR 3.15; 95% CI 1.05–9.50; p = 0.041). The findings are consistent in direction with a protective role of breastfeeding but do not provide statistical evidence of it in this sample, which may reflect the small sample size. They emphasize the need to promote exclusive breastfeeding, timely complementary feeding, smoke-free homes, and vaccination. Larger multicenter, preferably prospective studies are needed to confirm these findings.