THE USE OF PACIFIER IN BREASTFEED

The Use of Pacifier in Breastfeed



Abstract

Pacifiers are widely used in many developing countries. Although their use is not recommended for breastfeeding infants, there have been no published reports on the association between pacifier use and risk of early weaning. In a study of 354 infants in Brazil, mothers were asked about pacifier use at age 1 month, duration of breastfeeding, and introduction of other foods. Among 249 children still breastfed at 1 month, the risk that a child would be weaned at any age between 1 and 24 months was higher in pacifier users than in non-users (hazard ratio 3•0, 95% Cl 2•0-4•6). The association remained even after adjustment for the child's age, sex, birthweight, socioeconomic status, and age at introduction of bottle-feeding.

The Use of Pacifier in Breastfeed

Back Ground

The association between pacifier use and duration of breastfeeding remains highly controversial. In the late 1980s, the World Health Organization and UNICEF adopted avoidance of pacifiers as one of the Ten Steps of Successful Breastfeeding. Step 9 of the programme states: “Give no artificial teats or pacifiers to breastfeeding infants”(Kramer,2001).

Study design

A multicenter, randomized, non-inferiority, controlled trial comprising 1021 mothers highly motivated to breastfeed whose newborns regained birth weight by 15 days. They were assigned to offer versus not to offer pacifiers. Primary outcome was prevalence of exclusive breastfeeding at 3 months. Main secondary outcomes were the prevalence of exclusive and any breastfeeding at different ages and duration of any breastfeeding.

Pacifiers and breastfeeding

The potential impact of pacifiers on breastfeeding should be clearly understood especially now that the American Academy of Pediatrics guidelines recommend the use of the pacifier in infants at bedtime to reduce the risk of SIDS (Siegel,1989). The recommendations have caused a broad discussion among lactation consultants (Howard,2003).

Many observational studies have been published indicating a strong negative association between pacifier use and breastfeeding duration(Kramer,2001). However, observational studies cannot determine if pacifier use causes breastfeeding cessation or if it was decreased breastfeeding which led to increased pacifier use. Does pacifier use have an adverse effect on breastfeeding? Or is it simply a marker of breastfeeding difficulties or of an attempt to wean the baby? Evidence for causation can be better supplied by randomised controlled trials (RCTs) where pacifiers are introduced at a set time.

RCTs have not shown that providing pacifiers results in shortened breastfeeding duration, except when pacifiers are given in the first 5 days. In multivariate analyses, Howard found that pacifier use in the first 5 days versus pacifier use after 4 weeks postpartum was associated with shorter breastfeeding duration (Howard,2003).

A Swiss trial of healthy breastfeeding newborns evaluated the effect of the avoidance of pacifier, bottle, and supplemental feeding for the first 5 days versus no restrictions on pacifiers and fluid supplementation (Siegel,1989). They found no differences in breastfeeding duration. This study was not designed to evaluate separately effects of pacifiers and bottle-nipple exposure. The intervention was limited to the peripartum hospitalisation period.

A more recent trial by Kramer , looking at a longer period ...