Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. The Cochrane Library 2012, Issue 7
Abstract
Background
To
successfully initiate and maintain breastfeeding for a longer duration,
the World Health Organization's Ten Steps to Successful Breastfeeding
recommends total avoidance of artificial teats or pacifiers for
breastfeeding infants. Offering the pacifier instead of the breast to
calm the infant may lead to less frequent episodes of breastfeeding and
as a consequence may reduce breast milk production and shorten duration
of breastfeeding; however, this remains unclear.
Objectives
To
assess the effect of unrestricted versus restricted pacifier use in
healthy full-term newborns whose mothers have initiated breastfeeding
and intend to exclusively breastfeed, on the duration of breastfeeding,
other breastfeeding outcomes and infant health.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 March 2012).
Selection criteria
Randomised
and quasi-randomised controlled trials comparing unrestricted versus
restricted pacifier use in healthy full-term newborns who have initiated
breastfeeding regardless of whether they were born at home or in the
hospital.
Data collection and analysis
Two
authors independently assessed the studies for inclusion, assessed risk
of bias and carried out data extraction. Data were checked for
accuracy.
Main results
We
found three trials (involving 1915 babies) for inclusion in the review
but have included only two trials (involving 1302 healthy full-term
breastfeeding infants) in the analysis. Meta-analysis of the two
combined studies showed that pacifier use in healthy breastfeeding
infants had no significant effect on the proportion of infants
exclusively breastfed at three months (risk ratio (RR) 0.99; 95%
confidence interval (CI) 0.93 to 1.05), and at four months of age (RR
0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of
infants partially breastfed at three months (RR 1.00; 95% CI 0.98 to
1.13), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).
Authors' conclusions
Pacifier
use in healthy term breastfeeding infants, started from birth or after
lactation is established, did not significantly affect the prevalence or
duration of exclusive and partial breastfeeding up to four months of
age. However, evidence to assess the short-term breastfeeding
difficulties faced by mothers and long-term effect of pacifiers on
infants' health is lacking.
Plain language summary
Effect of pacifier use on duration of breastfeeding in full-term infants
Breast
milk is superior to other baby foods in providing balanced nutrition
and protection against allergy and infection to newborns. Breastfeeding
is recommended by the World Health Organization, exclusively in the
first six months and then as a dietary supplement. Breastmilk production
and supply are maintained by frequent suckling of the breast and nipple
stimulation. A pacifier is a non-nutritive sucking device used to calm
an infant that has become a cultural norm in many parts of the world.
However there is a widespread belief that pacifiers may interfere with
breast milk production and lead to discontinuation of breastfeeding.
Our
review concluded that for mothers who are motivated to breastfeed their
infants, pacifier use before or after breastfeeding was established did
not significantly affect the prevalence or duration of exclusive and
partial breastfeeding up to four months of age. The review provided
moderate evidence from three randomised controlled trials (involving
1915 babies) comparing unrestricted with restricted pacifier use by
healthy, full-term breastfeeding infants; two of the trials (1302
babies) were included in the analysis. However, there is a widespread
belief that pacifiers may interfere with breast milk production and lead
to discontinuation of breastfeeding.