Pacifier Restriction and Exclusive Breastfeeding.

1. Laura R. Kair, MD^a, 
2. Daniel Kenron, MSIE^b, 
3. Konnette Etheredge, RN, MSN^c, 
4. Arthur C. Jaffe, MD^a, and 
5. Carrie A. Phillipi, MD, PhD^a

1. ABSTRACT

   OBJECTIVE: We tested the hypothesis that removing pacifiers from routine distribution in our mother-baby unit (MBU) would be associated with greater breastfeeding initiation or exclusivity during the birth hospitalization.
   METHODS: We retrospectively compared exclusive breastfeeding, breastfeeding plus supplemental formula feeding, and exclusive formula feeding rates for 2249 infants admitted to the MBU at our university teaching hospital during the 5 months before and 8 months after restriction of routine pacifier distribution. Formula supplementation, if not medically indicated, was discouraged per standard practice, but access to formula was not restricted.
   RESULTS: Of the 2249 infants, 79% were exclusively breastfed from July through November 2010, when pacifiers were routinely distributed. During the 8-month period after pacifier restriction, this proportion decreased significantly to 68% (P < .001). A corresponding increase from 18% to 28% was observed in the number of breastfed infants receiving supplemental formula feeds in the same period (P < .001). During the study period, the proportion of exclusively formula-fed infants increased from 1.8% to 3.4% (P < .05).
   CONCLUSIONS: Restricting pacifier distribution during the newborn hospitalization without also restricting access to formula was associated with decreased exclusive breastfeeding, increased supplemental formula feeding, and increased exclusive formula feeding. Because high-quality, prospective medical literature addressing pacifier use and breastfeeding does not conclusively show an adverse relationship in women who are motivated to breastfeed, more studies are needed to help determine what effect, if any, pacifiers have on breastfeeding initiation and exclusivity in the immediate newborn period.

   http://pediatrics.aappublications.org/content/131/4/e1101.abstract

Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding

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.

 

Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding

Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding
Jaafar SH, Jahanfar S, Angolkar M, Ho JJ
Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD007202. DOI: 10.1002/14651858.CD007202.pub2

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 pacifier use and no 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.
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 pacifier use versus no 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 strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).

Selection criteria
Randomised and quasi-randomised controlled trials comparing pacifier use versus no 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.

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) 1.00; 95% confidence interval (CI) 0.95 to 1.06), 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 0.97 to 1.02), 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.