Pacifier Use and Breastfeeding

Pacifier Use May Not Adversely Affect Breast-Feeding Duration or Exclusivity

by Laurie Barclay

April 15, 2009 — Pacifier use may not adversely affect breast-feeding duration or exclusivity, according to the results of a systematic review reported in the April issue of the Archives of Pediatrics & Adolescent Medicine.

"Physicians who counsel families about pacifier use must now weigh the potential protective effect against SIDS [sudden infant death syndrome] against the potential deleterious effect on breastfeeding," write Nina R. O'Connor, MD, from University of Virginia School of Medicine in Charlottesville (at the time of the study), and colleagues. "To assist in this decision balance, a systematic review of the literature regarding the impact of pacifier use on breastfeeding was undertaken in an attempt to summarize the current evidence."

The investigators searched MEDLINE, CINAHL, the Cochrane Library, EMBASE, POPLINE, and bibliographies of identified articles for English-language records from January 1950 through August 2006 containing the Medical Subject Heading terms pacifiers and breast-feeding. Of 1098 reports identified, and after exclusion of duplicate and irrelevant studies, 29 studies met inclusion criteria for the review, including 4 randomized controlled trials (RCTs), 20 cohort studies, and 5 cross-sectional studies.

Two independent reviewers abstracted data from these studies and graded them for quality, with disagreements settled through consensus opinion reached using a third investigator. The exposure of interest was pacifier use, and the primary study endpoints were breast-feeding duration or exclusivity.

The 4 RCTs showed no difference in breast-feeding outcomes associated with different pacifier interventions, ie, pacifier use during tube feeds, pacifier use at any time after delivery, maternal education emphasizing avoidance of pacifiers, and a UNICEF(United Nations Children's Fund)/World Health Organization Baby Friendly Hospital environment. Pacifier use was associated with reduced duration of breast-feeding in most observational studies.

Limitations of this review include the possibility that pacifier use may be a marker for breast-feeding problems, inclusion of English-language reports only, and that none of the studies looked at pacifier use only at nap time or bedtime.

"The highest level of evidence does not support an adverse relationship between pacifier use and breastfeeding duration or exclusivity," the study authors write. "The association between shortened duration of breastfeeding and pacifier use in observational studies likely reflects a number of other complex factors, such as breastfeeding difficulties or intent to wean. Ongoing quantitative and qualitative research is needed to better understand the relationship between pacifier use and breastfeeding."

The University of Virginia Children's Hospital Research Grants Program supported this study in part. The review authors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2009;163:378-382.

Laurie Barclay, MD, is a freelance writer and reviewer for Medscape.