Jaafar SH, Jahanfar S, Angolkar M, et al. Pacifier use versus no pacifier
use in breastfeeding term infants for increasing duration of breastfeeding.
Cochrane Database Syst Rev. 2011 Mar 16;3:CD007202. (Review) PMID: 21412899

Read Abstract Read Comments

http://plus.mcmaster.ca/EvidenceUpdates/MMA.aspx?ArticleID=39118

 

 

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.

 

Comments from Clinical Raters

Obstetrics

Despite being a pro-breastfeeding obstetrician, experience over many years
shows us all that practically 100% of women determined not to use a pacifier
(aka 'dummy') with their as yet unborn baby change their minds very promptly
in the first few days and weeks postpartum, without any deleterious effects
on baby or milk supply specifically due to this lone factor. This study
provides good 'ammunition' for us to give our patients who are conflicted
when they encounter over-zealous childbirth educators and maternity staff ,
the so-called 'lactation nazis' for whom there is no compromise on anything.

Pediatrics (General)

This is important information which should lay to rest the argument about
nipple confusion. However, it is still useful to remember that pacifiers
carry the same risk as bottle feeding with regards to diarrhoeal illness due
to lack of cleanliness of the nipples specially in the developing world.

Pediatrics (General)

Important review to dispel anxieties about the effect of pacifiers
(dummies).


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