> Evan wrote:
 Kramer, Barr, Dagenais and Young, et al (2001) did a randomized, controlled
study on women who intended to breastfeed for at least 3 months and who were
delivered of singleton newborns of at least 37 completed weeks gestational
age and 2500g birth weight.  All women were given a breastfeeding promotion
package (informational pamphlets and a 45-minute interview with a nurse
trained in lactation consultation), but the women in the experimental group
were asked to avoid pacifiers when the infant was fussing and to first offer
her breast to try and calm it
> down.  If that failed, she should try to carry or rock the infant.  The
control group had all options for calming the infant discussed, including
pacifier use.  The results showed the difference in weaning prior to 3
months was not significantly different between the experimental (18.9%) and
the control group (18.3%).  This study is important because it is a
randomized, controlled study instead of using convenience sampling.  The
study found no evidence that pacifier use is harmful for breastfeeding, but
also that there were no beneficial effects of pacifiers on infant crying or
fussing.  The non-pacifier soothing methods in the experimental group
appeared to be adequate.


I think I would have two questions about this study. Most parents decide to
use (or not use) pacifiers based on many factors, and the instructions they
were given might not have been enough. I'd want to know how many of the
parents in each group actually used a pacifier, how often and for how long.
Secondly, I think that three months may be too short a time period to
determine the potential risks of pacifier use. It is just after this -
around four months - that nursing strikes, decreased milk supply, and other
problems often crop up and sometimes these seem to be related to pacifier
use. I think it would be more valuable to look at the six-month mark or even
a year - after all, that's what the AAP recommends as a minimum. I do think
that pacifiers can increase the number of babies who wean before a year.

>      Baker (2000) looked at studies that used convenience sampling of
women that had the option of using a pacifier.  She determined through
review of studies that there was a relationship between pacifier use and
breastfeeding outcomes, but the correlation between these two variables did
not support pacifiers as the cause of decreased breastfeeding duration.  She
found that if a pacifier is used for the purpose of delaying feeding it
could cause a decreased milk supply, but if it is used to soothe an infant
after a feeding or to help the infant fall asleep it may not.


Again, I would want to know what the breastfeeding duration being considered
is. If it is three months, I don't think this study tells us much. I think
that when the breast becomes seen as primarily a source of food, and the
pacifier more connected to comfort (such as when falling asleep) there is an
increased risk of early weaning as the baby is able to get food from other
sources such as solid foods or from a cup. It is those "comfort feeds" that
become most important to the baby after the first year - nursing to sleep,
nursing when hurt or upset, nursing to calm down. If the pacifier has become
the source of soothing and help to fall asleep, those nursings may be lost.

I don't think that pacifiers are evil and used one myself with my third
baby; I was also nursing his two-year-old sister and had an overly generous,
fast-flowing milk supply. He often wanted to suck but did not want the extra
milk. I found it sometimes helped to let him suck on a pacifier after
nursing. I think, though, that it needs to be used cautiously and
discontinued as early as possible.

Teresa Pitman
Guelph, Ontario

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