by Anne Eglash MD, IBCLC, FABM
Do pacifiers reduce the duration of exclusive breastfeeding? Many of us have suspected this, but so far studies have not been definitive on the topic. The issue has been that women with breastfeeding problems are more likely to use a pacifier, making it difficult to blame pacifiers themselves for the breastfeeding problems. For example, a mother with sore nipples due to an unresolved infant tongue-tie may be more likely to use a pacifier than a mother who does not have sore nipples.
In the United States, we receive conflicting messages about breastfeeding and pacifiers. The Baby Friendly Hospital Initiative recommends no pacifiers after birth in order to prevent interruption of breastfeeding. The American Academy of Pediatrics, however, recommends the use of pacifiers during sleep to prevent Sudden Infant Death Syndrome.
The authors of this meta-analysis reviewed all available studies that investigated the relationship between pacifier use and exclusive breastfeeding in the first 6 months of life.
What do you think the authors concluded about pacifier use and breastfeeding (choose 1):
- A. Pacifiers do not cause breastfeeding problems. Parents should use them to prevent Sudden Infant Death Syndrome.
- B. Pacifiers are one of the top 3 causes of breastfeeding problems in the first week of life.
- C. Pacifier use is a risk factor for premature interruption of exclusive breastfeeding.
- D. Pacifier use in the first week reduces sore nipples, because babies are not using their mothers as human pacifiers.
See the Answer
Matern Child Nutr. 2016 Nov 14. doi: 10.1111/mcn.12384. [Epub ahead of print]
Pacifier use and interruption of exclusive breastfeeding: Systematic review and meta-analysis.
Buccini GD1, Pérez-Escamilla R2, Paulino LM3, Araújo CL3, Venancio SI3.
Read Abstract at PubMed
Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six months. A search of CINAHL, Scopus, Web of Science, LILACS and Medline; from inception through 30 December 2014 without restriction of language yielded 1,866 publications (PROSPERO protocol CRD42014014527). Predetermined inclusion/exclusion criteria peer reviewed yielded 46 studies: two clinical trials, 20 longitudinal, and 24 cross-sectional studies. Meta-analysis was performed and meta-regression explored heterogeneity across studies. The pooled effect of the association between pacifier use and EBF interruption was 2.48 OR (95% CI = 2.16-2.85). Heterogeneity was explained by the study design (40.2%), followed by differences in the measurement and categorization of pacifier use, the methodological quality of the studies and the socio-economic context. Two RCT's with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and risk of EBF interruption (OR = 2.28; 95% CI = 1.78-2.93). Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use. Future studies that take into account the risks and benefits of pacifier use are needed to clarify this recommendation.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
This meta-analysis makes it pretty clear that pacifier use is associated with reduced exclusive breastfeeding. Nearly every study the authors included in their analysis found shorter exclusive breastfeeding rates associated with pacifier use. However, we still don’t know to what extent breastfeeding problems are the main driver of pacifier use, or whether pacifiers cause breastfeeding problems, such as sore nipples, decreased frequency of nursing, or shallow latching. Also, we don’t know when pacifier use has the strongest association of reduced exclusive breastfeeding- is it during the first week, month, or 3 months postpartum? This topic is also complicated by cultural differences. Some cultures may have different beliefs about pacifiers than others. In addition, it is possible that pacifiers have less impact on exclusive breastfeeding among mothers who have a strong intention to be successful with breastfeeding, as compared to mothers who have less intention.
My suggestion, clinically, is to observe whether families are using pacifiers in the first month or so. If pacifiers are being used, consider that the mother has a higher risk of shorter exclusive breastfeeding. So, you could ask the mother how breastfeeding is going. Does she have any problems? It would also be reasonable to ask why she decided to introduce a pacifier. By being proactive, we might learn more about the population of breastfeeding dyads that we are working with and find new ways to support them.