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January 15, 2011

Pacifiers no barrier to breastfeeding success, find School of Medicine researchers

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Many women have heard of the benefits of breastfeeding and pacifier use in reducing the risk of Sudden Infant Death Syndrome (SIDS) as well as other advantages. But many may question the effects of pacifiers on breastfeeding success. Mothers need not worry about that according to Fern Hauck, M.D., researcher and associate professor of family medicine and public health sciences at the University of Virginia School of Medicine. In a literature review, Hauck found that the highest level of evidence on pacifier use and breastfeeding shows no adverse relationship between the two. Her results appear in the April edition of the Archives of Pediatric Adolescent Medicine .

“Physicians, nurses and others who advise parents on infant care issues do need to be educated about the potential benefit of using a pacifier for SIDS prevention, and further, now need to be reassured that using the pacifier should not interfere with breastfeeding,” says Hauck, who also sits on an American Academy of Pediatrics task force on SIDS. Hauck authored a study on the association between pacifier use and reduced SIDS risk.

Hauck and a team of family medicine and public health researchers at UVA, set out to summarize literature examining an association between pacifiers and breastfeeding by gathering more than 1,000 reports containing the words pacifiers and breastfeeding. Of those, 29 studies met inclusion criteria for their review. Two independent reviewers collected data on study design, population demographics and study results. For each study, quantitative and qualitative characteristics were recorded. Tests of interrater agreement were applied to the data and quality characteristics. The quantity variables were submitted to meta analysis.

Of the 29 studies, four were randomized control studies (RCT), 20 were cohort studies and five were cross sectional studies. The research came from 12 countries-Australia, Brazil, Canada, Hungary, Italy, New Zealand, Poland, Russia, Sweden, the United Kingdom and the United States. Results from the four RCTs showed no difference in breastfeeding outcomes with different pacifier interventions, such as use with tube feedings, use after delivery or educational programs promoting non-use of pacifiers. Most of the observational studies- cross-sectional and cohort – reported an association between pacifier use and shortened duration of breastfeeding. This association was likely due to other factors such as breastfeeding difficulties or desire to wean, according to Hauck.

“Mothers who breastfeed are often advised not to use a pacifier. This recommendation needs to be corrected. However, if a baby refuses a pacifier, it should not be forced upon him or her,” Hauck advises.

Hauck adds that the best time to introduce a pacifier is usually when the baby is three to four weeks old, after breastfeeding is well established. Most of all, mothers who choose to breast-feed need lots of support.

“The biggest barriers to continuing breastfeeding are a lack of support from family members, going back to work and using supplemental formula, especially before breastfeeding is well established.”

In the future, Hauck and colleagues would like to study pacifiers and breastfeeding further with an eye toward pacifier use at bedtime and naptime.

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