The effects of early pacifier use on breastfeeding

Conclusion

The study summarized in this overview investigated the connection between the early use of pacifiers and the duration and frequency of breastfeeding. It was proven that the use of a pacifier - regardless of whether this was straight after the birth or later - has no negative impact on the duration and frequency of breastfeeding.

Background

The use of a pacifier with pre-term and full-term infants can contribute to preventing sudden infant death syndrome (SIDS)¹ and pain reduction². Pacifier use can also have many positive effects for premature infants:

• Reduction in the length of the hospital stay^3,4
• Easier transition from feeding tubes to oral feeding^5,6
• Reduced time to full breastfeeding^7,8
• Increased blood pressure⁹
• Improved heart rate¹⁰

For many years, the World Health Organization has expressly recommended full breastfeeding during the first six months. Breastfeeding should continue for a further 18 months or more, supplemented by solids.¹¹

Method

The parallel group study was conducted in an open, randomized, prospective and controlled way. 239 first-time mothers and their full-term infants were randomly allocated to either an intervention or control group. Members of the intervention group were recommended to use a soother from the first day of the baby's life. Members of the control group were instructed not to use the pacifier in the first two weeks of life. One objective of the study was to investigate whether the use of a pacifier in the first two weeks of a baby's life has an impact on the proportion of breastfeeding (full or partial) after six months, compared with no pacifier use in the first two weeks of life. The study also investigated whether any differences between the intervention and control group could be identified regarding early pacifier use with regard to the proportion of full or partial breastfeeding and breastfeeding problems at various points in time (two, four and six months). To identify any factors that may have an impact on breastfeeding, a multivariate logistical regression analysis was undertaken. 209 mother-baby couples completed the study and were included in the analysis.

Findings

• At no point (two, four or six months) could any differences be observed between both groups regarding full or partial breastfeeding. This was regardless of whether infants were fully or partially breastfed, or not breastfed at all. Similarly, as regards self-reported breastfeeding problems, no differences were identified between the intervention and control group.
• In the intervention group, the pacifier was offered significantly more frequently within two weeks (84.4% vs. 54%; p < 0.001). The pacifier was also introduced earlier in the intervention group, within four days, (37.6% vs. 21%; p=0.03) and thus within a median of one day ahead of the control group. After two and six months, no significant differences in the use of pacifiers could be identified.
• Owing to a lack of compliance, the effect of pacifier use on the success of breastfeeding was not assessed in the randomized groups, but rather in the design of an observational study. Overall, no significant differences in full or partial breastfeeding could be identified after four or six months, regardless of when the pacifier was first introduced (within four days, between five and 14 days, after two weeks, no soother use). Nor did the frequency of pacifier use have any effect on the proportion of breastfeeding.

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