Restricting pacifier use with newborns related to decrease in exclusive breastfeeding

Background

The decision of whether or not to offer their newborn child a pacifier can be a difficult one for parents. While many hospitals have traditionally supplied pacifiers at birth, the American Academy of Pediatrics (AAP) Section on Breastfeeding recommends avoiding pacifier use until breastfeeding is fully established, usually between 3 and 4 weeks of life. To further complicate the decision, the AAP Task Force on Sudden Infant Death Syndrome recommends offering a pacifier for naps and at bedtime.

It is widely accepted that breastfeeding is best for babies. The American Academy of Pediatrics (AAP) and the World Health Organization (WHO), among others, all recommend exclusive breastfeeding for at least 6 months. Conventional wisdom though, is that pacifiers could affect breastfeeding and some observational studies have suggested there may be a connection between pacifier use and breastfeeding duration.

However, the study conducted by Kair, et al. shows that this may not be the case and that many additional factors have a role in the success and duration of exclusive breastfeeding.

Methodology

A retrospective comparison was performed of exclusive breastfeeding, breastfeeding plus formula feeding, and exclusive formula feeding for 2,249 infants admitted to the Mother Baby Unit (MBU) at a hospital in Portland, Oregon. The comparison encompassed the 5 months before and 8 months after implementing a restriction on routine pacifier distribution at the hospital. Supplemental formula feeding was discouraged unless medically indicated but access to formula was not restricted.

A multidisciplinary group reviewed the types of feeds provided to infants in the MBU to provide data on exclusive breastfeeding, supplemental formula feeding and exclusive formula feeding. After routine distribution of pacifiers was halted, the pacifiers were placed in locked storage. If a pacifier was offered, it was signed out by the employee and the reason for offering the pacifier was recorded. During this time, parents could also bring pacifiers into the hospital though this behaviour was not monitored.

Results

• “Restricting pacifier distribution during the newborn hospitalization without also restricting access to formula was associated with decreased exclusive breastfeeding, increased supplemental formula feeding and increased exclusive formula feeding.”
• Of the 2,249 infants observed, 79% were exclusively breastfed during the 5 months when pacifiers were routinely distributed.
• “During the 8-month period after pacifier restriction, this proportion decreased significantly to 68% (P < .05).”
• During the same period, a corresponding increase from 18% to 28% was observed in the number of breastfed babies receiving supplemental formula fees.
• “The percentage of exclusively formula-fed infants increased significantly from 1.8% to 3.8% (P < 0.5) after pacifiers were restricted.”
• There were no significant differences in maternal age, race, ethnicity, gestational age, birth weight, type of delivery or length of stay in hospital.
• The authors conclude, “We believe additional scientific inquiry is needed to support the current, universal recommendation of not offering pacifiers to breastfeeding infants in the first 3 to 4 weeks of life.”
• All of the WHO “Ten Steps to Successful Breastfeeding” should be implemented together to achieve their intended effect. Implementing some of the steps in isolation may not achieve the desired outcome.

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