#402 Nipple Confusion or Nonsense? Pacifiers and Breastfeeding Duration
CLINICAL QUESTION
In term infants, does restricting early use of pacifiers result in higher rates of breastfeeding up to 6 months of age?
BOTTOM LINE
In healthy infants born after 37 weeks gestation, restricting the use of pacifiers does not change rates of any or exclusive breastfeeding at up to 6 months.
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EVIDENCE
- Results are statistically significant unless otherwise reported.
- Two systematic reviews of 3-5 randomized control trials (RCTs).1,2 Participants were mothers of 680-1661 healthy term infants (age 0-14 days) who planned to breastfeed for at least 3 months. Comparing unrestricted pacifier use (including providing participants with pacifiers) versus restricted use (recommendations to avoid pacifiers and encouraged alternate soothing methods like rocking or feeding).
- No difference in rates of any breastfeeding or exclusive breastfeeding at 2 to 6 months.
- One RCT not included in above systematic reviews, (239 participants):3
- No difference in rates of any breastfeeding at 2, 4, or 6 months.
- No difference in rates of reported breastfeeding difficulties.
- Limitations: At two weeks, rates of pacifier use similar between groups.
CONTEXT
- Observational data comparing infants who used a pacifier to infants who did not use a pacifier reported inconsistent effects on breastfeeding rates.3,4
- Use of pacifiers in preterm infants (one systematic review, 5 RCTs): shortened hospital stay and faster transition to oral feeding, without effect on breastfeeding rates at 6 months.2
- The WHO recommends counselling on the use and risks of pacifiers, but no longer prohibits use in term infants.5
- The Canadian Pediatric Society has recommendations for parents on appropriate use of pacifiers,6 and recommends that pacifier use should stop by age 3.
- The American Academy of Pediatrics encourages the use of pacifiers during sleep due to association with decreased risk of sudden infant death syndrome but recommends delaying pacifier introduction until breastfeeding is established.7
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Thanks for the update