Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial Breastfeeding Patterns in Relation to Thumb Sucking and Pacifier Use The effects of early pacifier use on breastfeeding duration. Advising mothers about breastfeeding and weaning reduced pacifier use in the first year of life: a randomized trial. Pacifier Restriction and Exclusive Breastfeeding Does the recommendation to use a pacifier influence the prevalence of breastfeeding? Provision of supplementary fluids to breast fed infants and later breast feeding success. UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding? The impact of pacifier use on breastfeeding: a prospective cohort study. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. PROSPECTIVE STUDIES OF THE EFFECT OF BREAST FEEDING ON INCIDENCE OF INFECTION AND ALLERGY Pacifier use, early weaning, and cry/fuss behavior: a randomized controlled trial.
OBJECTIVE To enhance breastfeeding practice s , the World Health Organization discourages pacifiers and bottle-feeding . However , the effect of artificial nipples on breastfeeding duration is poorly defined . The effects of 2 types of artificial nipple exposure on breastfeeding duration were evaluated : 1 ) cupfeeding versus bottle-feeding for the provision of in-hospital supplements and 2 ) early ( 2 - 5 days ) versus late ( > 4 weeks ) pacifier introduction . METHODS A total of 700 breastfed newborns ( 36 - 42 weeks , birth weight > or=2200 g ) were r and omly assigned to 1 of 4 intervention groups : bottle/early pacifier ( n = 169 ) , bottle/late pacifier ( n = 167 ) , cup/early pacifier ( n = 185 ) , or cup/late pacifier ( n = 179 ) . The cup/bottle intervention was invoked for infants who received supplemental feedings : cup ( n = 251 ) , bottle ( n = 230 ) . Data were collected at delivery and at 2 , 5 , 10 , 16 , 24 , 38 , and 52 weeks ' postpartum . Intervention effects on breastfeeding duration were evaluated with logistic regression and survival analyses . RESULTS Supplemental feedings , regardless of method ( cup or bottle ) , had a detrimental effect on breastfeeding duration . There were no differences in cup versus bottle groups for breastfeeding duration . Effects were modified by the number of supplements ; exclusive and full breastfeeding duration were prolonged in cup-fed infants given > 2 supplements . Among infants delivered by cesarean , cupfeeding significantly prolonged exclusive , full , and overall breastfeeding duration . Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers ( early pacifier group ; odds ratio : 1.5 ; 95 % confidence interval : 1.0 - 2.0 ) . Early , as compared with late , pacifier use shortened overall duration ( adjusted hazard ratio : 1.22 ; 95 % confidence interval : 1.03 - 1.44 ) but did not affect exclusive or full duration . CONCLUSIONS There was no advantage to cupfeeding for providing supplements to the general population of healthy breastfed infants , but it may have benefitted mother-infant dyads who required multiple supplements or were delivered by cesarean . Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding . These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period Abstract Objective To determine the effect of artificial teats ( bottle and dummy ) and cups on breast feeding in preterm infants . Design R and omised controlled trial . Setting Two large tertiary hospitals , 54 peripheral hospitals . Participants 319 preterm infants ( born at 23 - 33 weeks ' gestation ) r and omly assigned to one of four groups : cup/no dummy ( n = 89 ) , cup/dummy ( n = 72 ) , bottle/no dummy ( n = 73 ) , bottle/dummy ( n = 85 ) . Women with singleton or twin infants < 34 weeks ' gestation who wanted to breastfeed were eligible to participate . Interventions Cup or bottle feeding occurred when the mother was unable to be present to breast feed . Infants r and omised to the dummy groups received a dummy on entry into the trial . Main outcome measures Full breast feeding ( compared with partial and none ) and any breast feeding ( compared with none ) on discharge home . Secondary outcomes : prevalence of breast feeding at three and six months after discharge and length of hospital stay . Results 303 infants ( and 278 mothers ) were included in the intention to treat analysis . There were no significant differences for any of the study outcomes according to use of a dummy . Infants r and omised to cup feeds were more likely to be fully breast fed on discharge home ( odds ratio 1.73 , 95 % confidence interval 1.04 to 2.88 , P = 0.03 ) , but had a longer length of stay ( hazard ratio 0.71 , 0.55 to 0.92 , P = 0.01 ) . Conclusions Dummies do not affect breast feeding in preterm infants . Cup feeding significantly increases the likelihood that the baby will be fully breast fed at discharge home , but has no effect on any breast feeding and increases the length of hospital stay Objectives . To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants , on the duration of exclusive breastfeeding , and on the total breastfeeding duration . Study Design . Descriptive , longitudinal , prospect i ve study . Setting . The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital , Uppsala , Sweden between May 1989 and December 1992 . Study Population . 506 mother – infant pairs . Methods . Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study . Fortnightly home visits with structured interviews by a research assistant . Results . Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours , shorter duration of exclusive breastfeeding , and shorter total breastfeeding duration compared with no pacifier use . These associations were not found for thumb sucking . The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use . Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration . Conclusions . More frequent use of a pacifier was associated with shorter breastfeeding duration , even among a group of mothers who were highly motivated to breastfeed . breastfeeding duration , breastfeeding pattern , exclusive breastfeeding , pacifier use , thumb sucking OBJECTIVE To evaluate the effects of pacifier use and the timing of pacifier introduction on  breastfeeding duration , problems , and frequency . METHODS A cohort of 265 breastfeeding mother-infant dyads was followed prospect ively . Maternal interviews were conducted at delivery , 2 , 6 , 12 , and 24 weeks , and thereafter every 90 days until breastfeeding ended . Information was obtained regarding pacifier use , infant feeding , use of supplemental foods and breastfeeding frequency , duration , and problems . The effect of pacifier introduction by 6 weeks of age on breastfeeding duration was evaluated with Kaplan-Meier and Cox proportional hazards models . The effect of the timing of pacifier introduction ( < /=2 weeks and < /=6 weeks ) on breastfeeding duration at 2 and 3 months was evaluated using logistic regression modeling . RESULTS A total of 181 mothers ( 68 % ) introduced a pacifier before 6 weeks . In adjusted analyses , pacifier introduction by 6 weeks was associated with a significantly increased risk for shortened duration of full ( hazard ratio , 1.53 ; 95 % confidence interval : 1.15 , 2.05 ) and overall ( hazard ratio , 1.61 ; 95 % confidence interval : 1.19,2.19 ) breastfeeding . Women who introduced pacifiers tended to breastfeed their infants fewer times per day , with significant differences noted at 2 ( 8.1 + /- 2.6 vs 9.0 + /- 2.3 ) and 12 weeks ' ( 6.3 + /- 2.0 vs 7.4 + /- 1.6 ) postpartum . At 12 weeks postpartum , women who introduced pacifiers also were more likely to report that breastfeeding was inconvenient and that they had insufficient milk supplies . Pacifier use begun either before 2 weeks or before 6 weeks ' postpartum was not significantly associated with breastfeeding duration at 2 and 3 months . CONCLUSIONS Pacifier use was independently associated with significant declines in the duration of full and overall breastfeeding . Breastfeeding duration in the first 3 months ' postpartum , however , was unaffected by pacifier use . Women who introduced pacifiers tended to breastfeed their infants less frequently and experienced breastfeeding problems consistent with infrequent feeding . Findings from this study suggest that the decreases in breastfeeding duration associated with pacifier use may be a consequence of less frequent breastfeeding among women who introduce pacifiers to their infants OBJECTIVE To assess the effectiveness of home visits for advising mothers about breastfeeding and weaning on pacifier use in the first year of life . METHOD A r and omized field trial was conducted on mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo ( intervention group = 200 ; controls = 300 ) . The intervention group received the advice 10 days after the child 's birth , monthly up to 6 months , at 8 , 10 , and 12 months , based on the ' Ten Steps for Healthy Feeding ' , a Brazilian national health policy for primary care , which follows WHO guidelines . Relative risk ( RR ) was used to estimate the effects of the intervention on the risk of using a pacifier . RESULTS 55.4 % of the children in the intervention group and 66.1 % of the controls used a pacifier  in the first year of life . The risk of using a pacifier  was 16 % lower for the intervention group ( RR = 0.84 ; 95 % CI , 0.71 - 0.99 ) . A multivariable Poisson regression model showed higher adjusted risk of using a pacifier  for children who had breastfeeding interrupted in the first month of life ( RR = 1.43 ; 95 % CI , 1.21 - 1.69 ) and whose mothers presented higher level of depression ( RR = 1.40 ; 95 % CI , 1.17 - 1.66 ) . CONCLUSIONS  Pacifier use is highly prevalent in the population studied . The home visits for dietary advice appear to help in reducing  pacifier use in infants . These findings suggest the need for public health strategies that address early advice on pacifier use to promote child oral and general health OBJECTIVE : We tested the hypothesis that removing pacifiers from routine distribution in our mother-baby unit ( MBU ) would be associated with greater breastfeeding initiation or exclusivity during the birth hospitalization . METHODS : We retrospectively compared exclusive breastfeeding , breastfeeding plus supplemental formula feeding , and exclusive formula feeding rates for 2249 infants admitted to the MBU at our university teaching hospital during the 5 months before and 8 months after restriction of routine pacifier distribution . Formula supplementation , if not medically indicated , was discouraged per st and ard practice , but access to formula was not restricted . RESULTS : Of the 2249 infants , 79 % were exclusively breastfed from July through November 2010 , when pacifiers were routinely distributed . During the 8-month period after pacifier restriction , this proportion decreased significantly to 68 % ( P < .001 ) . A corresponding increase from 18 % to 28 % was observed in the number of breastfed infants receiving supplemental formula feeds in the same period ( P < .001 ) . During the study period , the proportion of exclusively formula-fed infants increased from 1.8 % to 3.4 % ( P < .05 ) . CONCLUSIONS : 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 . Because high- quality , prospect i ve medical literature addressing pacifier use and breastfeeding does not conclusively show an adverse relationship in women who are motivated to breastfeed , more studies are needed to help determine what effect , if any , pacifiers have on breastfeeding initiation and exclusivity in the immediate newborn period OBJECTIVE To evaluate whether the recommendation to offer a pacifier once lactation is well established reduces the prevalence or duration of breastfeeding . STUDY DESIGN A multicenter , r and omized , non-inferiority , controlled trial comprising 1021 mothers highly motivated to breastfeed whose newborns regained birth weight by 15 days . They were assigned to offer versus not to offer pacifiers . Primary outcome was prevalence of exclusive breastfeeding at 3 months . Main secondary outcomes were the prevalence of exclusive and any breastfeeding at different ages and duration of any breastfeeding . RESULTS At 3 months , 85.8 % infants in the offer pacifier group and 86.2 % in the not offer pacifier group were exclusively breastfeeding ( risk difference , 0.4 % ; 95 % CI , -4.9%-4.1 % ) , satisfying the pre-specified non-inferiority requirement of -7 % . Furthermore , the recommendation to offer a pacifier did not produce a significant decrease in the frequency of exclusive and any breastfeeding at different ages or in the duration of lactation . CONCLUSIONS The recommendation to offer a pacifier at 15 days does not modify the prevalence and duration of breastfeeding . Because pacifier use is associated with reduced incidence of sudden infant death syndrome , the recommendation to offer a pacifier appears safe and appropriate in similar population It has been shown that altering hospital policies in a way to avoid interference of routine prescriptions with initiation of breast feeding and to provide active encouragement to mothers and personnel can result in significant benefit for later breast feeding success . It is less clear , however , which of the elements of a promotional programme such as UNICEF/WHO 's " ten steps to successful breast feeding " are absolutely essential and which can be adapted to local cultural habits . We performed an open r and omized multicenter study in Switzerl and to evaluate , whether restriction of supplementary fluids for breast fed infants in the first week of life and strict avoidance of artificial teats and pacifiers affects later breast feeding success . Follow up to 6 months was ensured by mailed question naires . 602 mother infant pairs were enrolled . Of 294 infants in the intervention group 39 % were excluded from the final analysis because of protocol violations , mainly maternal request for the use of pacifiers or bottles . Though the number of dextrin maltose supplements during the first two days ( 1.7 vs. 2.2 on day 1 , 2.2 vs. 2.6 on day 2 ) and the percentage of infants receiving any supplement ( 85 % vs. 96.6 % ) was significantly smaller in the intervention group , the difference was disappointingly small . The prevalence of breast feeding was 100 % vs. 99 % at day 5 , 88 % vs. 88 % at 2 months , 75 % vs. 71 % at 4 months and 57 % vs. 55 % at 6 months , none of the differences being significant . We conclude that rigorous adherence to all of the ten steps may encounter obstinate resistance from cultural habits even in a population highly favourable to breast feeding . An improvement in adherence does not necessarily lead to better breast feeding success . The results of the few comparable studies in the literature show also that cultural practice s during the first months of life may influence profoundly the long term effects of interventions during the first days of life Abstract To promote breastfeeding , UNICEF/WHO have launched the “ baby-friendly hospital initiative ” focusing on hospital care routines during delivery and the first days of life . In industrialised countries , two aspects of the initiative have raised controversy : how do restriction of supplemental feedings and ban of bottles and pacifiers affect long-term breastfeeding performance ? From ten centres 602 healthy newborns were r and omly assigned either to a UNICEF group with restrictive fluid supplements and avoidance of bottles and pacifiers during the first 5 days of life , or to a st and ard group with conventional feeding practice . Breastfeeding was encouraged in both groups . The main study endpoints were the prevalences of breast-feeding on day 5 , and after 2 , 4 and 6 months . Of the newborns 46 % violated the UNICEF protocol , mostly because of maternal requests to give a pacifier or supplements by bottle . In the st and ard group , the drop-out rate was 9.7 % . No significant differences in breastfeeding frequency and duration could be found : ( UNICEF vs st and ard ) day 5 : 100 % vs 99 % ; 2 months : 88 % vs 88 % ; 4 months : 75 % vs 71 % ; 6 months : 57 % vs 55 % . Inclusion of drop-outs due to pacifier use did not alter the results . Conclusion In our study population fluid supplements offered by bottle with or without the use of pacifiers during the first 5 days of life were not associated with a lower frequency or shorter duration of breastfeeding during the first 6 months of life OBJECTIVES To determine the predictors of pacifier use during the first year of life and to assess the influence of pacifier use on the duration of breastfeeding . METHODOLOGY A prospect i ve cohort study was conducted . Three hundred and fifty mother-infant pairs were followed to 1 year of age to determine the impact of the use of a pacifier on the duration of breastfeeding . RESULTS A cohort of 441 mothers were enrolled and 79 % participated . Ninety four per cent were followed up to 1 year . Daily pacifier use was associated with early cessation of breastfeeding ( risk ratio ( RR ) 1.71 ; 95 % confidence interval ( 95%CI ) 1.29 , 2.28 ) and a reduced duration of full breastfeeding ( adjusted ( adj . ) RR 1.35 ; 95%CI 1.05 , 1.74 ) . Finger sucking was not associated with a reduced duration of breastfeeding ( RR 1.05 ; 95%CI 0.81 , 1.37 ) . Pacifier use less than daily was not associated with a change in duration of breastfeeding ( RR 1.02 ; 95%CI 0.75 , 1.39 ) . Most mothers commenced the use of a pacifier within the first month . Multiple logistic regression analysis found that the use of a pacifier was associated with male gender ( adj . RR 1.97 ; 95%CI 1.23 , 3.13 ) , maternal smoking in pregnancy ( adj . RR 2.23 ; 95%CI 1.01 , 4.95 ) , and low maternal confidence with breastfeeding ( adj . RR 2.70 ; 95%CI 1.48 , 4.93 ) . CONCLUSIONS Daily pacifier use is associated with a reduced duration of breastfeeding . Less frequent pacifier use does not reduce the duration of breastfeeding CONTEXT Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies . Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries . OBJECTIVE To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants . DESIGN The Promotion of Breastfeeding Intervention Trial ( PROBIT ) , a cluster-r and omized trial conducted June 1996-December 1997 with a 1-year follow-up . SETTING Thirty-one maternity hospitals and polyclinics in the Republic of Belarus . PARTICIPANTS A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed , 16491 ( 96.7 % ) of which completed the entire 12 months of follow-up . INTERVENTIONS Sites were r and omly assigned to receive an experimental intervention ( n = 16 ) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children 's Fund , which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support , or a control intervention ( n = 15 ) of continuing usual infant feeding practice s and policies . MAIN OUTCOME MEASURES Duration of any breastfeeding , prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection , 2 or more episodes of respiratory tract infection , and atopic eczema during the first 12 months of life , compared between the intervention and control groups . RESULTS Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months ( 19.7 % vs 11.4 % ; adjusted odds ratio [ OR ] , 0.47 ; 95 % confidence interval [ CI ] , 0.32 - 0.69 ) , were more likely to be exclusively breastfed at 3 months ( 43.3 % vs 6.4 % ; P<.001 ) and at 6 months ( 7.9 % vs 0.6 % ; P = .01 ) , and had a significant reduction in the risk of 1 or more gastrointestinal tract infections ( 9.1 % vs 13.2 % ; adjusted OR , 0.60 ; 95 % CI , 0.40 - 0.91 ) and of atopic eczema ( 3.3 % vs 6.3 % ; adjusted OR , 0.54 ; 95 % CI , 0.31 - 0.95 ) , but no significant reduction in respiratory tract infection ( intervention group , 39.2 % ; control group , 39.4 % ; adjusted OR , 0.87 ; 95 % CI , 0.59 - 1.28 ) . CONCLUSIONS Our experimental intervention increased the duration and degree ( exclusivity ) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life . These results provide a solid scientific underpinning for future interventions to promote breastfeeding ABSTRACT . Ch and ra , R. K. ( Department of Pediatrics , Memorial University of Newfoundl and , St. John 's , Newfoundl and , Canada ) . Prospect i ve studies of the effect of breast feeding on incidence of infection and allergy . Acta Paediatr Sc and 68 : 691 , 1979.—The effect of exclusive breast feeding  in the first few weeks after birth on infant  morbidity due to infectious and allergic disorders was investigated in three separate prospect i ve studies . In a rural community in India , breast‐fed infants had a significantly lower incidence of respiratory infection , otitis , diarrhoea , dehydration and pneumonia . In an urban population in Canada , breast feeding was associated with a marked decrease in the occurrence of otitis and respiratory disease and to a lesser extent of diarrhoea and dehydration . In newborn siblings of children with atopic disease exclusively breast‐fed for a minimum of six weeks , the incidence of eczema , recurrent wheezing , elevated serum IgE , IgE‐antibodies to cow 's milk , complement activation in vivo after milk challenge and hemagglutinating antibodies to β‐lactoglobulin was significantly lower compared with formula‐fed matched group . These observations provide clinical data attesting the immunologic advantages of human milk CONTEXT The World Health Organization and the United Nations Children 's Fund strongly discourage use of pacifiers because of their perceived interference with breastfeeding . Observational studies have reported a strong association between pacifier use and early weaning , but such studies are unable to determine whether the association is causal . OBJECTIVES To test whether regular pacifier use is causally related to weaning by 3 months postpartum and to examine differences in results according to r and omized intervention allocation vs observational use or nonuse of pacifiers . DESIGN Double-blind , r and omized controlled trial conducted from January 1998 to August 1999 . SETTING Postpartum unit of a university teaching hospital in Montreal , Quebec . PARTICIPANTS A total of 281 healthy , breastfeeding women and their healthy , term singleton infants . INTERVENTIONS Participants were r and omly allocated to 1 of 2 counseling interventions provided by a research nurse trained in location counseling . The experimental intervention ( n = 140 ) differed from the control ( n = 141 ) by recommending avoidance of pacifier use and suggesting alternative ways to comfort a crying or fussing infant . MAIN OUTCOME MEASURES Early weaning , defined as weaning within the first 3 months , compared between groups ; 24-hour infant behavior logs detailing frequency and duration of crying , fussing , and pacifier use at 4 , 6 , and 9 weeks . RESULTS A total of 258 mother-infant pairs ( 91.8 % ) completed follow-up . The experimental intervention increased total avoidance of pacifier use ( 38.6 % vs 16.0 % in the control group ) , reduced daily use ( 40.8 % vs 55.7 % ) , and decreased the mean number of pacifier insertions per day ( 0.8 vs 2.4 at 4 weeks [ P<.001 ] ; 0.8 vs 3.0 at 6 weeks [ P<.001 ] ; and 1.3 vs 3.0 at 9 weeks [ P = .004 ] ) . In the analysis based on r and omized intervention allocation , the experimental intervention had no discernible effect on weaning at 3 months ( 18.9 % vs 18.3 % in the experimental vs control group ; relative risk [ RR ] , 1.0 ; 95 % confidence interval [ CI ] , 0.6 - 1.7 ) , and no effect was observed on cry/fuss behavior ( in the experimental vs control groups , respectively , total daily duration , 143 vs 151 minutes at 4 weeks [ P = .49 ] ; 128 vs 131 minutes at 6 weeks [ P = .81 ] ; and 110 vs 104 minutes at 9 weeks [ P = .58 ] ) . When r and omized allocation was ignored , however , we observed a strong observational association between exposure to daily pacifier use and weaning by 3 months ( 25.0 % vs 12.9 % of the exposed vs unexposed groups ; RR , 1.9 ; 95 % CI , 1.1 - 3.3 ) . CONCLUSIONS We found a strong observational association between pacifier use and early weaning . No such association was observed , however , when our data were analyzed by r and omized allocation , strongly suggesting that pacifier use is a marker of breastfeeding difficulties or reduced motivation to breastfeed , rather than a true cause of early weaning
BACKGROUND To successfully initiate and maintain breastfeeding for a longer duration , the World Health Organization 's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants .
Concerns have been raised that offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast-milk production and shorten duration of breastfeeding .
OBJECTIVES To assess the effect of restricted versus unrestricted pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed , on the duration of breastfeeding , other breastfeeding outcomes and infant health .