Pacifier use, early weaning, and cry/fuss behavior

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 4/25/2009
Article title: Pacifier Use, Early Weaning, and Cry/Fuss Behavior
Author(s): Kramer MS, Barr RG, et al..
Journal: JAMA 286(3)
Volume (number): 322-326
Date: July 18, 2001
Major topic: Pacifier and its effect on Breast feeding
Type of Article: Double blind, randomized clinical trial
Main Purpose: This study evaluated whether advice to avoid use of the pacifier and use other techniques to soothe an infant reduces the risk of early weaning from breast feeding, and increases the risk of crying and fussing.
Materials and Methods: 281 randomized mothers were placed into two groups. Both groups received a basic breastfeeding package consisting of a 45 minute interview promoting breastfeeding. In the experimental group, mothers were asked to avoid pacifiers when the infant cried or fussed, and instead offer the breast. In the control group, all options were suggested to calm the infant. Follow up calls were placed at 10 days and 3 weeks postpartum. A behavior diary was completed by the mothers at 4, 6, and 9 weeks for 3 days at each interval.
Findings: 258 mothers, 127 experimental and 131 controls completed the study. The experimental intervention resulted in 38.6% avoiding the pacifier use, while the control group avoided pacifiers in 16% of the cases. The diaries confirmed a reduced number of pacifier insertions per day. However, early weaning from breast feeding was similar between the two groups at 3 months of age (18.9% vs 18.3%). Observation analysis indicated the daily pacifier use was more significant for early weaning, 25% vs. 12.9% who had never received a pacifier. The response rate for the diaries was fair with only 57.4% at the 9 weeks. Observations noted included slightly less crying and fussing at 4 and 6 weeks, and identical at 9 weeks
Key points/Summary : The experimental intervention reduced pacifier use, yet it did not reduce crying and fussing behavior at all time intervals. It also did not have an effect on reducing the risk of early weaning of breast feeding. However the pacifier use was strongly associated with early weaning, perhaps because of breastfeeding difficulties or reduced motivation to breastfeed.
Assessment of article: Interesting study to contrast with the advocates of breastfeeding who suggest that pacifiers use cause nipple confusion and early weaning