Pacifiers and Breastfeeding

Resident’s Name: Jessica Wilson

Article title: Pacifiers and Breastfeeding

Author(s): O’Connor et al.

Journal: Archives Pediatrics & Adolescent Medicine

Year. Volume (number). Page #’s: 2009. 163:4. 378-382.

Major topic: Pacifier use

Overview of method of research: Systematic Review

Background:
Pacifier use has traditionally been thought to interfere with optimal breastfeeding and in the 1980s the World Health Organization and UNICEF advised the avoidance of pacifiers in order to achieve success in breastfeeding. Since then, evidence has shown pacifiers may be associated with a decrease in incidence of SIDS by as much as 61%, especially when used during the initiation of sleep. The AAP recommend offering a pacifier at naptime and bedtime to reduce the risk of SIDS.

Purpose:
To summarize the current evidence regarding the impact of pacifier use on breastfeeding.

Methods:
A search was done for articles published between 1950 and 2006 related to pacifiers and breastfeeding and was limited to human studies using healthy infants with adequate follow-up(70%). 29 articles met all of the inclusion criteria. Data was then extracted and analyzed.

Results:
Four randomized control trials (RCTs), 20 cohort studies and 5 cross-sectional studies from 12 different countries were evaluated. None of the studies found a significant difference in breastfeeding outcomes with pacifier-related intervention. One study showed that within the group of infants instructed not to use the pacifier, over 60% still used the pacifier.

Key points/Summary:
The results of the 4 RCTs, the highest level of evidence, did not show a difference in breastfeeding outcomes and pacifier intervention.
The majority of the observational studies however, showed evidence of pacifier use and a shorter duration of breastfeeding.
This systematic review demonstrates the complex relationship between pacifier use and breastfeeding and the need for further research.

Assessment of Article:
Although the authors had great intentions and reviewed many different articles, the findings did not lead to many conclusions. This is still a very debatable topic and the matter remains unsettled.