The Breastfeeding Couple: Pacifiers and Breastfeeding

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The Breastfeeding Couple: Topics
Table of Contents
Pre module evaluation
Breastfeeding Initiation
Breast Care
New Family
Growth Spurts
Maternal Diet
Returning to Work
Post module evaluation

The Baby Friendly Hospital Initiative recommends that breastfeeding newborns not be given pacifiers or dummies while in the hospital after birth. See The ten steps to successful breastfeeding. Newborns who need to suck should practice suckling at the breast and the more frequent suckling at the breast will increase prolactin production which will increase breast milk production. Giving term healthy newborns a pacifier while still in the hospital has been associated with stopping of breastfeeding before 6 weeks of age ( Memorize DiGirolamo, 2008 ).

Is the use of pacifiers harmful to breastfeeding? A number of studies of mothers and infants in various countries have attempted to answer this question. Three studies observed mothers and infants from birth and monitored pacifier use until 6 months, 1 year or until breastfeeding ended. These studies were performed in Brazil, New Zealand, and the United States respectively. The results of all three studies were similar. Daily pacifier use starting before 4-6 weeks of age was associated in all three studies with a shortened duration of full breastfeeding (breastfeeding with infrequent use of water, small amounts of juice or tastes of food). Daily pacifier use was also associated with decreased maternal confidence in breastfeeding and concern about poor milk supply. ( Memorize Howard, 2003 , Memorize Victora, 1997 , Memorize Vogel, 2001 ).

Kramer and associates in Canada randomized a group of 281 women to breastfeeding support (control group) or breastfeeding support and the recommendation of avoidance of pacifier use and the use of alternative means of comforting a crying or fussing infant (experimental group). The mothers in the experimental group had decreased pacifier use 61% versus 84% in the control group. Daily pacifier use was also decreased in the experimental group 41% compared to 56% in the control group. There was no difference between the two groups in exclusive breastfeeding at 3 months (36% in the experimental group and 34% in control group) or in discontinuation of breastfeeding at 3 months (19% in the experimental group versus 18% in the control group). However, when Kramer analyzed the data as an observational study, mothers who used a pacifier daily had increased weaning at 3 months of age (25% versus 13%) ( Memorize Kramer, 2001 ).

The results of these 4 studies all show that early pacifier use is associated with a shorter duration of breastfeeding. Whether early pacifier use is a cause or is only a marker for mothers who are having difficulty with breastfeeding, have decreased confidence in their ability to breastfeed, or desire a short duration of breastfeeding is unknown. Pacifier use beginning after 4 weeks of age does not seem to be associated with a shorter duration of breastfeeding. Mothers who want to breastfeed should avoid giving a pacifier to their baby until breastfeeding is well established or until the baby is about 4 weeks of age.

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