October 2002 • Volume 2 • Number 5
Putting Research Into Practice
Are pacifiers
associated with early weaning from breastfeeding?
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| Abstract | TOP |
Background: The pacifier, a non-nutritive sucking device, is commonly
used for calming infants. The World Health Organization/United Nation's
Children's Fund (WHO/UNICEF) Baby Friendly Hospital Initiative recommends
avoiding pacifiers in breastfed term infants because it is thought to lead to
early weaning. Most studies that found early weaning to be associated with
pacifier use were observational in design. This Critically Appraised Topic
evaluates a randomized controlled trial that examines pacifiers and early
weaning.
Purpose: The objectives of the study analyzed were to test whether
regular pacifier use has a causal effect on early weaning from the breast by 3
months of age and to assess the difference in results when the data are examined
using randomized intervention allocation (intention to treat) versus
observational use of pacifiers.
Methods: Two hundred eighty-one breastfeeding women and their healthy
term infants were allocated randomly to 1 of 2 counseling interventions. Both
groups received basic breastfeeding promotion information. In addition, the
experimental group mothers (n = 140) were asked to avoid pacifiers and were
given other alternatives for comforting a crying infant. Logs detailing infant
crying, fussing, and pacifier use were completed at 4, 6, and 9 weeks of age,
and an interview at 3 months determined the duration of breastfeeding.
Results: The experimental group had a higher rate of total avoidance of
pacifier use (38.6% v 16% in the control group) and less daily use of
pacifiers (40.8% v 55.7%). When the data were analyzed based on the
intention to treat (randomized allocation), the experimental intervention group
had similar rates of early weaning as the control group (18.9% v 18.3%).
When the data were analyzed on the treatment given (ignoring randomization), a
strong observational association was found between daily exposure to pacifiers
and weaning by 3 months (25% v 12.9% of exposed versus unexposed groups).
Conclusion: The results imply that pacifier use may be a marker of
breastfeeding difficulties or decreased maternal motivation to breastfeed, as
opposed to being the causal agent in early weaning.
| Publishing and Reprint Information | TOP |
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