The effect of early introduction of pacifiers on the establishment of breastfeeding

Breastfeeding is usually established within the first few weeks after birth. It is unclear if early introduction of a pacifier during this period affects the establishment of breastfeeding.

Reading time approx. 12 minutes Published: June 29, 2021 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

What scientific studies are there on early introduction of pacifiers and the establishment of breastfeeding?

Identified literature

No relevant systematic review was identified but 13 primary studies were identified [1–13]. The primary studies were not assessed for risk of bias.

Table 1. Identified primary studies.
Included studies/ setting	Population/ Exposure	Measured outcome
Carbonell X et al, 1998 The incidence of breastfeeding in our environment. [1]
Study type: Observational Setting: Barcelona, Spain Maternity clinic in hospital	Population: 329 mothers and infants born during the study period Exposure: Early pacifier, during the first days of life	Measured outcome of interest: Breastfeeding at 3 months
Declercq E et al, 2009 Hospital practices and women's likelihood of fulfilling their intention to exclusively breastfeed. [2]
Study type: National survey (Listening to Mothers II) Setting: USA	Population: 915 women aged 18 to 45 years who had given birth in 2005 in a hospital to a singleton, still-living infant and were non-Hispanic Black or Hispanic Exposure: Hospital practice – the baby was given a pacifier in the hospital	Measured outcome of interest: Exclusive breastfeeding at 1 week, stratified by parity
Hermanson Å et al, 2020 The effects of early pacifier use on breastfeeding: A randomised controlled trial. [3]
Study type: Designed as RCT, also analysed on exposure as an observation study. Setting: Sweden, Linköping University hospital	Population: 239 mother-infant pairs. Mothers were primiparous; intended to breastfeed their infants for at least four months and gave birth to healthy full-term infants (>37 weeks of gestation, birth weight >2500 g). Intervention: Recommendation to offer a pacifier to their newborn child from the first day of life. Control: Recommendation to avoid pacifier to their newborn child during the first two weeks.	Measured outcome of interest: Exclusive and partial breastfeeding at 2 months Primary outcome: Full and partial breastfeeding at 6 months
Howard CR et al, 1999 The effects of early pacifier use on breastfeeding duration. [4]
Study type: Prospective cohort Data from a larger RCT Setting: USA Three independent, obstetric practices in six clinical offices in and around the Greater Rochester, NY, area.	Population: 265 breastfeeding mother–infant dyads Exposure of interest:	Measured outcome of interest: Breastfeeding at 2 and 3 months
Huang YY et al, 2011 The study of pacifier use in relation to infant sucking, maternal perception of milk supply and breastfeeding duration. [5]
Study type: Longitudinal Setting: Taiwan	Population: 241 mother-infant pairs Exposure of interest: Pacifier use at day 3 and at 2 weeks after birth	Measured outcome of interest: Infant sucking technique Exclusive breastfeeding at 3 days and two weeks
Ingram J et al, 2002 Breastfeeding in Bristol: teaching good positioning, and support from fathers and families. [6]
Study type: Non-randomised prospective cohort Setting: One postnatal hospital ward.	Population: 1325 mothers that were breastfeeding Exposure: Dummy by 2 weeks	Measured outcome of interest: Any breastfeeding at 2 weeks
Kair LR et al, 2013 Pacifier restriction and exclusive breastfeeding. [7]
Study type: Retrospective before and after study Setting: USA	Population: 2249 infants admitted to the mother-baby unit at a university teaching hospital Exposure: Hospital practice – restricted routine pacifier distribution	Measured outcome of interest: Exclusive breastfeeding in the hospital Exclusive formula-feeding in the hospital
Kair LR et al, 2017 Association Between In-Hospital Pacifier Use and Breastfeeding Continuation and Exclusivity: Neonatal Intensive Care Unit Admission as a Possible Effect Modifier. [8]
Study type: Cross-sectional survey CDC Pregnancy Risk Assessment Monitoring System (PRAMS) Survey at 4 months postpartum Setting: USA, 10 states	Population: 37628 mothers who were chosen by random birth certificate sampling Exposure: Pacifier use during the birth hospitalization	Measured outcome of interest: Exclusive breastfeeding ≥10 weeks Any breastfeeding ≥10 weeks
Marques NM et al, 2001 Breastfeeding and early weaning practices in northeast Brazil: a longitudinal study. [9]
Study type: Observational Setting: Hospitals, multicentre, Pernambuco state, Brazil	Population: Mothers of infants with a birth weight of >2500 g (n=364) Exposure of interest:: Pacifier introduction ≥7 days of age.	Measured outcome of interest: Introduction of other milk in first month of life
Pineda R et al, 2018 Pacifier use in newborns: related to socioeconomic status but not to early feeding performance. [10]
Study type: Observational; survey and feeding assessment Setting: Single hospital, United States	Population: Mother-infant dyads (n=51). Infants born >37 weeks of gestation. Exposure: Pacifier use at hospital.	Measured outcome of interest: Exclusively breastfed at hospital
Schliep KC et al, 2019 Factors in the Hospital Experience Associated with Postpartum Breastfeeding Success. [11]
Study type: Survey, Utah Pregnancy Risk Assessment Monitoring System (UT PRAMS) Setting: Hospitals, multicentre, Utah, United States	Population: Mothers who gave birth in hospital (n=5501) Exposure of interest: Pacifier given by hospital staff	Measured outcome of interest: Breastfeeding <2 months
Schubiger G et al, 1997 UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding? [12]
Study type: Multicentre prospective randomized trial. Setting: Maternity services at 10 hospitals, Switzerland. Included hospitals had established functioning breastfeeding programmes with early initiation of breastfeeding, lactation consultants, unrestricted rooming-in and policy of restricted infant formula use	Population: 602 healthy newborns >37 weeks of gestation with mothers intending to stay at hospital for 5 days postpartum and planning to breast-feed for ≥3 months. Intervention/control:UNICEF group [adhering to step six and nine in Baby-friendly hospital initiative]: Bottles, teats and pacifiers strictly forbidden; supplements, administered by cup or spoon, only given if medically indicated. Standard group: Pacifiers offered to all infants without restriction; supplements conventionally offered by bottle after breastfeeding.	Measured outcome of interest: Breastfeeding at day 5 and 2 months.
Sipsma HL et al, 2017 Pacifiers and Exclusive Breastfeeding: Does Risk for Postpartum Depression Modify the Association? [13]
Study type:: National survey Setting: Hospitals, multicentre, United States	Population: Mothers of healthy singleton babies >37 weeks of gestation, planning to breastfeed exclusively or in combination with formula (n=1349) High risk for postpartum depression: 6.7% (n=91) Lower risk for postpartum depression: 93.3% (n=1258) Exposure: Receiving pacifier in hospital	Measured outcome of interest: Exclusive breastfeeding at one week Exclusive breastfeeding at three weeks

References

Carbonell X, Botet F, Figueras J, Álvarez E, Riu A. The incidence of breastfeeding in our environment. Journal of Perinatal Medicine. 1998;26(4):320-4.
Declercq E, Labbok MH, Sakala C, O'Hara M. Hospital practices and women's likelihood of fulfilling their intention to exclusively breastfeed. American Journal of Public Health. 2009;99(5):929-35.
Hermanson Å, Åstr, LL. The effects of early pacifier use on breastfeeding: A randomised controlled trial. Women and Birth. 2020;33(5):e473-e82.
Howard CR, Howard FM, Lanphear B, deBlieck EA, Eberly S, Lawrence RA. The effects of early pacifier use on breastfeeding duration. Pediatrics. 1999;103(3).
Ingram J, Johnson D, Greenwood R. Breastfeeding in Bristol: teaching good positioning, and support from fathers and families. Midwifery. 2002;18(2):87-101.
Kair LR, Colaizy TT. Association Between In-Hospital Pacifier Use and Breastfeeding Continuation and Exclusivity: Neonatal Intensive Care Unit Admission as a Possible Effect Modifier. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine. 2017;12:12-9.
Kair LR, Kenron D, Etheredge K, Jaffe AC, Phillipi CA. Pacifier restriction and exclusive breastfeeding. Pediatrics. 2013;131(4):e1101-e7.
Marques NM, Lira PI, Lima MC, da Silva NL, Filho MB, Huttly SR, et al. Breastfeeding and early weaning practices in northeast Brazil: a longitudinal study. Pediatrics. 2001;108(4).
Pineda R, Luong A, Ryckman J, Smith J. Pacifier use in newborns: related to socioeconomic status but not to early feeding performance. Acta Paediatrica, International Journal of Paediatrics. 2018;107(5):806-10.
Schliep KC, Denhalter D, Gren LH, Panushka KA, Singh TP, Varner MW. Factors in the Hospital Experience Associated with Postpartum Breastfeeding Success. Breastfeeding Medicine. 2019;14(5):334-41.
Schubiger G, Schwarz U, Tonz O. UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding? Neonatal Study Group. European journal of pediatrics. 1997;156(11):874-7.
Sipsma HL, Kornfeind K, Kair LR. Pacifiers and Exclusive Breastfeeding: Does Risk for Postpartum Depression Modify the Association? Journal of Human Lactation. 2017;33(4):692-700.
Ya Yi H, Jian Tao L, Meei Ling G, Chiu Mieh H. The study of pacifier use in relation to infant sucking, maternal perception of milk supply and breastfeeding duration. Macau Journal of Nursing. 2011;10(2):16-21.

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Published: June 29, 2021 Report no: ut202114 Registration no: SBU 2021/370

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Literature search

CINAHL via EBSCO 17 May 2021

Association between dummy use and breastfeeding

AB = Abstract; AU = Author; DE = Term from the thesaurus; MH= Exact Subject Heading from CINAHL Subject Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; N = Near Operator (N) finds the words if they are a maximum of x words apart from one another, regardless of the order in which they appear.; W = Within Operator (W) finds the words if they are within x words of one another, in the order in which you entered them.
	Search terms	Items found
Population
1.	TI ( newborn OR neonate* OR infant* ) OR AB ( newborn OR neonate* OR infant* ) OR SU ( newborn OR neonate* OR infant* )	319 040
Intervention/Exposure
2.	TI ( pacifier* OR comforter* OR soother* OR dummy OR dummies OR (non N1 nutri* N1 sucking) ) OR AB ( pacifier* OR comforter* OR soother* OR dummy OR dummies OR (non N1 nutri* N1 sucking) ) OR SU ( pacifier* OR comforter* OR soother* OR dummy OR dummies OR (non N1 nutri* N1 sucking) )	2 644
Outcome
3.	TI ( breastfeed* OR ‘breast feed’ OR breastfed OR ‘breast fed’ OR wean OR lactat* OR (nurs* N1 (newborn OR infant* OR mother)) ) OR AB ( breastfeed OR ‘breast feed’ OR breastfed OR ‘breast fed’ OR wean OR lactat* OR (nurs* N1 (newborn OR infant* OR mother)) ) OR SU ( breastfeed OR ‘breast feed’ OR breastfed OR ‘breast fed’ OR wean OR lactat* OR (nurs* N1 (newborn OR infant* OR mother*)) )	59 353
Combined sets
4.	1 AND 2 AND 3	381
Limits
5.	Academic journals
Final result
	4 AND 5	333

Embase via Elsevier 17 May 2021

Association between dummy use and breastfeeding

/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified
	Search terms	Items found
Population
1.	’newborn’/exp	618 595
2.	(newborn OR neonate* OR infant*):ti,ab,kw	715 116
3.	1 OR 2	1 063 443
Intervention/Exposure
4.	‘pacifier’/exp	908
5.	(pacifier* OR comforter* OR soother* OR dummy OR dummies OR (non NEAR/2 nutri* NEAR/2 sucking)):ti,ab.kw	9 912
6.	4 OR 5	10 103
Outcome
7.	‘breast feeding’/exp OR ‘breast milk’/exp OR ‘lactation’/exp	126 809
8.	(breastfeed* OR ‘breast feed’ OR breastfed OR ‘breast fed’ OR wean OR lactat*):ti,ab,kw	62 628
9.	(nurs* NEAR/2 (newborn OR infant* OR mother*)):ti,ab,kw	4 725
10.	7 OR 8 OR 9	143 191
Limits:
11.	(‘article’/it OR ‘article in press’ OR ‘review’/it)
Combined sets
12.	3 AND 6 AND 10	651
Final result
	11 AND 12	539

Medline via OvidSP 17 May 2021

Association between dummy use and breastfeeding

.ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = Text, heading word, subject area node, title; “ “ = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other.
	Search terms	Items found
Population
1.	infant, newborn/	619 168
2.	(newborn or infant* or neonat*).ab,kf,ti.	724 224
3.	1 or 2	1 036 640
Intervention/Exposure
4.	Pacifiers/	501
5.	(pacifier* or soother* or comforter* or dummy or dummies or (non adj1 nutriti* adj1 sucking)).ab,kf,ti.	7 410
6.	4 or 5
Outcome
7.	Breast Feeding/ or Lactation/ or Lactation Disorders/	79 612
8.	(breastfeed* or breast feed* or breastfed or breast fed or wean* or lactat*).ab,kf,ti.	211 289
9.	(nurs* adj2 (newborn or infant* or mother*)).ab,kf,ti.	4 848
10.	7 or 8 or 9
Combined sets
11.	3 and 6 and 10	529
Final result
		529

Scopus via Elsevier 17 May 2021

Association between dummy use and breastfeeding

TITLE-ABS-KEY = Title or abstract or keywords; ALL = All fields; PRE/n = "precedes by". The first term in the search must precede the second by a specified number of terms (n).; W/n = "Within". The terms in the search must be within a specified number of terms (n) in any order.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document type article; LIMIT-TO (DOCTYPE, "re" = Limit to document type review
	Search terms	Items found
Population
1.	TITLE-ABS-KEY(infant OR newborn OR neonate)	1 651 439
Intervention/Exposure
2.	TITLE-ABS-KEY(pacifier or dummy or comforter or soother or (non W/1 nutri* W/1 sucking))	24 419
Outcome: Breast feeding
3.	TITLE-ABS-KEY(breastfeed* OR “breast feed” OR breastfed OR “breast fed” OR wean OR lactat* OR (nurs* W/1 (newborn OR infant OR baby OR mother))	397 754
Combined sets
4.	1 AND 2 AND 3	753
Limits:
5.	Limit to: article, review, letter
Final result
	4 AND 5	711

Page published June 29, 2021