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.

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

  1. 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.
  2. 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.
  3. Hermanson Å, Åstr, LL. The effects of early pacifier use on breastfeeding: A randomised controlled trial. Women and Birth. 2020;33(5):e473-e82.
  4. 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).
  5. Ingram J, Johnson D, Greenwood R. Breastfeeding in Bristol: teaching good positioning, and support from fathers and families. Midwifery. 2002;18(2):87-101.
  6. 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.
  7. Kair LR, Kenron D, Etheredge K, Jaffe AC, Phillipi CA. Pacifier restriction and exclusive breastfeeding. Pediatrics. 2013;131(4):e1101-e7.
  8. 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).
  9. 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.
  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.
  11. 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.
  12. 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.
  13. 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.

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.

Published: 6/29/2021
Report no: ut202114
Registration no: SBU 2021/370