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A Systematic Review

Nina R. O’Connor, MD; Kawai O. Tanabe, MPH; Mir S. Siadaty, MD, MS; Fern R. Hauck, MD, MS

Arch Pediatr Adolesc Med. 2009;163(4):378-382.

Objective  To summarize current evidence on the association between infant pacifier use and breastfeeding.

Data Sources  MEDLINE, CINAHL, the Cochrane Library, EMBASE, POPLINE, and bibliographies of identified articles.

Study Selection  A search for English-language records (from January 1950 through August 2006) containing the Medical Subject Heading terms pacifiers and breastfeeding was conducted, resulting in 1098 reports. Duplicate and irrelevant studies were excluded, yielding 29 studies that fit inclusion criteria for the review (4 randomized controlled trials, 20 cohort studies, and 5 cross-sectional studies). Two independent reviewers abstracted data and scored these studies for quality; disagreements were settled through consensus with a third investigator.

Main Exposure  Pacifier use.

Main Outcome Measures  Breastfeeding duration or exclusivity.

Results  Results from 4 randomized controlled trials revealed no difference in breastfeeding outcomes with different pacifier interventions (pacifier use during tube feeds, pacifier use at any time after delivery, an educational program for mothers emphasizing avoidance of pacifiers, and a UNICEF [United Nations Children’s Fund]/World Health Organization Baby Friendly Hospital environment). Most observational studies reported an association between pacifier use and shortened duration of breastfeeding.

Conclusions  The highest level of evidence does not support an adverse relationship between pacifier use and breastfeeding duration or exclusivity. The association between shortened duration of breastfeeding and pacifier use in observational studies likely reflects a number of other complex factors, such as breastfeeding difficulties or intent to wean. Ongoing quantitative and qualitative research is needed to better understand the relationship between pacifier use and breastfeeding.

Author Affiliations: Departments of Family Medicine (Drs O’Connor and Hauck and Ms Tanabe) and Public Health Sciences (Drs Siadaty and Hauck), University of Virginia School of Medicine, Charlottesville. Dr O’Connor is now with the Chestnut Hill Family Practice Residency Program, Philadelphia, Pennsylvania.

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