Research questions impact of pacifiers on disrupting breast-feeding

Pacifiers can soothe agitated infants, but some experts - including those at the World Health Organization (WHO) - discourage pacifier use in the first six months of life because of concerns that it may interfere with breast-feeding, widely seen as the best way to feed a newborn.

New research, however, casts doubt on the notion that pacifier use disrupts breast-feeding. In an analysis of feeding patterns among 2,249 infants in a single maternity ward over a 15-month period, researchers found the proportion of infants who were exclusively breast-fed dropped from 79% to 68% after pacifier use was restricted in the ward.

Meanwhile, the proportion of infants who needed formula in addition to breast-feeding jumped from 18% to 28% after the change in policy, according to the preliminary results of the study, which were presented today at the annual meeting of the Pediatric Academic Societies, in Boston.

"We were surprised - even disappointed - to find that our exclusive breast-feeding rates went down and supplemental formula feedings went up," says Carrie Phillipi, M.D., senior author of the study and an associate professor of pediatrics at Oregon Health & Science University, in Portland.

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The conventional wisdom is that pacifier use creates "nipple confusion" in newborns, says Pete Richel, M.D., chief of pediatrics at Northern Westchester Hospital, in Mt. Kisco, New York, who was not involved with the study.

The theory is that infants suckle their mother's nipple differently than they do a bottle or pacifier, and may have difficulty latching on to the mother if they're given too much exposure to artificial nipples.

In addition, the body produces breast milk according to demand, so frequently giving infants a pacifier may in some cases compromise the mother's milk supply, Phillipi says.

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Prohibiting the use of pacifiers and artificial nipples is one of the 10 steps for encouraging breast-feeding that hospitals in the United States must take to earn a "baby-friendly" designation from the WHO and the United Nations Children's Fund (UNICEF).

As part of its efforts to qualify for this baby-friendly status, the Doernbecher Children's Hospital at OHSU curtailed the use of pacifiers in its mother-baby unit in December 2010. After that date, the hospital required nurses and doctors to sign pacifiers out and use them only for "medically appropriate reasons," such as when a baby undergoes a painful surgical procedure or is withdrawing from drugs the mother took while pregnant.

The policy change provided Phillipi and her colleagues with a handy way of assessing before-and-after changes in pacifier use and breast-feeding, but their analysis lacks the rigor of a carefully designed and controlled study.

For instance, the hospital allowed visitors to bring their own pacifiers into the mother-baby unit, which is specially designed to accommodate mothers, infants, and family members. The researchers have no way of knowing how many outside pacifiers were brought it, or how often the infants used them.

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Moreover, the analysis didn't take into account the mothers' demographic profiles and the hospital's staffing levels, in particular the availability of doctors and nurses to give breast-feeding advice, Phillipi says.

Despite these weaknesses, the findings add another wrinkle to the already confusing recommendations for pacifier use in newborns. In contrast to the WHO, which discourages all pacifier use in the first six months of life, the American Academy of Pediatrics recommends giving babies pacifiers as they fall asleep beginning at the one-month mark, because this practice has been linked with a lower risk of sudden infant death syndrome (SIDS).

"It's very logical to think that pacifiers might interfere with breastfeeding, but there isn't really strong evidence that pacifiers are the problem, and they do turn out to be beneficial for reducing the risk of SIDS," Phillipi says. "Maybe we could approach mothers and their infants on a more individual basis… We can't make blanket recommendations about complex things."

Copyright Health Magazine 2011