Pulling plug on pacifiers: New data do not support recommendation to restrict soothers in breastfeeding infants

New research, however, challenges that assertion. In fact, limiting the use of pacifiers in newborn nurseries may actually increase infants' consumption of formula during the birth hospitalization, according to a study presented April 30, at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Studies have shown that breastfed infants have fewer illnesses such as ear infections and diarrhea as well as a reduced risk of certain cancers, obesity and asthma. Moms benefit, too, from more rapid loss of pregnancy-associated weight gain, reduced risks of certain cancers and improved cardiovascular health. Based on that evidence, the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first six months of life.

To encourage exclusive breastfeeding, the World Health Organization and United Nations Children's Fund recommend that hospitals caring for newborns follow Ten Steps to Successful Breastfeeding. One of the steps states that artificial teats or pacifiers should not be provided to breastfeeding babies. Medical centers that follow the 10 steps can be recognized as Baby-Friendly Hospitals.

In their study, Laura Kair, MD, and Carrie Phillipi, MD, PhD, from Oregon Health & Science University (OHSU), sought to determine if eliminating routine pacifier distribution on the hospital's mother-baby unit increased the rate of exclusive breastfeeding.

OHSU, which has been working to become a Baby-Friendly Hospital, implemented a policy in December 2010 restricting nurses from routinely giving pacifiers to breastfed newborns. The pacifiers were locked up and nurses had to enter a code and a patient's name in order to access them for special circumstances (e.g., to help soothe infants undergoing painful procedures).

Drs. Kair and Phillipi analyzed feeding data on 2,249 infants born between June 2010 and August 2011. Results showed that the rate of exclusive breastfeeding on the mother-baby unit decreased significantly after pacifiers were restricted -- from 79 percent of infants in July to November 2010 to 68 percent in January to August 2011.

In addition, the proportion of breastfed infants receiving supplemental formula increased from 18 percent before the policy was changed to 28 percent afterward. The percentage of infants fed only formula remained statistically unchanged during the study period.

"There is a great deal of energy nationally as well as internationally in support of increasing the number of Baby-Friendly Hospitals," said Dr. Kair, pediatric resident at OHSU Doernbecher Children's Hospital. "Taken together, the 10 steps improve exclusive breastfeeding rates in the hospital. However, the effect of pacifier use on initiation and duration of exclusive breastfeeding has not been well-established in the medical literature.

"Our goal with publicizing this data is to stimulate conversation and scientific inquiry about whether there is sufficient evidence to support the universal recommendation of not offering pacifiers to breastfeeding infants in the first few days to weeks of life," Dr. Kair added. "This subject poses an additional dilemma for parents and pediatric providers as pacifier use is associated with a decreased risk of sudden infant death syndrome (SIDS), and the AAP recommends using a pacifier for sleep after breastfeeding is established."

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