Science You Can Use: Before you pop in that pacifier, take a closer look at this study.

Earlier this month the topic of pacifiers and breastfeeding was all over the news.  At least 85 articles ran in print and online publications about it.

The big news?  Researchers from the Oregon Health & Science University (OHSU) reported a decline in exclusive breastfeeding and an increase in formula supplementation when pacifiers were banned as part of a hospital’s effort to become Baby Friendly.

Since this seemed to contradict other research, and since it had gotten so much press that sooner or later I’d get asked about it by my in-laws, it seemed like a good idea to take a closer look.

After all, as I’d written in this Booby Traps post, pacifiers have long been viewed as detrimental to breastfeeding.  So much so that “giving no artificial teats or pacifiers to breastfeeding infants” is one of the evidence-based Ten Steps to Successful Breastfeeding, and the American Academy of Pediatrics (AAP) in their breastfeeding policy, says: “Pacifier use is best avoided during the initiation of breastfeeding and used only after breastfeeding is well established.”  Despite this, the CDC reports that only 30% of hospitals limit the use of pacifiers so that less than 10% of healthy full-term breastfed infants are given pacifiers by maternity care staff members.

So, what exactly is this study?  It is a retrospective, observational look at exclusive breastfeeding and formula supplementation at one hospital which eliminated pacifiers as part of an effort to become Baby Friendly.  It examined feeding records of 2,249 infants born between June 2010 and August 2011.

Three things stood out for me as I learned more about the research, none of which got a whole lot of attention in the press reports:

1)  This research was being presented at a conference but and is preliminary and unpublished, which means that it hasn’t been peer reviewed by experts in the field.  This type of research is not considered as rigorous as methods like randomized controlled trials.

2)  As Dr. Richard Schanler, chair of the American Academy of Pediatrics‘ breast-feeding section pointed out, “the study did not offer information about how newborns were comforted who did not receive pacifiers or how hospital staff members were educated about this issue during the research” adding “you cannot draw conclusions to change health care practices from this type of study.”  As Miriam Labbok pointed out, if pacifiers were removed without parents being taught other methods of soothing babies, is it that surprising that parents would reach for a bottle?

3)  The authors themselves discourage the conclusion that limiting pacifier use harms breastfeeding.  One of the study’s authors states:  “We view this as an interesting observation, but we do not claim a cause and effect relationship. Our goal in publicizing this data is to stimulate dialogue and scientific inquiry into the relationship between pacifiers and breastfeeding.” [emphasis mine]

What does the other research on this topic say?

This topic has been investigated quite a bit, so there is a decent body of research to look at.  A meta-analysis of 29 studies studies on this topic found the following:

  • The 4 randomized controlled trials revealed no difference in breastfeeding outcomes with different pacifier interventions
  • Most of the 25 observational studies reported an association between pacifier use and shortened duration of breastfeeding.

In other words (mine), the evidence is mixed, with an  suggestion, unconfirmed in rigorous research, that pacifiers have an effect on breastfeeding.

To bink, or not to bink?

Ever heard of the “precautionary principle?”  This is a term from the environmental movement which (to paraphrase significantly) means that if an action carries a suspected risk of causing harm, in the absence of scientific consensus that the action causes harm, you don’t do it.

Since the evidence is mixed, the safest course of action is to proceed with caution.  Will your baby – and breastfeeding – be affected if you give your baby a pacifier?  We can’t say for certain.  But since at least some of the evidence supports a risk, it’s best to avoid it (as the AAP says) until breastfeeding is well established.

And in the meantime, learn the fine art of soothing a baby without a pacifier or bottle, starting of course with plenty of breastfeeding and skin-to-skin time!  Holding, babywearing, and motion go a long way to…yes, keeping the binkie at bay.

Did you use a pacifier?  Did it have any effect on your breastfeeding experience?  What did you think of this study?

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7 Comments | Last revised on 05/24/2012

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