Does the use of pacifiers influence breastfeeding?

Author Dr. J. Hower, paediatrician from Germany

A low prevalence of breastfeeding increases the risk of infant morbidity and mortality in both developed and developing countries. For this reason, the World Health Organization (WHO) introduced the “10 steps for successful breastfeeding” and therein advised against the use of pacifiers. Avoiding the use of pacifiers should encourage infants to suck more at the breast.
There are now several studies that have shown that the use of pacifiers reduces the risk of sudden infant death syndrome; a finding which conflicts with the recommendations published by the WHO. In the most recent study, the authors investigated whether the use of pacifiers in cases of established breastfeeding decreases the prevalence and duration of breastfeeding.

Study design: A randomized, controlled, multicentre study comprising 1,021 mothers and their newborn babies. The participants were randomly assigned to one of the two study arms, whereby in one of the groups pacifiers were offered and in the other they weren’t. The primary objective of this study was to collect data on the prevalence of breastfeeding (exclusive breastfeeding) after three months. The secondary objective was to collect data on the prevalence of breastfeeding at different ages and the duration of breastfeeding.
Outcome: At three months, 85.8% of the infants in the group with pacifiers and 86.2% in the group without pacifiers were exclusively breastfed. The use of pacifiers did not produce a significant decrease in the frequency of breastfeeding and breastfeeding in general at different ages or during lactation.

Conclusion: The recommendation to introduce a pacifier at 15 days in cases of established breastfeeding does not alter the prevalence and duration of breastfeeding. As the use of pacifiers is associated with a reduced incidence of sudden infant death syndrome, the recommendation to offer a pacifier appears safe and appropriate.

Jenik, AG et al. Does the recommendation to use a pacifier influence the prevalence of breastfeeding? J Pediatr 2009 Sep; 155(3): 350-354

Comment: According to scientific consensus, exclusive breastfeeding during the first six months is superior to every other form of nutrition. Jenik et al., the authors of this randomized clinical trial, the largest so far, found that the use of pacifiers does not influence successful breastfeeding. Mothers of newborns, who are able to successfully breastfeed after two weeks and who are planning to continue breastfeeding for at least the next three months, can do so also when offering a pacifier.