Pacifier use and interruption of exclusive breastfeeding: Systematic review and meta‐analysis

Abstract

Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six month. A search of CINAHL, Scopus, Web of Science, LILACS and Medline; from inception through 30 December 2014 without restriction of language yielded 1,866 publications (PROSPERO protocol CRD42014014527). Predetermined inclusion/exclusion criteria peer reviewed yielded 46 studies: two clinical trials, 20 longitudinal, and 24 cross-sectional studies. Meta-analysis was performed and meta-regression explored heterogeneity across studies. The pooled effect of the association between pacifier use and EBF interruption was 2.48 OR (95% CI = 2.16-2.85). Heterogeneity was explained by the study design (40.2%), followed by differences in the measurement and categorization of pacifier use, the methodological quality of the studies and the socio-economic context. Two RCT's with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and risk of EBF interruption (OR = 2.28; 95% CI = 1.78-2.93). Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use. Future studies that take into account the risks and benefits of pacifier use are needed to clarify this recommendation.

Prevalence and associated factors for early interruption of exclusive breastfeeding: meta-analysis on Brazilian epidemiological studies

“…A metaanalysis with cohort and cross-sectional studies reported that the use of pacifiers has increased the occurrence of breastfeeding interruption (OR: 2.48; CI95%: 2.16-2.85). 34 The use of the pacifier may be one of the EBF interruption causes, but also a marker of difficulties related to breastfeeding, as well as reducing maternal motivation to breastfeeding. In addition, mothers who have problems with breastfeeding make its use to ease the child.…”

“…In addition, mothers who have problems with breastfeeding make its use to ease the child. 34 It is possible that pacifier use inhibits breastfeeding, sucking reduction may compromise milk production with consequent risk of weaning.…”

“…Future studies need to take into account their designs to deal with the possibility of reverse causality. 34 The use of pacifiers is strongly influenced by cultural, motivational and maternal psychological factors. 35 Qualitative studies are needed to obtain an in depth understanding of reasons behind the introduction of pacifier use.…”

“…35 Qualitative studies are needed to obtain an in depth understanding of reasons behind the introduction of pacifier use. 34 In the analyzed studies, male newborns have presented an association to EBF discontinuation. A similar result was observed in Brazilian children, in which there was a higher prevalence of EBF among girls.…”

Defining Behavior Patterns Towards Exclusive Breastfeeding Using Latent Class Analysis

“…The use of a pacifier has been reported as an indicator of maternal difficulty in BF management and it signals their willingness to wean (26). The association between pacifier use and duration of AME presents conflicting results, although recent systematic reviews concluded that the use of pacifier associated with the shortest time of AME (27,28).…”