title: Associations of pacifier use, digit sucking, and child care attendance with cessation of breastfeeding.
abstract: OBJECTIVE
  Breast milk is the recommended method of nutrition for newborns and infants. Several studies have investigated factors associated with the cessation of breast-feeding. This study assessed the associations between pacifier use, digit sucking, childcare attendance, and breastfeeding cessation among 1387 infants in the Iowa Fluoride Study.
  
  
  METHODS
  This was a longitudinal questionnaire survey. Mothers completed mailed questionnaires sent at infant ages 6 weeks, 3 months, and 6 months.
  
  
  METHODS
  Parents were recruited postpartum at 8 Iowa hospitals.
  
  
  METHODS
  Survival analysis (using Cox proportional hazards model) assessed the time covariate effects of pacifier use, digit sucking, and child care attendance on cessation of breastfeeding, while adjusting for other possible confounding variables (not planning to breastfeed, maternal smoking, infants' sex and antibiotic use, maternal and paternal age and education, and income group).
  
  
  RESULTS
  Percentages of women who did any breastfeeding were 46%, 36%, and 27%, at 6 weeks, 3 months, and 6 months, respectively. Percentages using pacifiers were 81%, 71%, and 59%. Combinations of pacifier use and digit sucking for various levels of child care had statistically significant associations with cessation of breastfeeding, with the effect being strongest for pacifier users and digit suckers with no child care days (hazard ratio = 1.88; 95% CI, 1.36-2.62).
  
  
  CONCLUSIONS
  Pacifier use and digit sucking were associated with cessation of breastfeeding, with results dependent on the level of childcare attendance. The strongest associations were found for those not attending childcare and for combined use of pacifier with digit sucking.
authors.affiliation: Universit of Iowa, Iowa City 52242, USA. steven-levy@uiowa.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Levy
authors.forename: Susan L
authors.initials: SL
authors.lastname: Slager
authors.forename: John J
authors.initials: JJ
authors.lastname: Warren
authors.forename: Barcey T
authors.initials: BT
authors.lastname: Levy
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Nowak
mesh_terms: D002656:Child Day Care Centers; D005386:Fingersucking; D006801:Humans; D007223:Infant; D007224:Infant Care; D007484:Iowa; D008137:Longitudinal Studies; D016016:Proportional Hazards Models; D014886:Weaning