title: Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding.
abstract: OBJECTIVE
  To enhance breastfeeding practices, the World Health Organization discourages pacifiers and bottle-feeding. However, the effect of artificial nipples on breastfeeding duration is poorly defined. The effects of 2 types of artificial nipple exposure on breastfeeding duration were evaluated: 1) cupfeeding versus bottle-feeding for the provision of in-hospital supplements and 2) early (2-5 days) versus late (>4 weeks) pacifier introduction.
  
  
  METHODS
  A total of 700 breastfed newborns (36-42 weeks, birth weight >or=2200 g) were randomly assigned to 1 of 4 intervention groups: bottle/early pacifier (n = 169), bottle/late pacifier (n = 167), cup/early pacifier (n = 185), or cup/late pacifier (n = 179). The cup/bottle intervention was invoked for infants who received supplemental feedings: cup (n = 251), bottle (n = 230). Data were collected at delivery and at 2, 5, 10, 16, 24, 38, and 52 weeks' postpartum. Intervention effects on breastfeeding duration were evaluated with logistic regression and survival analyses.
  
  
  RESULTS
  Supplemental feedings, regardless of method (cup or bottle), had a detrimental effect on breastfeeding duration. There were no differences in cup versus bottle groups for breastfeeding duration. Effects were modified by the number of supplements; exclusive and full breastfeeding duration were prolonged in cup-fed infants given >2 supplements. Among infants delivered by cesarean, cupfeeding significantly prolonged exclusive, full, and overall breastfeeding duration. Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers (early pacifier group; odds ratio: 1.5; 95% confidence interval: 1.0-2.0). Early, as compared with late, pacifier use shortened overall duration (adjusted hazard ratio: 1.22; 95% confidence interval: 1.03-1.44) but did not affect exclusive or full duration.
  
  
  CONCLUSIONS
  There was no advantage to cupfeeding for providing supplements to the general population of healthy breastfed infants, but it may have benefitted mother-infant dyads who required multiple supplements or were delivered by cesarean. Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding. These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. cindy.howard@viahealth.org
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Howard
authors.forename: Fred M
authors.initials: FM
authors.lastname: Howard
authors.forename: Bruce
authors.initials: B
authors.lastname: Lanphear
authors.forename: Shirley
authors.initials: S
authors.lastname: Eberly
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: deBlieck
authors.forename: David
authors.initials: D
authors.lastname: Oakes
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Lawrence
mesh_terms: D000328:Adult; D001724:Birth Weight / Q000502:physiology; D001903:Bottle Feeding / Q000009:adverse effects*; D001942:Breast Feeding / Q000706:statistics & numerical data*; D002657:Child Development / Q000502:physiology; D005248:Feeding Methods / Q000009:adverse effects; D005260:Female; D006801:Humans; D015370:Infant Equipment / Q000009:adverse effects; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D016015:Logistic Models; D041361:Pacifiers / Q000009:adverse effects* / Q000706:statistics & numerical data; D011247:Pregnancy; D013391:Sucking Behavior / Q000502:physiology; D016019:Survival Analysis