Pacifiers and breastfeeding: a systematic review.
OBJECTIVE
To summarize current evidence on the association between infant pacifier use and breastfeeding.


METHODS
MEDLINE, CINAHL, the Cochrane Library, EMBASE, POPLINE, and bibliographies of identified articles.


METHODS
A search for English-language records (from January 1950 through August 2006) containing the Medical Subject Heading terms pacifiers and breastfeeding was conducted, resulting in 1098 reports. Duplicate and irrelevant studies were excluded, yielding 29 studies that fit inclusion criteria for the review (4 randomized controlled trials, 20 cohort studies, and 5 cross-sectional studies). Two independent reviewers abstracted data and scored these studies for quality; disagreements were settled through consensus with a third investigator.


METHODS
Pacifier use.


METHODS
Breastfeeding duration or exclusivity.


RESULTS
Results from 4 randomized controlled trials revealed no difference in breastfeeding outcomes with different pacifier interventions (pacifier use during tube feeds, pacifier use at any time after delivery, an educational program for mothers emphasizing avoidance of pacifiers, and a UNICEF [United Nations Children's Fund]/World Health Organization Baby Friendly Hospital environment). Most observational studies reported an association between pacifier use and shortened duration of breastfeeding.


CONCLUSIONS
The highest level of evidence does not support an adverse relationship between pacifier use and breastfeeding duration or exclusivity. The association between shortened duration of breastfeeding and pacifier use in observational studies likely reflects a number of other complex factors, such as breastfeeding difficulties or intent to wean. Ongoing quantitative and qualitative research is needed to better understand the relationship between pacifier use and breastfeeding.
Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908-0729, USA.
Nina R
NR
O'Connor
Kawai O
KO
Tanabe
Mir S
MS
Siadaty
Fern R
FR
Hauck
D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data*; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D007231:Infant, Newborn; D008297:Male; D041361:Pacifiers / Q000009:adverse effects / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000592:standards / Q000639:trends; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D013391:Sucking Behavior / Q000502:physiology*; D013997:Time Factors; D014481:United States; D014886:Weaning