title: Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding.
abstract: BACKGROUND
  To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast milk production and shorten duration of breastfeeding; however, this remains unclear.
  
  
  OBJECTIVE
  To assess the effect of pacifier use versus no pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).
  
  
  METHODS
  Randomised and quasi-randomised controlled trials comparing pacifier use versus no pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital.
  
  
  METHODS
  Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
  
  
  RESULTS
  We found three trials (involving 1915 babies) for inclusion in the review but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 1.00; 95% confidence interval (CI) 0.95 to 1.06), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.97 to 1.02), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).
  
  
  CONCLUSIONS
  Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.
authors.affiliation: Department of Obstetrics and Gynaecology, Ipoh Specialist Hospital, Raja Dihilir Street, Ipoh, Perak, Malaysia, 30450.
authors.forename: Sharifah Halimah
authors.initials: SH
authors.lastname: Jaafar
authors.forename: Shayesteh
authors.initials: S
authors.lastname: Jahanfar
authors.forename: Mubashir
authors.initials: M
authors.lastname: Angolkar
authors.forename: Jacqueline J
authors.initials: JJ
authors.lastname: Ho
mesh_terms: D001942:Breast Feeding / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009042:Motivation; D041361:Pacifiers / Q000009:adverse effects / Q000706:statistics & numerical data*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors