title: Pacifier restriction and exclusive breastfeeding.
abstract: OBJECTIVE
  We tested the hypothesis that removing pacifiers from routine distribution in our mother-baby unit (MBU) would be associated with greater breastfeeding initiation or exclusivity during the birth hospitalization.
  
  
  METHODS
  We retrospectively compared exclusive breastfeeding, breastfeeding plus supplemental formula feeding, and exclusive formula feeding rates for 2249 infants admitted to the MBU at our university teaching hospital during the 5 months before and 8 months after restriction of routine pacifier distribution. Formula supplementation, if not medically indicated, was discouraged per standard practice, but access to formula was not restricted.
  
  
  RESULTS
  Of the 2249 infants, 79% were exclusively breastfed from July through November 2010, when pacifiers were routinely distributed. During the 8-month period after pacifier restriction, this proportion decreased significantly to 68% (P < .001). A corresponding increase from 18% to 28% was observed in the number of breastfed infants receiving supplemental formula feeds in the same period (P < .001). During the study period, the proportion of exclusively formula-fed infants increased from 1.8% to 3.4% (P < .05).
  
  
  CONCLUSIONS
  Restricting pacifier distribution during the newborn hospitalization without also restricting access to formula was associated with decreased exclusive breastfeeding, increased supplemental formula feeding, and increased exclusive formula feeding. Because high-quality, prospective medical literature addressing pacifier use and breastfeeding does not conclusively show an adverse relationship in women who are motivated to breastfeed, more studies are needed to help determine what effect, if any, pacifiers have on breastfeeding initiation and exclusivity in the immediate newborn period.
authors.affiliation: Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA. kair@ohsu.edu
authors.forename: Laura R
authors.initials: LR
authors.lastname: Kair
authors.forename: Daniel
authors.initials: D
authors.lastname: Kenron
authors.forename: Konnette
authors.initials: K
authors.lastname: Etheredge
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Jaffe
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Phillipi
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D006757:Hospital Units / Q000592:standards; D006801:Humans; D007224:Infant Care / Q000379:methods* / Q000592:standards; D041943:Infant Formula / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D041361:Pacifiers; D011181:Postnatal Care / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies