Pacifiers May Lead to Early Weaning, No Effect on Crying
Evidence Against the Infant Soothers Mounts
By Aman Shah, MD
WebMD Medical News
Reviewed by Michael W. Smith, MD
July 17, 2001 -- In spite of their use for at least 3,000 years, today pacifiers are called "an instrument of torture" by many experts, partially due to the belief that they can decrease breastfeeding. A new study in the July 18 issue of JAMA shows that the pacifier's enemies may -- or may not -- have a point. Although researchers found no direct association between pacifier use and early weaning, they found that pacifier use is a marker for breastfeeding difficulties or reduced motivation to breastfeed. They also found that pacifiers did not calm crying or fussy behavior -- the reason so many parents use them.
"Pacifier use can be a marker that breastfeeding is not going well, and moms who gave pacifiers to their newborns tended to breastfeed for a shorter duration," says study co-author Luisa Ciofani, MSc, IBCLC, clinical nurse specialist at McGill University Health Center in Montreal. "Pacifiers are engrained in people's minds. ... If you sent any mother to the store to buy five items, I am sure she would buy a pacifier."
The researchers enrolled 281 mothers and their breastfed infants in a prospective, double-blind study. All mothers received counseling regarding the proper way to calm a fussy infant, with half being randomized to counseling against pacifier use. Infant behavior over a 24-hour period was assessed at 4, 6, and 9 weeks. The researchers collected data on early weaning over a 3-month follow-up period.
Only 16% of the control group avoided pacifier use, compared with 38.6% of the group that had been counseled against it. Daily pacifier use also decreased from 55.7% in the control group to 40.8% in the group counseled against it. Interestingly, there were no differences in crying and fussing behavior between the two groups.
There was also no difference in early weaning between the two groups, with around 18% of the infants in each group being weaned during the study period.
However, when actual pacifier use was compared with no pacifier use, 25% of the daily pacifier use infants were weaned at 3 months compared with 12.9% of unexposed infants.
The bottom line, says Ciofani, is that pacifiers "won't enhance anything," and mothers should be counseled to focus on breastfeeding and use other methods of soothing an infant such as rocking or carrying, which seem to work as well as pacifier use.
"There are studies that show that early weaning and breastfeeding are connected somehow," Alan Greene, MD, assistant professor of pediatrics at Stanford University, tells WebMD. "I go on at length about the benefits of breastfeeding and how healthy and helpful breast milk is for kids, but I also explain to them that all kids are built with a need for non-nutritive sucking."
Greene, who was not involved in the study, says he teaches parents early on to try out various soothers such as rocking, singing, swaddling, or whispering to see what their newborn responds to. On the other hand, he feels that pacifiers won't do any harm, so if the parents feel that it comforts their child, it is OK to let them use one. "I have never seen people who are motivated to breastfeed where [breastfeeding] stops because of pacifier use," he says. "I encourage parents to let kids suck a thumb or pacifier if the kid is interested in that."
"Pacifier use has no detrimental effects, so choose your battles," agrees Kenneth Cohen, MD, a pediatrician in Pembroke Pines, Fla.
"I usually tell parents not to introduce a pacifier during the first month, and after that babies will get an idea about nutritive nipples and non-nutritive nipples," Cohen tells WebMD. "But if a child is still sucking on a pacifier at age 2, it's time to start cutting back on its use."