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Pacifier use, early weaning, and cry/fuss behavior: a randomized controlled trial.

M S Kramer1, R G Barr, S Dagenais

  • 11020 Pine Ave W, Montreal, Quebec, Canada H3A 1A2. mkrame@po-box.mcgill.ca

JAMA
|July 24, 2001
PubMed
Summary

Pacifier use is associated with early weaning, but a randomized controlled trial found no causal link. Pacifier use may indicate underlying breastfeeding challenges rather than causing early weaning.

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Area of Science:

  • Pediatrics
  • Maternal and Child Health
  • Evidence-Based Practice

Background:

  • International health organizations advise against pacifier use due to potential breastfeeding interference.
  • Observational studies suggest a link between pacifier use and early weaning, but causality remains unproven.

Purpose of the Study:

  • To determine if regular pacifier use causally leads to weaning by 3 months postpartum.
  • To compare findings from randomized intervention allocation versus observational data on pacifier use.

Main Methods:

  • A double-blind, randomized controlled trial involving 281 breastfeeding mothers and their infants.
  • Participants received counseling on pacifier avoidance (experimental) or standard care (control).
  • Infant behavior and weaning status were monitored via logs and follow-up assessments.

Main Results:

  • Randomized intervention significantly increased pacifier avoidance and reduced daily use.
  • No causal association was found between pacifier use and weaning at 3 months in the randomized analysis.
  • An observational analysis revealed a strong association between pacifier use and early weaning.

Conclusions:

  • Pacifier use is likely a marker for breastfeeding difficulties, not a direct cause of early weaning.
  • Randomized controlled trial data refute the causal link suggested by observational studies.
  • Findings highlight the importance of distinguishing correlation from causation in infant feeding research.