Breastfeeding and pacifier use in Brazil

To determine the relationship between pacifier use and the duration of exclusive breast-feeding in the first six months of age, among poor children with unfavourable birth weight, from an underdeveloped region in Brazil.

Prospective cohort study with infants followed from birth to 6 months of age. Healthy children born with unfavourable birth weight (< 3,000), being exclusively breastfed, were selected from 8 maternity hospitals in the city of Fortaleza (Brazil) between November 1996 and April 1997. Two main outcome measures were used: (i) time to stop exclusive breast-feeding at the 1st and (ii) at the 6th month of life. Main exposures were pacifier use at 1st and 6th month of age. Data were collected at maternity hospitals and during home interviews, using structured questionnaires, by trained data collectors unaware of the study aims, and analyzed using survival analysis and the Cox Proportional Hazard Model.

500 children were enrolled and 13% were lost to follow up at the 1st month. Most of the families had a monthly income less than five times the minimum wage. One third of the mothers were adolescents, one fifth were working outside the home by the 6th month and most attended prenatal care visits. Approximately 60% of the children were using pacifiers by the 1st month. The average number of days for exclusive breast-feeding for pacifier use by the 6th month was 125.3 compared to 87.0 among non-users (p=0.0001). Children using pacifiers were 1,9 more likely to have stopped exclusive breastfeeding by the 6th month compared to non-users, even after controlling potential confounders.

Pacifier use was associated with the early termination of breast-feeding in Brazil, among poor children with unfavourable birth weight, living in an underdeveloped area. As a possible marker of early weaning, pacifier use can help health workers identify those mothers in need of extended counselling to reinforce breast-feeding practices.