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Breastfeeding and pacifier use in Brazil
Antonio J Ledo Alves da Cunha1, Alvaro Madeiro Leite2, Marcia Maria Tavares Machado3
1Institute of pediatrics, Ceará Federal University, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. acunha@hucff.ufrj.br.
Insights
Pacifier use significantly shortens exclusive breastfeeding duration in low-income Brazilian infants. This finding highlights pacifier use as a marker for early weaning, aiding health workers in identifying mothers needing breastfeeding support.
Area of Science:
- Public Health
- Pediatrics
- Maternal and Child Nutrition
Background:
- Exclusive breastfeeding is crucial for infant health, especially in vulnerable populations.
- Understanding factors influencing breastfeeding duration is vital for targeted interventions.
- Low birth weight and socioeconomic status are known risk factors for suboptimal infant feeding practices.
Purpose of the Study:
- To investigate the association between pacifier use and the duration of exclusive breastfeeding.
- To examine this relationship in a cohort of low-income infants with unfavorable birth weight in Brazil.
- To identify potential implications for public health interventions aimed at promoting breastfeeding.
Main Methods:
- A prospective cohort study followed 500 infants from birth to six months.
- Infants were selected based on unfavorable birth weight (<3,000g) and exclusive breastfeeding status.
- Pacifier use was assessed at one and six months, with survival analysis and Cox Proportional Hazard Model used for data analysis.
Main Results:
- Approximately 60% of infants used pacifiers by one month of age.
- Pacifier users breastfed exclusively for an average of 125.3 days, compared to 87.0 days for non-users (p=0.0001).
- Pacifier use increased the likelihood of stopping exclusive breastfeeding by six months by 1.9 times, even after adjusting for confounders.
Conclusions:
- Pacifier use is significantly associated with early cessation of exclusive breastfeeding in the studied population.
- Pacifier use can serve as an indicator for early weaning.
- Health workers can utilize this marker to identify mothers requiring additional support and counseling to sustain breastfeeding practices.
Objective:
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.
Method:
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.
Results:
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.
Conclusion:
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.