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Pacifier use and short breastfeeding duration: cause, consequence, or coincidence?
C G Victora1, D P Behague, F C Barros
1Departamento de Medicina Social, Universidade Federal de Pelotas, Brazil.
Pediatrics
|March 1, 1997
Summary
Pacifier use is linked to shorter breastfeeding duration, especially for mothers lacking confidence. Interventions must address breastfeeding challenges and maternal anxieties, not just pacifier reduction.
Area of Science:
- Public Health
- Maternal and Child Health
- Human Lactation
Background:
- Pacifier use is associated with reduced breastfeeding duration, but causality is debated due to confounding factors.
- Investigating the relationship between pacifier use and breastfeeding requires addressing potential biases like reverse causality and self-selection.
Purpose of the Study:
- To investigate the causal relationship between pacifier use and breastfeeding duration.
- To explore the role of maternal confidence and breastfeeding challenges in this association.
Main Methods:
- A combined epidemiologic and ethnographic study in southern Brazil.
- Population-based cohort (650 mothers/infants) with follow-up at 1, 3, and 6 months.
- In-depth interviews and observations with a subsample (80 mothers/infants).
Main Results:
- Pacifier use was common (85% at 1 month) and dynamic.
- Intense pacifier use at 1 month was associated with a fourfold increased likelihood of stopping breastfeeding by 6 months.
- Ethnographic data revealed pacifiers used as weaning aids, particularly by mothers with breastfeeding difficulties and low confidence.
Conclusions:
- Pacifiers can act as weaning mechanisms for mothers facing breastfeeding challenges.
- Effect on breastfeeding duration is less pronounced in confident mothers.
- Effective breastfeeding promotion requires addressing maternal anxieties and breastfeeding difficulties, not solely pacifier reduction.