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Beginnings Guides Blog

Pacifiers protect against SIDS, but what about breastfeeding?

The home visitors at Aspiranet Welcome Home Baby Program and their
supervisor, Odessa Caton sent in two questions about the recent Bulletin
Blog alerting Beginnings Guides user’s to findings that use of a pacifier
reduces the risk of SIDS up to 90%. They ask, Does the pacifier
recommendation apply to breast fed and bottle fed babies? Does
the research still indicate that pacifiers are barriers to breastfeeding?
The short answers: Yes. No.
 
Pacifiers, SIDS & Breastfeeding
The World Health Organization’s Ten Steps to Successful Breastfeeding
recommends against any pacifier use for breastfeeding infants. Another
BG Bulletin reader, Cathy Morris of the Heart of Georgia Healthy Start
Coalition, suggests waiting one month before offering a pacifier to a
breastfeeding baby in order to firmly establish breastfeeding.  Both of
these advisories are supported by a number of studies linking pacifiers
to reduced breastfeeding. And they illustrate the ongoing controversy
fueled in part by a few studies that have found pacifier use promotes or
supports breastfeeding, and in part by competing goals of promoting
breastfeeding and protecting against SIDS.  None of the reported studies
is able to tell if pacifier use is a signal of breastfeeding difficulties leading
to early weaning, or the cause of such difficulties.  There is some new,
perhaps more definitive research.
 
New Findings
A 2012 Cochrane Review of more recent and stronger evidence from
randomized trials reached this opposing conclusion: For mothers who are
motivated to breastfeed their infants, pacifier use before or after
breastfeeding was established did not significantly affect the prevalence
or duration of exclusive or partial breastfeeding for up to four months of age
The authors warn that this finding may not apply to mothers who are less
motivated; so the chicken-or-egg question about pacifiers and early weaning
remains.
 
At least one author contends the Review is severely flawed. So the longer,
final answers to these good questions depend on who you ask and how you
interpret the evidence.
 
Editors’ Conclusion
SIDS is rare before age one month, (highest risk is 2-4 months); so there is
little risk in waiting to offer a pacifier to a breastfeeding baby. Recent
research on the highly protective value of pacifiers, along with new evidence
that pacifiers interfere with breastfeeding less than previously believed
warrants a recommendation to offer a pacifier to both breast fed and
formula fed babies at all sleep times during the SIDS risk period
(age 1 to 6 months). You’ll see the change in the new 2012 edition
of Beginnings Parents Guide.  And I’ll be watching to see what WHO has
to say about the new Review. Stay tuned.
 
References
Jaafar SH, Jahanfar S, Angolkar M & Ho JJ. (2012). Pacifier use versus no
pacifier use in breastfeeding infants for increasing duration of
breastfeeding (Review). The Cochrane Collabortion. Wiley & Sons. 
Abstract free online:
 
Jenik AG & Nestor V. (2009). The pacifier debate. Early Human Development 85; S89-S91.
 
 
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