To the Editor.
Increasing breastfeeding rates has long been advocated as a
method of improving maternal and child health in both developed and
developing countries. In the United States, breastfeeding duration
rates remain low, particularly among low-income and minority women.1 Better understanding factors related to
breastfeeding duration can help improved breastfeeding education,
support, and, ultimately, rates among target populations.
Many factors related to breastfeeding duration have been cited in the
literature.2 However, limited information exists concerning modifiable factors such as pacifier use.3-6 Recent studies suggest that pacifier use is associated with shorter breastfeeding duration and with lactation difficulties,3,4 although research remains inconclusive.5,6 This study
sought to examine the relationship between pacifier use and
breastfeeding duration and problems among low-income, predominantly minority women.
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METHODS |
A convenience sample of 129 low-income breastfeeding women who
delivered in a southeastern US public hospital was followed prospectively. Only women for whom data on pacifier use were available and who provided data through breastfeeding termination were included in the study. Seventy-eight percent of the women were black and 18%
were Hispanic. Most of the women (84%) were enrolled in the Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC).
As part of routine postpartum breastfeeding support, periodic telephone
contacts were made with the women from within 1 week postpartum until
breastfeeding ended.
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RESULTS |
Mean breastfeeding duration was 3.6 ± 3.8 months (range:
<1 month-28 months). Lactation difficulties reported by the women included sore nipples (44%; 56/126), engorgement (35%; 44/126), and
inadequate breastmilk supply (35%; 39/111). Approximately 54%
(70/129) of women reported giving pacifiers to their breastfed infants.
Pacifier use was negatively associated with length of breastfeeding
(r = 
0.43, P < .01; Kruskall-Wallace
H[1,127] = 24.2, P < .000001). Infants who used
pacifiers were 8.7 times more likely to stop breastfeeding before age 6 months compared with infants not given pacifiers (95% confidence
interval [CI]: 3.1-25.0; P < .000001). Women who
gave their infants pacifiers were also significantly more likely to
report experiencing sore nipples (r = 0.14, P < .05) and having an insufficient breastmilk supply (r = 0.22, P < .05), although these findings were of low
magnitude. No association was found between infant pacifier use and
maternal report of engorgement. After controlling for infant
gestational age at birth and for maternal marital status, age,
educational level, and enrollment on the WIC Program, multiple linear
regression analyses showed that pacifier use remained significantly
independently associated with shorter breastfeeding duration.
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COMMENTS |
Pacifier use is associated with shorter overall breastfeeding
duration, breastfeeding termination before age 6 months, and lactation
difficulties such as sore nipples and insufficient breast milk supply.
These findings are consistent with research conducted among other
populations.3,4
Pacifier use may not be causally related to decreased breastfeeding
duration but can potentially serve as an indicator of impending weaning
or breastfeeding difficulties. These findings suggest that mothers who
report introducing pacifiers to their breastfed infants should be
referred to a lactation consultant for assessment and counseling.
| |
ACKNOWLEDGMENT |
I would like to thank Mary Nicholson-Jackson for her assistance.
