The effects of early pacifier use on breastfeeding duration

Objective. To evaluate the effects of pacifier use and the timing of pacifi er introduction on breastfeeding duration, problems, and frequency. Methods. A cohort of 265 breastfeeding mother-infant dyads was followed pro spectively. Maternal interviews were conducted at delivery, 2, 6, 12, and 2 4 weeks, and thereafter every 90 days until breastfeeding ended. Informatio n was obtained regarding pacifier use, infant feeding, use of supplemental foods and breastfeeding frequency, duration, and problems. The effect of pa cifier introduction by 6 weeks of age on breastfeeding duration was evaluat ed with Kaplan-Meier and Cox proportional hazards models. The effect of the timing of pacifier introduction (less than or equal to 2 weeks and less th an or equal to 6 weeks) on breastfeeding duration at 2 and 3 months was eva luated using logistic regression modeling. Results. A total of 181 mothers (68%) introduced a pacifier before 6 weeks. In adjusted analyses, pacifier introduction by 6 weeks was associated with a significantly increased risk for shortened duration of full (hazard rati o, 1.53; 95% confidence interval: 1.15, 2.05) and overall (hazard ratio, 1. 61; 95% confidence interval: 1.19,2.19) breastfeeding. Women who introduced pacifiers tended to breastfeed their infants fewer times per day, with sig nificant differences noted at 2 (8.1 +/- 2.6 vs 9.0 +/- 2.3) and 12 weeks' (6.3 +/- 2.0 vs 7.4 +/- 1.6) postpartum. At 12 weeks postpartum, women who introduced pacifiers also were more likely to report that breastfeeding was inconvenient and that they had insufficient milk supplies. Pacifier use be gun either before 2 weeks or before 6 weeks' postpartum was not significant ly associated with breastfeeding duration at 2 and 3 months. Conclusions. Pacifier use was independently associated with significant dec lines in the duration of full and overall breastfeeding. Breastfeeding dura tion in the first 3 months' postpartum, however, was unaffected by pacifier use. Women who introduced pacifiers tended to breastfeed their infants les s frequently and experienced breastfeeding problems consistent with infrequ ent feeding. Findings from this study suggest that the decreases in breastf eeding duration associated with pacifier use may be a consequence of less f requent breastfeeding among women who introduce pacifiers to their infants.