TUESDAY, March 4, 2003 (HealthDayNews) -- If new parents can hold off giving their newborn a pacifier for at least the first month, the baby will be more likely to breast-feed exclusively and for a longer period of time.
That's the conclusion of a new study that, for the first time, finds pacifier use has an impact on breast-feeding. The research also found early bottle feeding or cup-sipping will also cut breast-feeding short.
"Hold off for a month; your baby will do better," says Dr. Cynthia R. Howard, study author and the pediatric director of the Mother-Baby Unit at Rochester General Hospital.
Whether used early or late, pacifiers didn't cause such health problems as a baby's refusal to nurse, low milk production in the mother, jaundice or slow weight gain, as some experts have contended they might. The Rochester study, published in the March issue of Pediatrics, says that in the first six months after a baby is born, pacifiers make no difference in the number of these kinds of problems that crop up.
However, the study does counter two earlier studies that found pacifiers had no effect on how long a baby breast-fed.
The researchers looked at 700 breast-fed newborns delivered between 1997 and 1998 at the Rochester General Hospital in New York. They were split into four groups: those given pacifiers early and fed with bottles; those fed by bottle and given pacifiers later; those fed by cup and given pacifiers early; and those fed by cup and given pacifiers later. The researchers checked on the mother-baby pairs seven times during the year after the babies were born.
Babies who used a pacifier within the first week or so of life tended to be breast-fed about 140 days; those given a pacifier when they were about a month old tended to be breast-fed for about 163 days. Babies given bottles early on tended to be breast-fed about 140 days; those fed by cup early on tended to be breast-fed about 105 days.
One of the flaws in the study was that none of the parents would agree to totally abstain from using a pacifier, so there was no control group, says Howard. "It's a practical trial in that sense," she adds. Nearly all the babies were using pacifiers by 6 weeks of age. One reason: babies' crying really increases over that time, Howard says.
Pacifiers may be all right for babies that are totally bottle-fed, says Dr. Naomi Baumslag, pediatrician and advisor on the Health Council of La Leche League International. "[But] they're a no-no for breast-fed babies." She believes they interfere with breast-feeding the entire time, they may introduce infections and they may even harm the baby's mouth.
Despite finding pacifiers to be relatively harmless, the study authors still endorse guidelines that warn mothers to avoid pacifiers. Exclusive breast-feeding reduces fertility and cuts the baby's risk of ear infections and diarrhea, making the practice especially important in poor countries, where birth control, clean water, healthy food and medical care may not be common.
As in most things, there are exceptions.
"Pacifiers are really beneficial if it's a pre-term baby," says Carol Huotari, manager for La Leche's Center for Breast-feeding Information. It helps strengthen the muscles they use for sucking, she explains.
Other findings in the study: Feeding a baby formula or sugar water or other supplements while the mother and baby are still in the hospital, either from a cup or a bottle, shortened the time a mother breast-fed her baby. "It was a very highly significant predictor," Howard says.
Women who delivered by Caesarian didn't follow this pattern. Those who let their babies sip formula from a cup, breast-fed their babies up to 10 weeks longer than the other women in the trial, and the Caesarian group breast-fed them exclusively about 10 days longer than the other women.
The critical point seemed to be when the babies had at least two feedings by bottle or cup while in the hospital in the first week or so after they were born, Howard says. "We had this huge difference for overall breast-feeding duration. What struck me was, on average, their babies got twice as many supplements as babies delivered vaginally."
Why the difference? It's not just one experience with the bottle or cup that causes a problem but many experiences, Howard says.
The study is well-designed, but has to be repeated by others before the results are solid, says Dr. Nicholas Cunningham, emeritus professor of clinical pediatrics and clinical public health at Columbia University and attending pediatrician at Children's Hospital of New York-Presbyterian.
One possible problem: Rochester General is one of the finest hospitals in the country when it comes to breast-feeding support, Cunningham says, so that something not considered a problem there might be a problem at a other places.
Cunningham urges his patients not to automatically reach for the pacifier but to pick up the baby when it cries and try comforting actions such as singing and talking to the baby, holding it, rocking it and other intimate activity.
Both Baumslag and Cunningham cite their extensive experiences in Africa as a cue for Western behavior: In Africa there are no pacifiers, but there is almost constant skin-to-skin contact with the mother or other relatives, and there are no problems with breast-feeding, thumb sucking or other comfort-seeking behavior.
More information
Check out what the American Academy of Pediatrics has to say on thumb sucking and pacifiers. Or take a look at what La Leche League has to say about pacifiers.
