Pacifiers certainly receive a bad rap from breastfeeding advocates, but have legitimate concerns about possible deleterious effects been transformed into dogma without adequate scientific validation? In several recent reports from various countries, pacifiers have been associated with fewer breast feeds per day and a shorter duration of both exclusive and total breastfeeding. However, are pacifiers the real culprits or are they innocent bystanders? Are we mistaking the association of pacifier use with undesirable outcomes for direct causation of those outcomes? Is pacifier use only a marker for other factors such as maternal intention or behavior that result in both pacifier use and early weaning? Other questions also come to mind. Does the timing of pacifier introduction matter? Does the amount of pacifier use make a difference? Since pacifiers are ubiquitous in our culture, these are important questions to answer in order to most effectively focus our resources on breastfeeding promotion.

smoking, birth weight, and gender on breastfeeding outcomes. Both had excellent follow-up rates (> 90%). In the first study, Vogel² prospectively followed a cohort of 350 mothers and their infants in New Zealand until one year of age to determine the impact of pacifier use on the duration of breastfeeding. The median age of weaning was 7.6 months; 44% were exclusively breastfeeding at 3 months. Although 47% of all mothers stated immediately after delivery that they did not intend to use pacifiers, 79% of mothers did so, most within the first month and half on a daily basis. Regular, daily pacifier use, but not less frequent use, was associated with a shorter duration of exclusive breastfeeding and earlier weaning. For infants with daily use, pacifiers were introduced earlier (66% at < 2 weeks of age). Daily pacifier use was predicted by the infant being male, maternal smoking and low maternal confidence with breastfeeding.

In the second study, ¹ Kramer, et al enrolled 281 Canadian mothers and their infants in a randomized, controlled, intervention trial to examine the effect of pacifier use on early weaning and infant crying behavior during the first 3 months after birth. Half of the mothers were counseled to offer the breast rather than a pacifier when their infant cried or fussed. Although counseling did reduce any pacifier use (39% - 16%) as well as daily pacifier use (56% - 41%), the rates of exclusive breastfeeding and weaning (19% vs 18%)