Pacifiers and breastfeeding: a systematic review

Arch Pediatr Adolesc Med. 2009 Apr;163(4):378-82. doi: 10.1001/archpediatrics.2008.578.


Objective: To summarize current evidence on the association between infant pacifier use and breastfeeding.

Data sources: MEDLINE, CINAHL, the Cochrane Library, EMBASE, POPLINE, and bibliographies of identified articles.

Study selection: A search for English-language records (from January 1950 through August 2006) containing the Medical Subject Heading terms pacifiers and breastfeeding was conducted, resulting in 1098 reports. Duplicate and irrelevant studies were excluded, yielding 29 studies that fit inclusion criteria for the review (4 randomized controlled trials, 20 cohort studies, and 5 cross-sectional studies). Two independent reviewers abstracted data and scored these studies for quality; disagreements were settled through consensus with a third investigator.

Main exposure: Pacifier use.

Main outcome measures: Breastfeeding duration or exclusivity.

Results: Results from 4 randomized controlled trials revealed no difference in breastfeeding outcomes with different pacifier interventions (pacifier use during tube feeds, pacifier use at any time after delivery, an educational program for mothers emphasizing avoidance of pacifiers, and a UNICEF [United Nations Children's Fund]/World Health Organization Baby Friendly Hospital environment). Most observational studies reported an association between pacifier use and shortened duration of breastfeeding.

Conclusions: The highest level of evidence does not support an adverse relationship between pacifier use and breastfeeding duration or exclusivity. The association between shortened duration of breastfeeding and pacifier use in observational studies likely reflects a number of other complex factors, such as breastfeeding difficulties or intent to wean. Ongoing quantitative and qualitative research is needed to better understand the relationship between pacifier use and breastfeeding.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Breast Feeding / psychology
  • Breast Feeding / statistics & numerical data*
  • Feeding Behavior
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Infant Behavior
  • Infant, Newborn
  • Male
  • Pacifiers / adverse effects
  • Pacifiers / statistics & numerical data*
  • Pediatrics / standards
  • Pediatrics / trends
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Sucking Behavior / physiology*
  • Time Factors
  • United States
  • Weaning