While pacifiers have been found from as early as 1000 BC, the United Nations and the World Health Organization seem to know better than millennia of parents-or do they?
In the early part of the last century, the infant welfare movement sought to condemn pacifier use, and, "avoidance of pacifiers constitutes step 9 of the World Health Organization/United Nations Children's Fund Baby-friendly Hospital Initiative." However, the reasoning used to justify such positions has been based upon observational studies, not randomized experimental research. The authors of a new report, published in the Journal of the American Medical Association, have purposed to conduct just that sort of controlled research in order to determine what effect pacifiers actually do have. Along the way, the researchers, from McGill University, discover some insights into the nature of research schemes.
The experiment involved a program to persuade mothers to not use pacifiers. 38.6% of mothers in the experimental group totally avoided using pacifiers, while only 16% abstained in the control group, and daily use of pacifiers among the experimental group vs. the control group was also substantially reduced-by 30%.
"[C]linicians and public health practitioners have raised concerns that the pacifier causes 'nipple confusion' and thereby leads to early weaning," state the authors. In fact, early weaning, defined as weaning within the first three months, was no less common for children in the experimental group (18.9%) than in the control group (18.3%; RR, 1.0; 95% CI, 0.6-1.7). "The results for exclusive breastfeeding were similar: 63.8% of infants in the experimental group had discontinued exclusive breastfeeding by age 3 months vs. 66.4% of those in the control group (RR, 1.0; 95% CI, 0.8-1.1)."
Interestingly, in observational analyses, 25% of infants who were given a pacifier on a daily basis were seen to be weaned before three months, compared to only 12.9% of those infants who did not (RR, 1.9; 95% CI, 1.1-3.3). The authors note: "We found a strong observational association between pacifier use and early weaning. No such association was observed, however, when our data were analyzed by randomized allocation, strongly suggesting that pacifier use is a marker of breastfeeding difficulties or reduced motivation to breastfeed, rather than a true cause of early weaning." Furthermore, "No physiological evidence has validated the concept of nipple confusion; an infant can apparently distinguish nutritive from non-nutritive sucking."
On the other hand, when evaluating the effectiveness of pacifier use in calming an infant, the researchers, while finding "no evidence that pacifier use is harmful for breastfeeding, also detected no beneficial effects on infant crying and fussing." Therefore, other (non-pacifier) soothing methods appear to be perfectly justified.
The researchers also question the validity of observational studies, particularly in behavioral assessments, in this case leading to "residual confounding and reverse causality bias," which need to be corrected for by "the bias reduction provided by randomized trials."
In the end, the McGill researchers advise, "the absence of a causal link between pacifier use and early weaning should lead breastfeeding programs and international agencies to reexamine their stanch opposition to pacifiers." In other words, let parents, not the U.N. and WHO, do the parenting.
