Impact of a Baby-Friendly-Aligned Pacifier Policy on Pacifier Use at 1 Month of Age

Maheswari Ekambaram; Matilde M Irigoyen; Andrew Paoletti; Iqra Siddiqui

doi:10.1016/j.acap.2019.02.002

Impact of a Baby-Friendly-Aligned Pacifier Policy on Pacifier Use at 1 Month of Age

Acad Pediatr. 2019 Sep-Oct;19(7):808-814. doi: 10.1016/j.acap.2019.02.002. Epub 2019 Feb 14.

Authors

Maheswari Ekambaram¹, Matilde M Irigoyen², Andrew Paoletti¹, Iqra Siddiqui¹

Affiliations

¹ Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Penn Dr. Ekambaram is now with Baylor Scott & White Medical Center, Round Rock, Tex.
² Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Penn Dr. Ekambaram is now with Baylor Scott & White Medical Center, Round Rock, Tex. Electronic address: irigoyem@einstein.edu.

PMID: 30772504
DOI: 10.1016/j.acap.2019.02.002

Abstract

Objective: Pacifier use decreases the risk of sudden infant death syndrome, but its impact on breastfeeding remains controversial. We evaluated the impact of a pacifier policy aligned with the World Health Organization and United Nations Children's Fund Baby-Friendly Hospital Initiative on subsequent pacifier use and breastfeeding at 1 month of age.

Methods: We conducted a prospective 2-stage (pre- and post-implementation) cohort study of newborns at a birth hospital before and after implementation of a Baby-Friendly-aligned pacifier policy. Consecutive mothers of newborns admitted to the nursery participated in a telephone survey when the infants were 1 month of age.

Results: In total, 342 mothers participated (190 before and 152 after implementation of the policy). Pacifier adoption was delayed in the post-implementation group, but pacifier use by 1 month of age was comparable (78.9% pre-implementation vs 77.6% post-implementation; P = .793). In the pre-implementation group, female and male infants used pacifiers at comparable rates; however, in the post-implementation group, females were significantly less likely to use a pacifier compared to males after controlling for insurance, race, parity, and delivery mode (adjusted odds ratio, 0.35; 95% confidence interval, 0.15-0.83; P = .02). In the post-implementation group, exclusive breastfeeding rates at discharge increased significantly (from 40% to 51.3%; P = .04), but rates were not different at 1 month (23.7% pre-implementation vs 24.3% post-implementation; P = .89).

Conclusion: A Baby-Friendly-aligned pacifier policy delayed pacifier adoption but did not impact overall pacifier use or breastfeeding rates at 1 month of age. The finding of lower pacifier use rates among female infants post-intervention requires verification in other populations before evaluating public heath relevance.

Keywords: Baby-Friendly; breastfeeding; newborns; pacifier; sudden infant death syndrome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Age Factors
Breast Feeding*
Cohort Studies
Female
Health Policy*
Humans
Infant
Infant, Newborn
Male
Pacifiers*
Sudden Infant Death / prevention & control*