Kaplan - Meier and Cox proportional hazards survival analyses were used in unadjusted and adjusted analyses of the effect of pacifier
use on breastfeeding duration.19 Logistic regression modeling was used to evaluate the effect of pacifier timing on breastfeeding duration.20 Significance levels were not adjusted for multiple comparisons.
The purpose of this analysis was to evaluate the effects of pacifier
use on breastfeeding duration in a cohort of US mother — infant dyads and the influence that timing of pacifier introduction exerts on any associated declines in breastfeeding duration.
Randomised trial of sidecar crib
use on breastfeeding duration (NECOT).
Not exact matches
Our
use of observational data reflects the existing literature
on lactation and maternal health; apart from a single randomized trial examining the effect of exclusive lactation
duration on maternal weight loss, 48 there are no published studies of maternal health outcomes in randomized trials of
breastfeeding.
Most studies have revealed protective effects of
breastfeeding on common infections in the first 8 to12 months of life.8, 27,29,30 One study, which distinguished between infectious diseases until and from the age of 6 months, revealed results similar to those from our study.24 Although the authors
used exclusive
breastfeeding for 3 months as the reference group, exclusive
breastfeeding for 6 months reduced the risk of gastrointestinal tract infections between the ages of 3 and 6 months but not between the ages of 6 and 12 months.24 We can not explain why
breastfeeding duration was only associated with lower risks of lower respiratory tract infection from 7 to 12 months.
We assumed that
breastfeeding rates were correlated between pregnancies based
on several sources of observational data18, 19 and
used data from the Infant Feeding Practices Study II to model
breastfeeding duration in a subsequent pregnancy contingent
on duration of
breastfeeding for the prior birth.19
We
used data from a large cluster - randomized trial to assess the impact of a
breastfeeding promotion intervention
on socioeconomic inequalities in
breastfeeding (exclusivity and
duration) and in child cognitive ability at early school age.
In particular,
breastfeeding may be of concern because it has been shown to be associated with both child's
use of antibiotics36, 37 and cow's milk allergy, although inconsistently so.38 In a large Finnish birth cohort, the median
durations of exclusive and total
breastfeeding were 1.4 months and 7.0 months, respectively, and the proportion of
breastfed infants decreased from 95 % at the age of 1 month to 58 % at the age of 6 months.39 Another limitation is our reliance
on pharmacy records, which provides only a rough estimation of drug
use.
The effect of the timing of pacifier introduction (≤ 2 weeks and ≤ 6 weeks)
on breastfeeding duration at 2 and 3 months was evaluated
using logistic regression modeling.
Although pacifier
use is common in developed countries, 14 there are no published reports of the effects of pacifier
use on the
duration of
breastfeeding in a cohort of US mothers and infants.
The timing of pacifier introduction
on breastfeeding was evaluated by
using logistic regression modeling to predict
breastfeeding duration to 2 and 3 months» postpartum.
Breastfeeding terms and definitions
used in this study are modifications of those recommended by The Interagency Group for Action
on Breastfeeding.21
Breastfeeding duration is defined by the following categories 1) full and 2) overall.
Some barriers include the negative attitudes of women and their partners and family members, as well as health care professionals, toward
breastfeeding, whereas the main reasons that women do not start or give up
breastfeeding are reported to be poor family and social support, perceived milk insufficiency, breast problems, maternal or infant illness, and return to outside employment.2 Several strategies have been
used to promote
breastfeeding, such as setting standards for maternity services3, 4 (eg, the joint World Health Organization — United Nations Children's Fund [WHO - UNICEF] Baby Friendly Initiative), public education through media campaigns, and health professionals and peer - led initiatives to support individual mothers.5 — 9 Support from the infant's father through active participation in the
breastfeeding decision, together with a positive attitude and knowledge about the benefits of
breastfeeding, has been shown to have a strong influence
on the initiation and
duration of
breastfeeding in observational studies, 2,10 but scientific evidence is not available as to whether training fathers to manage the most common lactation difficulties can enhance
breastfeeding rates.
In addition, there was no effect
on breastfeeding duration when the pacifier was introduced at 1 month of age.280 A more recent systematic review found that the highest level of evidence (ie, from clinical trials) does not support an adverse relationship between pacifier
use and
breastfeeding duration or exclusivity.281 The association between shortened
duration of
breastfeeding and pacifier
use in observational studies likely reflects a number of complex factors such as
breastfeeding difficulties or intent to wean.281 A large multicenter, randomized controlled trial of 1021 mothers who were highly motivated to
breastfeed were assigned to 2 groups: mothers advised to offer a pacifier after 15 days and mothers advised not to offer a pacifier.
Although some SIDS experts and policy - makers endorse pacifier
use recommendations that are similar to those of the AAP, 272,273 concerns about possible deleterious effects of pacifier
use have prevented others from making a recommendation for pacifier
use as a risk reduction strategy.274 Although several observational studies275, — , 277 have found a correlation between pacifiers and reduced
breastfeeding duration, the results of well - designed randomized clinical trials indicated that pacifiers do not seem to cause shortened
breastfeeding duration for term and preterm infants.278, 279 The authors of 1 study reported a small deleterious effect of early pacifier introduction (2 — 5 days after birth)
on exclusive
breastfeeding at 1 month of age and
on overall
breastfeeding duration (defined as any
breastfeeding), but early pacifier
use did not adversely affect exclusive
breastfeeding duration.
Consideration is not always given to the effects of
breastfeeding duration or the
use of combined feeding methods
on later psychosocial outcomes.
Radiation therapy may also require an interruption in
breastfeeding, depending
on the type of radiation
used and the
duration of treatment.