To review all data on the association of pacifier use with breastfeeding, sudden infant death syndrome, infection and dental malocclusion among full-term healthy infants and young children.

• Studies with healthy full-term infants and healthy children up to 16 years
• Randomized controlled intervention, cohort or case-control studies
• Studies must provide effect estimate of the association
• Must report pacifier use in relation to one of the following:
  • Breastfeeding
  • SIDS
  • Infection
  • Dental malocclusion.
• Reports published in English, Spanish or German between January 1960 and October 2003.

• Studies that looked at pre-term infants or infants and children with severe illness or congenital malformation
• Cross-sectional studies or studies that did not meet the requirement of appropriate temporal sequencing
• Studies that examined pacifier use and procedural pain or gastro-esophageal reflux.

Search Strategy 

Searches were done in the following sources:

• Literature databases searched include: Medline, Cochrane Library, Embase, Current Contents, Pubmed, DARE, CINAHL, PsycINFO, Best Evidence, TRIP, CenterWatch, Expanded Academic Index, Australian Medical Index, ERIC and Austrom  
• Citation search using Science Citation Index
• Evidence-based guidelines: Trawling the Net, Netting the Evidence, Agency for Health Research Quality
• Government documents: "Eat Well Australia", "Dietary Guidelines for children and Adolescents in Australia Incorporating the Infant Feeding Guidelines for Health Workers"
• Books: WHO reports "The Innocenti Declaration: Progress and Achievements" and "The Baby-friendly Hospital Initiative. Monitoring and Reassessment: Tools to Sustain Progress."
• Professional websites: Australian Breastfeeding Association, La Leche League, Lactnet, BMJ-Pediatrics, MD Consult, American Dental Association
• National associations: The Australian Breastfeeding Association, the College of Lactation Consultants, the International Lactation Consultants Association
• Hand search on reference lists of relevant articles
• Consult with area experts
• Google and Yahoo.

Search terms: Dummy, dummies, pacifier(s), soother(s), comforter(s), non-nutritive sucking, infant, child, infant care.

Screening done by pairs of not-masked principal investigators. 

Design

A systematic review.

Information collected includes:

• Authors and setting
• Design
• Exposure and outcome
• Confounders controlled
• Analysis
• Main findings.

Methodological quality assessment done by groups of at least three investigators.

Unclear how many investigators participated in data collection.

For the review of pacifier use and breastfeeding only

• Total number of studies identified from the search: Not reported
• Number of studies included after "initial review": 59
• Number of studies included after "intensive critique": 32
• Number of studies included after "final review": 10
• Locations:
  • Brazil (two studies)
  • Sweden (one study)
  • USA (three studies)
  • Italy (one study)
  • Canada (one study)
  • New Zealand (one study)
  • Australia (one study).

[Note that "initial review", "intensive critique" and "final review" are not defined].

Quality Assessment

Methodological quality of included studies was assessed independently by groups of three or more principal investigators and clinicians using a checklist. All studies that were accepted met minimum set criteria.

Other Findings

• All but one study found that pacifier use decreases breastfeeding duration or exclusivity, although infrequent pacifier use may have little impact
• Definition of breastfeeding and pacifier use varied among different studies
• There may be differential loss to follow-up. There may be higher loss in higher SES population.

It is plausible that pacifier use causes babies to breast-feed less, but a causal relationship has not been irrefutably proven.

This article is not indexed on Pubmed; therefore no Pubmed ID.