The Baby Friendly Initiative exists to support health care facilities to implement best practice standards for breastfeeding. Breastfeeding is an important public health issue and its impact on the health of mothers and babies has been well documented. A recent review of the impact of breastfeeding in the developed world has also confirmed that breastfeeding is associated with a reduction in the incidence of sudden infant death syndrome (1). It is therefore crucial that health professionals ensure that mothers are provided with information and support which will enable them to initiate and continue to breastfeed for as long as possible.

Dummy use has been negatively associated with both duration and exclusivity of breastfeeding (2) and therefore the standards for Step 9 of the 'Ten Steps to Successful Breastfeeding' and Point 4 of the 'Seven Point Plan for the Protection, Promotion and Support of Breastfeeding in Community Health Care Settings' state that all breastfeeding mothers should be discouraged from using teats and dummies during the establishment of breastfeeding.

Research has shown that the mechanism used to suck on a dummy differs from how a baby feeds on the breast. Sucking on a dummy can therefore interfere with a baby’s ability to breastfeed effectively during the crucial early weeks when breastfeeding is being established (3, 4, 5). Dummy use can also interfere with demand feeding if mothers misinterpret feeding cues and use a dummy to settle or pacify their baby rather than offering a breastfeed (6, 7). Frequent baby led feeding is essential to establish and maintain a good milk supply and anything which interferes with this will result in less than optimal lactation. As insufficient milk is the most common reason cited by women for stopping breastfeeding earlier than they would have wanted (8) it is essential that information provided for mothers will enable them to continue to breastfeed for as long as they choose.

The Baby Friendly Initiative recognizes the dilemma which health professionals may face when discussing this issue with mothers given the apparently contradictory nature of the evidence. We would however, maintain our usual position that mothers require effective information in order that they can make a fully informed choice with regards to dummy use.

In addition to the preceding information, the following points may be useful when discussing this issue with mothers:

1. The Foundation for the Study of Infant Death guidance states that dummies should not be used by  breastfeeding babies for the first four weeks in order to allow for breastfeeding to become established. Experience has shown that a small minority of babies may require longer to establish breastfeeding, and health professionals should therefore monitor this on an individual basis.
2. Babies who are successfully breastfeeding at four weeks of age may refuse to accept a dummy and mothers should be reassured that this is common. It is important not to force a baby to take a dummy but to reiterate the importance of continued breastfeeding as a means of protecting the health and well being of the baby.
3. Mothers who have made a decision to use a dummy after breastfeeding has been established should be advised to use the dummy only when settling the baby to sleep. Teaching mothers to recognize feeding cues and discussing the importance of not replacing breastfeeds with dummy use will help ensure maintenance of a good milk supply.

References

1. Ip S et al (2007) Breastfeeding and Maternal Health Outcomes in Developed Countries. AHRQ Publication. No. 07-E007.
2. Joanna Briggs Institute (2006) Early childhood pacifier use in relation to breastfeeding, SIDS, infection and dental malocclusion. Nursing Standard, 20(38):52-55.
3. Righard L, Alade MO (1997) Breastfeeding and the use of pacifiers. Birth, 2:116-120.
4. Woolridge M (1986a) The ‘anatomy’ of infant sucking, Midwifery, 2(4):164-171.
5. Nowak AJ, Smith WL, Erenberg A, (1994) Imaging evaluation of artificial nipples during bottle feeding. Archives of pediatrics and adolescent medicine, 148:40-42.
6. Victora CG et al (1997) Pacifier use and short breastfeeding duration: cause, consequence or coincidence? Pediatrics, 99(3):445-453.
7. Barros FC et al (1995a) Use of pacifiers is associated with decreased breastfeeding duration. Pediatrics, 95(4):497-499.
8. Bolling K et al (2007) Infant Feeding Survey 2005. The Information Centre. NHS.