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

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 1month (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.