Scolaris Content Display Scolaris Content Display

Uso limitado de chupetes en recién nacidos a término que reciben lactancia para aumentar la duración de la lactancia materna

Collapse all Expand all

References

Referencias de los estudios incluidos en esta revisión

Jenik 2009 {published data only}

Jenik A. Influence of pacifiers on breastfeeding duration. ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 20 February 2008). CENTRAL
Jenik A, Vain N, Gorenstein A, Jacobi N, the Pacifier & Breastfeeding Study Group. Does the recommendation to use a pacifier influence the prevalence of breastfeeding? Results of a multicenter randomized clinical trial. Breastfeeding Medicine 2008;3(3):200. CENTRAL
Jenik AG, Vain NE, Gorestein AN, Jacobi NE, for the Pacifier and Breastfeeding Trial Group. Does the recommendation to use a pacifier influence the prevalence of breastfeeding?. Journal of Pediatrics 2009;155(3):350‐4. CENTRAL

Kramer 2001 {published data only}

Kramer MS, Barr RG, Dagenais S, Yang H, Jones P, Ciofani L, et al. Pacifier use, early weaning, and cry/fuss behavior: a randomized controlled trial. JAMA 2001;286(3):322‐6. CENTRAL
Kramer MS, Barr RG, Jane R, Yang H, Dagenais S, Jones P, et al. Pacifier use, breastfeeding, and infant CRY/FUSS behavior: a randomized trial. Pediatric Research 2000;47(4):203A. CENTRAL

Schubiger 1997 {published data only}

Kind C, Schubiger G, Schwarz U, Tonz O. Provision of supplementary fluids to breast fed infants and later breast feeding success. Advances in Experimental Medicine & Biology 2000;478:347‐54. CENTRAL
Schubiger G, Schwarz U, Tonz O. UNICEF/WHO baby‐friendly hospital initiative: Does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding?. European Journal of Pediatrics 1997;156:874‐7. CENTRAL

Referencias de los estudios excluidos de esta revisión

Collins 2004 {published data only}

Collins CT, Ryan P, Crowther CA, McPhee AJ, Paterson S, Hiller JE. Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial. BMJ 2004;329(7459):193‐8. CENTRAL

Feldens 2013 {published data only}

Feldens CA, Ardenghi TM, Cruz LN, Scalco GP, Vitolo MR. Advising mothers about breastfeeding and weaning reduced pacifier use in the first year of life: a randomized trial. Community Dentistry & Oral Epidemiology 2013;41(4):317‐26. CENTRAL

Howard 2003 {published data only}

Howard CR, Howard FM, Lanphear B, Eberly S, deBlieck EA, Oakes D, et al. Randomized clinical trial of pacifier use and bottle‐feeding or cupfeeding and their effect on breastfeeding. Pediatrics 2003;111(3):511‐8. CENTRAL

AAP 2011

Task Force on Sudden Infant Death Syndrome, Moon RY. SIDS and other sleep‐related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011;128(5):1030‐9. [PUBMED: 22007004]

Aarts 1999

Aarts C, Hornell A, Kylberg E, Hofyander Y, Gebre‐Medhin M. Breastfeeding patterns in relation to thumb sucking and pacifier use. Pediatrics 1999;104(4):e50.

Barros 1995

Barros FC, Victora CG, Semer TG, Tonioli Filho S, Tomasi E, Weiderpass E. Use of pacifiers is associated with decreased breastfeeding duration. Pediatrics 1995;95(4):497‐9.

Boccolini 2015

Boccolini CS, Lazaro de Carvalho M, Couto de Oliveira MI. Factors associated with exclusive breastfeeding in the first six months of life in Brazil: a systematic review. Revista de Saude Publica 2015;49(91):1‐15.

Caglar 2005

Caglar E, Larsson E, Andersson EM, Hauge MS, Ogaard B, Bishara S, et al. Feeding, artificial sucking habits, and malocclusion in 3‐year‐old girls in different regions of the world. Journal of Dentition in Children 2005;72(1):25‐30.

Darwazeh 1995

Darwazeh AM, Al Bashir A. Oral candidal flora in healthy infants. Journal of Oral Pathological Medicine 1995;24(8):361‐4.

Gomes 2006

Gomes CF, Trezza EM, Murade EC, Padovani CR. Surface electromyography of facial muscles during natural and artificial feeding of infants. Journal of Pediatrics 2006;82(2):85‐6.

Hauck 2005

Hauck FR, Omojokun OO, Siadaty MS. Do pacifiers reduce the risk of sudden infant death syndrome? A meta‐analysis. Pediatrics 2005;116(5):716‐23.

Hauck 2011

Hauck FR, Thompson JM, Tanabe KO, Moon RY Vennemann MM. Breastfeeding and reduced risk of sudden infant death syndrome: a meta‐analysis. Pediatrics 2011;128(1):103‐10.

Higgins 2011

Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Howard 1999

Howard CR, Howard FM, Lanphear B, DeBlieck EA, Eberly S, Lawrence RA. The effects of early pacifier use on breastfeeding duration. Pediatrics 1999;103(3):e133.

Jackson 1999

Jackson JM, Mourino AP. Pacifier use and otitis media in infants twelve months of age or younger. Pediatric Dentition 1999;21(4):255‐60.

Kair 2013

Kair LR, Kenron D, Etheredge K, Jaffe AC, Phillipi C. Pacifier restriction and exclusive breastfeeding. Pediatrics 2013;131(4):e1101‐06.

Karabulut 2009

Karabulut E, Yalcin SS, Ozdemi‐ Geyik P, Karaağaoğlu E. Effect on pacifier use on exclusive and any breastfeeding: meta‐analysis. Turkish Journal of Paediatrics 2009;51(1):35‐43.

Labbok 1990

Labbok M, Kosovec K. Towards consistency in breastfeeding definition. Studies in Family Planning 1990;21(4):226‐30.

Levi 2002

Levy SM, Slager SL, Warren JJ, Levy BT, Nowak AJ. Associations of pacifier use, digit sucking, and child care attendance with cessation of breastfeeding. Journal of Family Practice 2002;51(5):465.

Levin 1971

Levin S. Dummies. South African Medical Journal 1971;45:237‐40.

Mascarenhas 2006

Mascarenhas ML, Albernaz EP, Da Silva MB, Da Silviera RB. Prevalence of exclusive breastfeeding and its determiners in the first 3 months of life in South Brazil. Journal de Pediatria 2006;82(4):289‐94.

Neifert 1995

Neifert M, Lawrence RA, Seacat J. Nipple confusion: toward a formal definition. Journal of Pediatrics 1995;126:S125‐S129.

Neville 1988

Neville MC, Keller R, Seacat J, Lutes V, Neifert M, Casey C, et al. Studies in human lactation: milk outputs in lactating women during the onset of lactation and full lactation. American Journal of Clinical Nutrition 1988;48(6):1375‐86.

O'Connor 2009

O’Connor NR, Tanabe KO, Siadaty MS, Hauck FR. Pacifiers and breastfeeding: a systematic review. Archives of Pediatrics & Adolescent Medicine 2009;163(4):378‐82.

Pinelli 2000

Pinelli J, Symington A. How rewarding can a pacifier be? A systematic review of nonnutritive sucking in preterm infants. Neonatal Network : NN 2000;19:41‐8.

RevMan 2014 [Computer program]

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Righard 1992

Righard L, Alade MO. Sucking technique and its effect on success of breastfeeding. Birth 1992;19(4):185‐9.

Righard 1998

Righard L. Are breastfeeding problems related to incorrect breastfeeding technique and the use of pacifiers and bottles?. Birth 1998;25(1):40‐4.

Scott 2005

Scott JA, Binns CW, Oddy WH, Graham KI. Predictors of breastfeeding duration: evidence from a cohort study. Pediatrics 2005;117:e646‐e655.

Ullah 2003

Ullah S, Griffiths P. Does the use of pacifiers shorten breastfeeding duration in infants. British Journal of Community Nursing 2003;8(10):458‐63.

Victora 1997

Victora CG, Behague DP, Barros FC, Olinto MT, Weiderpass E. Pacifier use and short breastfeeding duration: cause, consequence, or coincidence?. Pediatrics 1997;99(3):445‐53.

Vogel 2001

Vogel AM, Hutchison BL, Mitchell EA. The impact of pacifier use on breastfeeding: a prospective cohort study. Journal of Paediatrics and Child Health 2001;37(1):58‐3.

WHO 1998

WHO. World Health Organization. Evidence for the Ten Steps to Successful Breastfeeding. WHO/CHD/98.9. Geneva: WHO, 1998.

Referencias de otras versiones publicadas de esta revisión

Jaafar 2011

Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database of Systematic Reviews 2011, Issue 3. [DOI: 10.1002/14651858.CD007202.pub2]

Jaafar 2012

Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database of Systematic Reviews 2012, Issue 7. [DOI: 10.1002/14651858.CD007202.pub3]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Jump to:

Jenik 2009

Methods

A multicentre, non‐inferiority, RCT. The randomisation was carried out centrally with consecutively numbered, sealed, opaque envelopes containing random‐generated numbers constructed by an independent statistician.

Participants

1021 mothers highly motivated to breastfeed their term newborns of birthweight 2500 g or more and who regained weight by 15 days postpartum, were assigned to offer or not to offer pacifiers as part of the advice given on how to comfort crying infants. Mothers with breast problems that could interfere with breastfeeding were not included in the study. The study did not state whether twins were included.

Interventions

The group offered pacifiers (n = 528) received a package containing 6 silicone pacifiers and a written guide for parents. They were also informed that other pacifiers could be use according to their preference.

The group that were not offered pacifier use (n = 493) received a guide with other alternatives for comforting a crying baby.

At the 3‐month assessment, complete data for 499 mother‐infants pairs in the group offered pacifiers and 471 in the group not offered pacifiers were available for the main outcome analysis.

Outcomes

Primary outcomes: the prevalence of exclusive breastfeeding at 3 months.

Secondary outcomes: prevalence of exclusive and any breastfeeding at specified ages and duration of any breastfeeding.

Notes

The study was carried out at 5 tertiary centres in Argentina. The author stated that the sponsor (International Children Medical Research Association, Switzerland) had no role in any part of the study. However, they acknowledge helpful advice from Peter Weiss, a consultant from a pacifier manufacturer who may be the same Peter Weiss who is the vice president of the funding body.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

It is reported that the randomisation was carried out centrally with random generation conducted by an independent statistician.

Allocation concealment (selection bias)

Low risk

Consecutively numbered, sealed opaque envelopes were used to conceal a randomly‐generated assignment. A series of 500 envelopes was given to research assistants at each participating hospital with instructions to open the envelopes in numerical sequence and to assign the dyads to the corresponding group.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Not reported.

Comment: participant binding is not feasible.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Outcome assessors were 'blinded to the group assignment'.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

4.9% (26/528) participants in 'offer pacifier' group and 4.5% (22/493) in the non‐offer pacifier group were lost to follow‐up due to various reasons.

Selective reporting (reporting bias)

Low risk

None detected.

Other bias

Low risk

None detected.

Kramer 2001

Methods

Double‐blinded RCT.

Participants

A total of 281 healthy breastfeeding women who were motivated to breastfeed and their healthy term singleton infants recruited in the immediate postpartum period prior to hospital discharge.

Interventions

Participants were randomly allocated to 1 of 2 counselling interventions provided by a research nurse trained in lactation counselling. A basic breastfeeding promotion package was included in both the intervention and control groups.

The intervention group (n = 140) were "asked to avoid pacifiers when the infant cried or fussed" and suggested alternative ways to provide comfort.

The control group (n = 141) "all options were discussed for calming an infant" including pacifier use.

Outcomes

Mothers were asked to complete a validated behaviour diary on 3 consecutive days, at 4, 6 and 9 weeks of age. Study mothers were interviewed at 3 months.

Primary outcome measures: rate of early weaning at 3 months, 72‐hour infant behaviour logs detailing frequency and duration of crying and fussing and pacifier use at 4, 6, 9 weeks.

Notes

The trial was carried out from January 1998 to August 1999 on women giving birth at the Royal Victoria Hospital, a McGill University‐affiliatted maternity hospital in Montreal, Quebec.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"Randomisation within each stratum was accomplished using computer‐generated random numbers in blocks of 4." "Women were stratified by parity and if multiparous according to whether they had breastfed previously."

Allocation concealment (selection bias)

Low risk

"The assigned allocation was contained in an opaque envelope opened by a research nurse after the consent was obtained."

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Not reported.

Comment: blinding of the participants is not feasible.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

"Study mothers were interviewed at 3 months by a research assistant who was blinded to the intervention status of the mother."

Incomplete outcome data (attrition bias)
All outcomes

Low risk

8.2% (23/281) participants, i.e. 13/140 from pacifier‐avoidance group, 10/141 from pacifier‐advised group lost to follow‐up and did not complete the trial.

Selective reporting (reporting bias)

Low risk

None detected.

Other bias

Low risk

None detected.

Schubiger 1997

Methods

Multicentre prospective randomised trial (from 10 centres).

Participants

A total of 602 healthy full‐term infants (> 37 weeks of gestation, birthweight 2750 g to 4200 g) of mothers who intended to stay in the hospital for 5 days postpartum and planned to breastfeed for more than 3 months. The study did not state whether twins were included.

Interventions

UNICEF group (n = 294): "bottles, teats and pacifiers were strictly forbidden"; "supplements if medically indicated were administered by cup or spoon".

Standard group (n = 308): "pacifiers were offered to all infants without restriction. Supplements were conventionally offered by bottle after breastfeeding".

In both groups, the fluid supplements during the first few days consisted of a 10% dextrin‐maltose solution. Fluid supplements were considered to be medically indicated in the following situations: babies agitated or screaming after breastfeeding; signs of dehydration (no urine output over 4 hours after day 1); symptoms of hypoglycaemia with blood glucose < 2 mmol/L. In the standard group fluids were more liberally offered.

About 180 participants in the UNICEF group and 291 participants in the standard group completed the protocol. Almost 40% of the participants in the UNICEF group violated protocol during the first 5 days in the hospital.

Upon discharge from the hospital, it was left to the mothers of both groups to decide whether to use a pacifier and/or bottle.

Outcomes

Incidence of breastfeeding at day 5, and at 2, 4, 6 months, proportion of fully or partially breastfeeding on day 5, sucking behaviour (good, mediocre, insufficient), incidence of fever, incidence of phototherapy. Questionaires administered to mothers at 2, 4, and 6 months were used to collect breastfeeding outcomes after hospital discharge.

Notes

Study conducted in Switzerland. Results were reported in 2 separate publications with slight differences in the presentation of results. This study however was not included for analysis due to high attrition bias (almost 40% loss of participants in the intervention group) due to protocol violation in the first weeks of the study.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

"Sealed protocol forms were centrally randomised."

Comment: The method of random sequence generation is not described.

Allocation concealment (selection bias)

Low risk

"Sealed protocol forms were centrally randomised."

Comment: Allocation concealment incompletely described but likely to have been present.

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

Randomising participants in the same room or ward rather than comparing routines of one ward to another ‐ not feasible to blind participants.

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Blinding of clinician and outcome assessor is not described. However it is unlikely that they were blinded to the intervention.

Incomplete outcome data (attrition bias)
All outcomes

High risk

The rate protocol violators is approximately 15% and 5.5% respectively and the rate of lost to follow‐up is 7.8% and 4.2%. Thus, the total dropout rate is 22% versus 9.7%, respectively after 70 protocol violaters due to pacifier use included into the analysis.

The other protocol violaters were due to bottle feeding, failure to spoon/cup feed, early discharge and others.

Selective reporting (reporting bias)

Low risk

Protocol not available. All expected outcomes reported.

Other bias

High risk

Primary outcome data have to be imputed from percentages and exact denominators at 4 and 6 months follow‐up are unclear.

RCT: randomised controlled trial

Characteristics of excluded studies [ordered by study ID]

Jump to:

Study

Reason for exclusion

Collins 2004

This RCT aimed to determine the effect of artificial teats and cup on breastfeeding in preterm infants and not term infants, our pre‐specified inclusion criteria.

Feldens 2013

This was an RCT examining the effect of home visits for the purpose of giving breastfeeding advice as well as advice about pacifier use. The control group treatment was not described. The primary outcome was pacifier use.

Howard 2003

This RCT evaluated the effect of bottle feeding and pacifier use versus cup feeding and delayed pacifier use in breastfeeding infants. Infants in both the intervention and the control group used pacifiers and hence there is no comparison between pacifier use and non‐pacifier use in breastfeeding infants. The study is excluded because the study population do not meet our inclusion criteria, as it included women who did not intend to breastfeed. Furthermore, the results for breastfeeding duration are presented as adjusted odds ratios and the primary data are not reported. Additionally, our review did not have an outcome 'breastfeeding at 5 weeks', as this is too short a duration to be clinically meaningful.

RCT: randomised controlled trial

Data and analyses

Open in table viewer
Comparison 1. Restricted pacifier use versus unrestricted

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of infants exclusively breastfed at 3 months Show forest plot

2

1228

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.96, 1.07]

Analysis 1.1

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 1 Proportion of infants exclusively breastfed at 3 months.

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 1 Proportion of infants exclusively breastfed at 3 months.

2 Proportion of infants partially breastfed at 3 months Show forest plot

2

1228

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.98, 1.02]

Analysis 1.2

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 2 Proportion of infants partially breastfed at 3 months.

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 2 Proportion of infants partially breastfed at 3 months.

3 Proportion of infants exclusively breastfed at 4 months Show forest plot

1

970

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.94, 1.09]

Analysis 1.3

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 3 Proportion of infants exclusively breastfed at 4 months.

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 3 Proportion of infants exclusively breastfed at 4 months.

4 Proportion infants partially breastfed at 4 months Show forest plot

1

970

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.97, 1.02]

Analysis 1.4

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 4 Proportion infants partially breastfed at 4 months.

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 4 Proportion infants partially breastfed at 4 months.

: 'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 1

Figure 1: 'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 1 Proportion of infants exclusively breastfed at 3 months.
Figures and Tables -
Analysis 1.1

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 1 Proportion of infants exclusively breastfed at 3 months.

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 2 Proportion of infants partially breastfed at 3 months.
Figures and Tables -
Analysis 1.2

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 2 Proportion of infants partially breastfed at 3 months.

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 3 Proportion of infants exclusively breastfed at 4 months.
Figures and Tables -
Analysis 1.3

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 3 Proportion of infants exclusively breastfed at 4 months.

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 4 Proportion infants partially breastfed at 4 months.
Figures and Tables -
Analysis 1.4

Comparison 1 Restricted pacifier use versus unrestricted, Outcome 4 Proportion infants partially breastfed at 4 months.

Summary of findings for the main comparison. Restriction of pacifier use versus no restriction for increasing duration of breastfeeding

Pacifier use versus pacifier restriction for increasing duration of breastfeeding

Patient or population: healthy full‐term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed
Settings: multi‐centre trial carried out at 5 tertiary centres in Argentina
Intervention: restricted pacifier use

Comparison: no restriction in pacifier use

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Pacifier use versus pacifier restriction

Proportion of infants exclusively breastfed at 4‐6 months

Study population

RR 1.01
(0.94 to 1.09)

970
(1 study)

⊕⊕⊕⊝
moderate1

Not downgraded for study limitations (lack of blinding of the intervention as there was blinding of the outcome assessor and outcome is objective)

743 per 1000

751 per 1000
(699 to 810)

Duration of full or exclusive breastfeeding

Outcome not reported

Breastfeeding difficulties

Outcome not reported

Maternal satisfaction and level of confidence in parenting

Outcome not reported

Infant otitis media

Outcome not reported

Infant dental malocclusion

Outcome not reported

*The basis for the assumed risk (e.g. the median control group risk across studies) taken from the included studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Evidence obtained from only one study and so downgraded for imprecision

Figures and Tables -
Summary of findings for the main comparison. Restriction of pacifier use versus no restriction for increasing duration of breastfeeding
Comparison 1. Restricted pacifier use versus unrestricted

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion of infants exclusively breastfed at 3 months Show forest plot

2

1228

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.96, 1.07]

2 Proportion of infants partially breastfed at 3 months Show forest plot

2

1228

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.98, 1.02]

3 Proportion of infants exclusively breastfed at 4 months Show forest plot

1

970

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.94, 1.09]

4 Proportion infants partially breastfed at 4 months Show forest plot

1

970

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.97, 1.02]

Figures and Tables -
Comparison 1. Restricted pacifier use versus unrestricted