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: 'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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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.
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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.
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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.
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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.
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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.
Figuras y tablas -
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

Figuras y tablas -
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]

Figuras y tablas -
Comparison 1. Restricted pacifier use versus unrestricted