The UNICEF/World Health Organizatio...

The UNICEF/World Health Organization Baby Friendly Hospital Initiative commends avoiding the use of pacifiers or bottle feeding to establish auspicious breastfeeding; however, the evidence supporting this recommendation is limited. cupful feeding has been suggested as a safe alternative to bottle feeding in breastfed infants who require supplemental feedings to obstruct "nipple confusion" or future question s with breastfeeding. Howard and colleagues demeanored a dual-intervention, randomized trial to investigate the issues of pacifier use, cup feeding, and bottle feeding upon 700 breastfed newborns.

Inclusion criteria were uncomplicated singleton pregnancy, mother's intention to breastfeed for at least four weeks, and parents' indecision about pacifier use or desire to use a pacifier in the infant. forward admission to the hospital, the unborn infants were randomized to receive supplemental feeding with either a cupful or bottle (only if medically indicated or desireed by parents), and to receive a pacifier early (two to five days) or late (after four weeks). A total of 129 infants received beaker feedings and early pacifier introduction, 122 infants received portion feedings with late pacifier introduction, 119 infants had bottle feedings and early pacifier introduction, and 111 infants had the bottle feedings with late pacifier use. At discharge, parents were interchange of opinioned about the advantages of breastfeeding and the potential adverse drifts of supplementation on milk stock No specific instructions on supplemental feeding courses were given.

Mothers were interviewed at several intervals up to the 52nd postnatal week. The investigators and feed at the breast interviewers were masked to form into groups assignments. No differences existed in maternal race, parity, calling status, smoking status, breastfeeding experience, age, or education between the reflection groups. The majority of mothers whose infants received supplementation were primiparous, receiving federal assistance, breastfeeding for the first time, or had cesarean delivery.

The researchers bring to an end that early pacifier introduction is associated with fewer mothers exclusively breastfeeding at common month and decreased overall breastfeeding duration when compared with later pacifier introduction. Supplementation at cup or bottle led to a decrease in overall breastfeeding duration compared with infants receiving no supplementation. In mothers who had cesarean delivery, draught feeding was significantly associated with higher rates of exclusive breastfeeding and overall duration of breastfeeding compared with bottle feeding.

Howard CR et al. Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their purport on breastfeeding. Pediatrics March 2003;111:511-8

Editor's note: In the research by Howard and colleagues, infants requiring supplementation received bowl feedings in small plastic medicine draughts Although bottle feeding is a far more universal method of supplementation in the United States, portion feeding is an important alternative to consider. Studies have shown that it has the same, and perhaps better, efficiencys on infant heart rate, respiration rate, and oxygen saturation when compared with bottle feeding. (See Marinelli KA, et al. A comparison of the safety of cupfeedings and bottlefeedings in premature infants whose mothers intend to breastfeed. J Perinatol September 2001;21:350-5)

COPYRIGHT 2003 American Academy of Family Physicians

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