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Use of pacifiers and breastfeeding duration
CURRENT LITERATURE AND CLINICAL ISSUES
Abstracts from the literature Use of pacifiers and breastfeeding duration Victora CG, Tomasi E, Olinto MTA, Barros FC. Lancet 341:404-6, 1993.
Objective." To determine the association between the use of pacifiers at 1 month of age and the age at termination of breast-feeding. Design: Historical cohort. Setting: Slums of Pelotas, Brazil. Patients: All 354 infants less than 2 years of age in two slum areas were surveyed. Those still breast fed at age 1 month were included in the analysis. Main outcome measures: Age at full weaning (termination of breast-feeding). Results: Of 249 infants still breast fed at age 1 month, 166 (67%) were using pacifiers daily. The likelihood of being fully weaned was greater at all ages for infants using pacifiers at 1 month: of those who had used a pacifier at 1 month, 65% were weaned by 6 months age, in comparison with 24% among nonusers at 1 month of age. For all ages from l to 24 months, the adjusted risk ratio was 3.0. After Cox regression analysis to adjust for possible confounding factors (sex, birth weight, maternal education, family income, and age at introduction of bottle feeding), the authors found that only age at introduction of bottle feeding was significantly associated with age at full weaning; however, adjustment for this factor had minimal effect on the risk ratio for weaning at any specific age. Conclusions: There is a significant relationship between the use of pacifiers at age t month and an earlier termination of breast-feeding in this population. Comment: Guidelines such as those for "Baby Friendly Hospitals," promulgated by the World Health Organization,* specifically state that breast-fed babies should not be offered pacifiers. Little research has been available to support or challenge this advice (which is rarely followed, especially in developing nations). In this study, the authors surveyed mothers of infants less than 2 years of age regarding pacifier use at age 1 month and age at termination of breast-feeding. The critical issue in cohort studies is whether the groups being compared were similar with respect to de*See "Protecting, Promoting, and Supporting Breast-feeding: The Special Role of Maternity Services--A Joint WHO/UNICEF Statement." Geneva: World Health Organization, 1989. 9/34/49206
terminants of outcome other than the one of interest. In this study, all infants were from two geographic areas, all eligible infants participated, and adjustment was carried out for possible confounding factors. These findings suggest that, at the very least, pacifier use is a marker for an infant at risk for early weaning and that pacifier use may have a causative role in early weaning. Future research should focus on whether discouragement of pacifier use extends the duration of breast-feeding, especially in very high risk populations such as the one reported in this study. Virginia A. Moyer, MD, M P H Department of Pediatrics University of Texas Medical School at Houston Houston, T X 77030
Potential interventions for preventing pneumonia a m o n g young children: lack of effect of antibiotic treatment for upper respiratory infections Gadomski AM. Pediatr Infect Dis J 1993;12:l 15-20.
Objective: To determine whether antimicrobial treatment of upper respiratory tract infections (URI) in children will prevent lower respiratory tract infectious complications (LRI). Design: Critical review. Data sources: Existing randomized clinical trials were identified through the use of a literature search (technique not described) and the pursuit of references cited in relevant studies and other review articles. Study selection: Of 27 existing studies dealing with antimicrobial treatment of URI, only five had the required combination of a pediatric patient population, a randomized, placebo-controlled study design, acute antimicrobial intervention, and clear definitions of both " U R I " and "LRI." Data extraction: Evaluable studies were individually assessed, and the results then were combined by means of a metaanalysis technique in which single pooled odds ratio estimates, variance, and 95% confidence intervals could be calculated. Despite variability among the studies, the author accepted the definitions of " U R I " and " L R I " utilized in each study as equivalent. Data synthesis: The five studies were conducted at various times (1950s, 2; 1960s, 1; 1970s, 1; 1990s, 1)and in various countries (Indonesia, 1; Thailand, I; United States, 3). The authors used a variety of antimierobial drugs (ampicillin, tetracycline, penicillin, sulfonamides, chloramphenicol).
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Abstracts from the literature Use of pacifiers and breastfeeding duration Victora CG, Tomasi E, Olinto MTA, Barros FC. Lancet 341:404-6, 1993.
Objective." To determine the association between the use of pacifiers at 1 month of age and the age at termination of breast-feeding. Design: Historical cohort. Setting: Slums of Pelotas, Brazil. Patients: All 354 infants less than 2 years of age in two slum areas were surveyed. Those still breast fed at age 1 month were included in the analysis. Main outcome measures: Age at full weaning (termination of breast-feeding). Results: Of 249 infants still breast fed at age 1 month, 166 (67%) were using pacifiers daily. The likelihood of being fully weaned was greater at all ages for infants using pacifiers at 1 month: of those who had used a pacifier at 1 month, 65% were weaned by 6 months age, in comparison with 24% among nonusers at 1 month of age. For all ages from l to 24 months, the adjusted risk ratio was 3.0. After Cox regression analysis to adjust for possible confounding factors (sex, birth weight, maternal education, family income, and age at introduction of bottle feeding), the authors found that only age at introduction of bottle feeding was significantly associated with age at full weaning; however, adjustment for this factor had minimal effect on the risk ratio for weaning at any specific age. Conclusions: There is a significant relationship between the use of pacifiers at age t month and an earlier termination of breast-feeding in this population. Comment: Guidelines such as those for "Baby Friendly Hospitals," promulgated by the World Health Organization,* specifically state that breast-fed babies should not be offered pacifiers. Little research has been available to support or challenge this advice (which is rarely followed, especially in developing nations). In this study, the authors surveyed mothers of infants less than 2 years of age regarding pacifier use at age 1 month and age at termination of breast-feeding. The critical issue in cohort studies is whether the groups being compared were similar with respect to de*See "Protecting, Promoting, and Supporting Breast-feeding: The Special Role of Maternity Services--A Joint WHO/UNICEF Statement." Geneva: World Health Organization, 1989. 9/34/49206
terminants of outcome other than the one of interest. In this study, all infants were from two geographic areas, all eligible infants participated, and adjustment was carried out for possible confounding factors. These findings suggest that, at the very least, pacifier use is a marker for an infant at risk for early weaning and that pacifier use may have a causative role in early weaning. Future research should focus on whether discouragement of pacifier use extends the duration of breast-feeding, especially in very high risk populations such as the one reported in this study. Virginia A. Moyer, MD, M P H Department of Pediatrics University of Texas Medical School at Houston Houston, T X 77030
Potential interventions for preventing pneumonia a m o n g young children: lack of effect of antibiotic treatment for upper respiratory infections Gadomski AM. Pediatr Infect Dis J 1993;12:l 15-20.
Objective: To determine whether antimicrobial treatment of upper respiratory tract infections (URI) in children will prevent lower respiratory tract infectious complications (LRI). Design: Critical review. Data sources: Existing randomized clinical trials were identified through the use of a literature search (technique not described) and the pursuit of references cited in relevant studies and other review articles. Study selection: Of 27 existing studies dealing with antimicrobial treatment of URI, only five had the required combination of a pediatric patient population, a randomized, placebo-controlled study design, acute antimicrobial intervention, and clear definitions of both " U R I " and "LRI." Data extraction: Evaluable studies were individually assessed, and the results then were combined by means of a metaanalysis technique in which single pooled odds ratio estimates, variance, and 95% confidence intervals could be calculated. Despite variability among the studies, the author accepted the definitions of " U R I " and " L R I " utilized in each study as equivalent. Data synthesis: The five studies were conducted at various times (1950s, 2; 1960s, 1; 1970s, 1; 1990s, 1)and in various countries (Indonesia, 1; Thailand, I; United States, 3). The authors used a variety of antimierobial drugs (ampicillin, tetracycline, penicillin, sulfonamides, chloramphenicol).
483