Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding

Batista, Christyann L.C.; Ribeiro, Valdinar S.; Nascimento, Maria do Desterro S.B.; Rodrigues, Vandilson P.

doi:10.1016/j.jped.2017.10.005

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Original articles • J. Pediatr. (Rio J.) 94 (6) • Nov-Dec 2018 • https://doi.org/10.1016/j.jped.2017.10.005 copy

Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding^☆ ☆ Please cite this article as: Batista CL, Ribeiro VS, Nascimento MD, Rodrigues VP. Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding. J Pediatr (Rio J). 2018;94:596-601. , ^☆☆ ☆☆ Study carried out at Universidade Federal do Maranhão (UFMA), University Hospital, São Luís, MA, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To investigate the association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding.

Method:

A cross-sectional study was conducted with 427 babies/mothers. Socio-demographic, perinatal data, and information about the use of artificial nipples (pacifier and/or bottle) were collected through a questionnaire. The breastfeeding aspects regarding position, affectivity, sucking behavior, baby responses, and breast anatomy were evaluated through observation during breastfeeding. The chi-squared test and the multiple linear regression analysis were used to investigate the association between the variables.

Results:

The aspects of breastfeeding that showed higher percentages of the category "poor" were sucking behavior (22.5%) and position (22.2%). The group of infants who used pacifiers and/or bottle showed higher percentages in the poor and fair categories when compared with the good category for all five breastfeeding aspects evaluated (p < 0.001). The linear regression analysis revealed that the increase in the number of unfavorable behaviors regarding position, affectivity, sucking behavior, and baby responses were independently associated with both pacifier and bottle use (β positive, p < 0.05), while breast anatomy was independently associated only with bottle use.

Conclusion:

The findings suggest that the use of pacifiers and/or bottle-feeding may be associated with unfavorable behaviors during breastfeeding, especially the use of bottle-feeding.

KEYWORDS
Breastfeeding; Pacifiers; Bottle-feeding

Evaluated aspects	Number of unfavorable behaviors	Score classification^a a Based on the study by Carvalhaes and Corrêa.20
		Good	Fair	Poor
Mother/child position	05	0-1	2-3	4-5
Binomial responses	06	0-1	2-3	4-6
Sucking behavior	06	0-1	2-3	4-6
Breast anatomy	04	0	1	2-4
Affectivity	03	0	1	2-3

Variables	n	(%)
Baby's age
≤28 days	62	(14.5)
>28 days	365	(85.5)
Baby's gender
Female	214	(50.1)
Male	213	(49.9)
Maternal age
Up to 19 years	72	(16.9)
Between 20 and 29 years	191	(44.7)
30 years or older	164	(38.4)
Maternal marital status
No partner	127	(29.7)
With partner	300	(70.2)
Maternal occupation
Unemployed or no occupation	245	(57.4)
Works outside the home	175	(41.0)
Works at home	7	(1.6)
Maternal schooling
Up to elementary school	70	(16.4)
Finished high school	245	(57.4)
Finished college/university	105	(24.6)
Finished post-graduation	7	(1.6)
Family income
Up to 1 MW	205	(48.0)
Higher than 1 and up to 3 MW	147	(34.4)
Higher than 3 up to 5 MW	53	(12.4)
Higher than 5 MW	22	(5.2)
First child
Yes	250	(58.5)
No	177	(41.5)
Type of delivery
Vaginal	217	(50.8)
Cesarean section	210	(49.2)
Received prenatal care
Yes	424	(99.3)
No	3	(0.7)
Place of delivery
Outside health unit	5	(1.2)
Public health unit	355	(83.1)
Private health unit	67	(15.7)
Received information on breastfeeding in the pre- and/or postnatal consultation
No	75	(17.6)
Yes	352	(82.4)
Bottle-feeding
Yes	87	(20.4)
No	340	(79.6)
Pacifier use
Yes	68	(15.9)
No	359	(84.1)

Variables	Total	Pacifier use and/or bottle feeding		p ^a a Chi-squared test.
		Yes	No
	n (%)	n (%)	n (%)
Mother/baby position				<0.001
Good	231 (54.1)	54 (42.5)	177 (59.0)
Fair	101 (23.7)	29 (22.8)	72 (24.0)
Poor	95 (22.2)	44 (34.7)	51 (17.0)
Affectivity				<0.001
Good	358 (83.8)	86 (67.7)	272 (90.7)
Fair	57 (13.3)	35 (27.6)	22 (7.3)
Poor	12 (2.8)	6 (4.7)	6 (2.0)
Sucking behavior				<0.001
Good	219 (51.3)	41 (32.3)	178 (59.3)
Fair	112 (26.2)	23 (18.1)	89 (29.7)
Poor	96 (22.5)	63 (49.6)	33 (11.0)
Baby's response				<0.001
Good	374 (87.6)	95 (74.8)	279 (93.0)
Fair	38 (8.9)	23 (18.1)	15 (5.0)
Poor	15 (3.5)	9 (7.1)	6 (2.0)
Breast anatomy				<0.001
Good	391 (91.6)	106 (83.5)	285 (95.0)
Fair	20 (4.7)	9 (7.1)	11 (3.7)
Poor	16 (3.7)	12 (9.4)	4 (1.3)

Independent variables	Dependent variables (number of unfavorable behaviors)
	Mother/baby position	Affectivity	Sucking behavior	Baby's responses	Breast anatomy
	β (p-value)	β (p-value)	β (p-value)	β (p-value)	β (p-value)
Baby's age (days)	-0.01 (0.011)	0.00 (0.186)	-0.01 (0.023)	-0.01 (0.002)	-0.01 (0.001)
Maternal age (years)	-0.01 (0.150)	0.00 (0.372)	0.02 (0.129)	0.00 (0.507)	0.00 (0.193)
Mother's number of children	0.27 (0.035)	-0.01 (0.743)	0.21 (0.109)	0.00 (0.985)	0.00 (0.992)
Information on breastfeeding (no = 0; yes = 1)	-0.40 (0.081)	-0.13 (0.039)	-0.35 (0.021)	-0.27 (0.034)	-0.09 (0.068)
Previous breastfeeding experience (no = 0; yes = 1)	-0.34 (0.147)	0.00 (0.883)	-0.52 (0.035)	-0.20 (0.124)	-0.10 (0.064)
Bottle-feeding (no = 0; yes = 1)	0.79 (<0.001)	0.25 (<0.001)	1.59 (<0.001)	0.69 (<0.001)	0.22 (<0.001)
Pacifier use (no = 0; yes = 1)	0.50 (0.040)	0.25 (<0.001)	0.81 (0.001)	0.35 (0.011)	0.08 (0.135)
Multiple R² (p-value)	0.08 (<0.001)	0.11 (<0.001)	0.19 (<0.001)	0.16 (<0.001)	0.17 (<0.001)

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[1] * Corresponding author. E-mail:christyann.batista@huufma.br (C.L. Batista).