Impact of a Baby-Friendly–Aligned Pacifier Policy on Pacifier Use at 1 Month of Age

ObjectivePacifier use decreases the risk of sudden infant death syndrome, but its impact on breastfeeding remains controversial. We evaluated the impact of a pacifier policy aligned with the World Health Organization and United Nations Children's Fund Baby-Friendly Hospital Initiative on subsequent pacifier use and breastfeeding at 1 month of age.MethodsWe conducted a prospective 2-stage (pre- and post-implementation) cohort study of newborns at a birth hospital before and after implementation of a Baby-Friendly–aligned pacifier policy. Consecutive mothers of newborns admitted to the nursery participated in a telephone survey when the infants were 1 month of age.ResultsIn total, 342 mothers participated (190 before and 152 after implementation of the policy). Pacifier adoption was delayed in the post-implementation group, but pacifier use by 1 month of age was comparable (78.9% pre-implementation vs 77.6% post-implementation; P = .793). In the pre-implementation group, female and male infants used pacifiers at comparable rates; however, in the post-implementation group, females were significantly less likely to use a pacifier compared to males after controlling for insurance, race, parity, and delivery mode (adjusted odds ratio, 0.35; 95% confidence interval, 0.15–0.83; P = .02). In the post-implementation group, exclusive breastfeeding rates at discharge increased significantly (from 40% to 51.3%; P = .04), but rates were not different at 1 month (23.7% pre-implementation vs 24.3% post-implementation; P = .89).ConclusionA Baby-Friendly–aligned pacifier policy delayed pacifier adoption but did not impact overall pacifier use or breastfeeding rates at 1 month of age. The finding of lower pacifier use rates among female infants post-intervention requires verification in other populations before evaluating public heath relevance.     

Pacifier use: What makes mothers change their mind?

AIM: To find out the reasons for mothers to either use or not use a pacifier and to find out the mother's reasons for changing their mind. METHOD: We analysed the data of 174 mother-infant pairs by means of a semistructured questionnaire performed shortly after birth, and at the age of 7 weeks and 5 months, respectively. RESULTS: The main reason for mothers primarily refusing a pacifier was their concern about malformation of the teeth or jaw. Until the end of the fifth month, 31% of the mothers changed their mind about pacifier use. Mothers primarily refusing a pacifier introduced a pacifier due to the need of soothing the infant. Mothers, who initially intended to use a pacifier, changed their mind due to rejection by the infant. The prevalence of pacifier use at the age of 5 months was 78%. The majority of mothers (69%) introduced the pacifier during the first week of life. CONCLUSION: About one third of mothers had changed their mind about pacifier use, either because of rejection by the infant or the need of settling. Breastfeeding mothers require more and better information concerning the appropriate time of pacifier onset.     

Accidental or inflicted?

The visible evidence of child physical abuse most often is minimal or nonexistent, and the children at greatest risk of becoming victims are those too young to verbalize the history. As pediatric clinicians, we must be able to recognize potential sequelae of abuse and the high-risk situations that lead to physical abuse; we also must acknowledge that victims of child physical abuse often have injuries at multiple locations and in multiple organ systems. As a routine part of pediatric practice, healthcare providers, through anticipatory guidance, try to maximize the child's safety in the home environment. With this goal in mind, healthcare providers must consider the possibility of physical abuse when faced with a child with a traumatic injury. While it is important to identify these inflicted injuries, our ultimate goal is to prevent their occurrence in the first place.     

Anemic or not?

Laboratory data obtained from blood analysis by an electronic cell counter is a routine test along with physical evaluation. We assessed the hematological characteristics of schoolchildren to establish the prevalence of anemia in Istanbul. The study was performed on 1,600 students between the ages of 6-16. Hematological parameters of all the students were measured by an electronic cell counter on blood taken intravenously. Anemia prevalence was primarily determined according to Dallman's criteria. The results showed that if hemoglobin (Hb) was used as the primary criterion to define anemia, 423 students (27.6%) were found anemic; if hematocrit (Hct) was used, 625 students (40.8%) were found anemic and if mean corpuscular volume (MCV) was taken as a criterion to define microcytosis, 121 students (7.9%) remained below the normal level. The difference of anemia prevalence was high (p < 0.001) when two evaluation criteria (Hb or Hct) were compared. Furthermore it is known that a 3% difference occurs when automated and spun Hct values are compared. When a correction was made by adding this 3% to our series' Hct values, the anemic students' number decreased to 418 and the ratio became 27.3%, quite similar to Hb criterion ratio. Population based screening surveys for anemia must be designed and compared cautiously taking into account the method used (electronic counters or gravity based centrifuges), otherwise misleading results can be achieved. We evaluated the data of the survey according to different cut-off values and tried to select the proper one for our conditions.