Can Pacifiers Reduce Infant Obesity?

Babies suck. 

Let me explain. Infants have a natural reflex for what is called nonnutritive sucking (NNS), such as sucking on their thumb or a pacifier. They do not get any nutrition from this sucking, as they would with breastfeeding, thus “nonnutritive.”

We also see occasional nonnutritive sucking from my favorite sports teams. But, I digress. 

Due to the rise in the number of obese children, and that breastfeeding can be associated with a reduced risk of pediatric overweight, researchers recently had a hypothesis that, “infants with their innate desire for gratification through [nonnutritive sucking] may overfeed if the bottle or breast is constantly being offered instead of a pacifier to satisfy this need.”¹

In other words, since babies like sucking, if parents are constantly feeding them (especially with formula versus breast milk), the babies will keep sucking, increasing their risk of overfeeding and being overweight.

With this in mind, almost 400 infants 9 to 15 months old (95% African American, only 5% college-educated) were separated into two groups, based on whether or not the pacifier was used consistently for ≥ 9 months.

1. Pacifier User
2. Non-User

They then looked at the percentages of children classified as overweight or obese in each group. As you see here, there was an increased prevalence of overweight and obesity in infants who’s parents did not use a pacifier consistently than those who parents did use the pacifier consistently.

Okay, so why would this be?

Based on their results, the majority of mothers (70%) stated that pacifier use was used to minimize frequent feedings, which was even more important in the formula fed babies - since there are increased odds of being overweight in children who are formula fed instead of breast fed. 

But...

Another recent study just found that the opposite results. 250 infants were followed from 10-14 days postpartum for 2 years. In this case, mothers were largely white, non-Hispanic, married, and college educated.

As shown in this figure, those who used a pacifier 4 months or later had a higher percentage of infants classified as "overweight" at 1 year and 2 years.

So, who is right?

Most likely, both.

The two samples were quite different, including their ethnicity, education level, socieoeconomic status, and use of formula vs. breastfeeding.  Also, the researchers in the first study did not examine differences by timing of pacifier use (earlier vs. later infancy), as in the second study.

Thus, the authors conclude, "These conflicting results suggest that relationships between pacifiers and weight may differ depending on timing of use, highlighting the need for additional longitudinal studies."²

Clarify

So, this one is clarify.

1. There is nothing miraculous about the ‘ol paci, nuk, or binky – its shape, color, taste, or chemical composition that can help prevent overweight and obesity in children.
2. Rather, the research to this point highlights that the pacifier has been used as a simple tool to help parents not overfeed their children, thus reducing the child’s risk of becoming overweight or obese.
3. But, pacifier use at 4 months or later could also be associated with lower rates of breast feeding in certain populations, thus increasing the risk of becoming overweight or obese. 

So, it appears that pacifier use could be helpful in some infants, but not others. We do not know why, but it appears to be related to whether or not the pacifier use allows the parent to breastfeed the proper amount and timing for the health of the baby.

For more information on how much you should feed your child to keep them healthy, please see your Pediatrician.

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References

1. Amer, A., Abusamaan, M., Li, X., & Fischer, H. (2017). Does Pacifier Use in Infancy Decrease the Risk of Obesity? Clinical Pediatrics, 0009922817701171.
2. Hohman, E. E., Savage, J. S., Birch, L. L., Beiler, J. S., & Paul, I. M. (2017). Pacifier use and early life weight outcomes in the intervention nurses start infants growing on healthy trajectories study. Childhood Obesity. https://doi.org.ezproxy.library.tamu.edu/10.1089/chi.2017.0177