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PLoS One. 2018 Dec 19;13(12):e0208261. doi: 10.1371/journal.pone.0208261. eCollection 2018.

Exclusive breastfeeding changes in Brazil attributable to pacifier use.

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Departament of Nutrition, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Departament of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America.
Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Department of Director, Instituto de Saúde, São Paulo, São Paulo, Brazil.



Identifying key interventions to increase exclusive breastfeeding duration has been a challenge. Pacifier use has been associated with exclusive breastfeeding discontinuation in Brazil. However, the proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown.


Quantify the proportion of increases in exclusive breastfeeding prevalence that can be attributed to reduced pacifier use over time.


Secondary data analyses of two nationally representative cross-sectional surveys conducted in States' capitals in 1999 and in 2008 (N = 42,395 Brazilian infants under 6 months of age). We estimated the fraction of exclusive breastfeeding prevalence improvements that could be attributed to pacifier use based on multilevel regression analysis.


From 1999 to 2008, there was an increase of 15.2 percentage points in exclusive breastfeeding prevalence and a decrease of approximately 17 percentage points in the prevalence of pacifier use among infants under 6 months. Reduction in pacifier use explained an increase in 5.5 percentage points' exclusive breastfeeding rates. If pacifier use were to decrease from 41.6% (prevalence in 2008) to 14% (as found in New Zealand), there would be an expected additional increase in exclusive breastfeeding of approximately 12 percentage points.


About one-third of the improvements in EBF prevalence observed in Brazil over a decade can be attributed to the corresponding decline in pacifier use.

Conflict of interest statement

The authors have declared that no competing interests exist.

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