1 Universidade de São Paulo - Faculdade de Saúde Pública, São Paulo, Brazil; 2 Yale School of Public Health, New Haven, CT, United States of America; 3 Instituto de Saúde. Secretaria Estadual da Saúde de São Paulo. São Paulo, Brazil.
Background: Exclusive breastfeeding (EBF) rates have increased in Brazil although it would take six years to reach an EBF rate of 50%. Thus, it is important to identify relevant modifiable key risk factors for the premature interruption of EBF. Objective: To find out if pacifier use is an independent risk factor with the interruption of EBF among Brazilian infants. Methods: We conducted secondary cross-sectional data analyses of two waves of infant feeding surveys conducted in 1999 and in 2008 in Brazilian Capitals and the Federal District (N=42,395 children under six months of age). Multivariate logistic regression was used to test the association between pacifier use and risk of interruption of EBF in a pooled sample and within each survey wave adjusting for socio-economic, demographic and biomedical confounders. Results: In the pooled sample a third of the infants were exclusively breastfed (32.7%) and almost 80% had used a pacifier. While EBF prevalence among infants increased from 25.1% in 1999 to 40.3% in 2008, pacifier use prevalence decreased from 82.7% to 74.8% in the same time period. Pacifier use was strongly associated with the risk of interruption of EBF in 1999 (Adjusted odds ratio (AOR)); 95% CI: 2.65; 2.38 to 2.94), 2008 (3.18; 2.81 to 3.60) and in the pooled sample (2.77; 2.63 to 2.91) after adjusting for key confounders. Conclusion: Pacifier use was the strongest risk factor with the early interruption of EBF. Effective strategies to reduce pacifier use among infants under six months may further improve EBF rates in Brazil.