Breast-feeding is a natural process, but it doesn't always happen naturally, especially with babies born prematurely. There are several techniques to get a preemie used to taking milk from his mother's breast, including using a pacifier, a bottle, a medicine cup, or a tube to feed the baby or let him practice sucking. Researchers from a hospital in South Australia studied the effect of these surrogate breasts to see how they affected a baby's transition to breast-feeding.

What the researchers wanted to know: Does giving a preemie bottles, pacifiers, and cups make the baby more or less likely to breast-feed?

What they did: The scientists enrolled about 300 mothers and their infants, who were all born between 23 and 33 weeks of pregnancy (at least four weeks before their due date). Women were assigned to a cup or bottle-feeding group soon after the birth of their baby, and within those groups to pacifier or no pacifier. They all breast-fed when they could, and either a bottle or cup was used for feeding when they could not breast-feed. The ultimate goal, and the variable the scientists measured, was to get the babies to breast-feed exclusively so they did not need any other methods to get food.

What they found: The pacifier made no difference in how quickly or how much an infant breast-fed. Babies assigned to the cup group were more likely to use breast milk as the sole source of food before they were discharged from the hospital than babies given a bottle. However, babies fed through a cup had longer hospital stays on average than those fed through a bottle, perhaps because babies fed through a cup more often need tube feeding and that can delay discharge.

What it means to you: One of the major findings of this study is that a pacifier had no effect on a baby's ability to breast-feed. Previous reports have shown that it may have a detrimental effect. The study did show a possible slight advantage of cup feeding over using a bottle but both seemed to work—there were no significant differences in breast-feeding between the bottle and cup groups after six months.

Caveats: The major problem with this study was that the mothers did not seem to want to go through with it. More than half of the babies in the cup-feeding group had a bottle introduced before the end of the study period, and a third of the infants who were not supposed to receive a pacifier got one. In that light, these results are hard to interpret, because many of the participants did not follow the rules of the study, especially in the group that was assigned to cup feeding and no pacifier, making it hard to get a statistically representative sample from the remaining people that did follow the protocol.

Find out more: For parents, a website called Preemie Info has information and discussion groups where parents can post their stories and questions.

The National Women's Health Information Center has a great page about breast-feeding, with lots of articles and places to go for help.

Read the article: Collins, C.T. et al. "Effect of Bottles, Cups, and Dummies on Breast Feeding in Preterm Infants: A Randomised Controlled Trial." British Medical Journal. July 24, 2004, Vol. 329, No. 7459, pp. 193–198.

Abstract online: http://bmj.bmjjournals.com