Pacifiers are used world-wide and often believed by health professionals and lay people to be harmless, or even necessary and beneficial for the infant’s development. But are they really a boon? Or a boondoggle?
At the most recent San Diego County Breastfeeding Coalition meeting, Nancy E. Wight (MD, IBCLC, FABM, FAAP) from the coalition told attendees that although pacifier use has its benefits, there is enough evidence to show that pacifiers CAN effect breastfeeding, when used early in the hospital, and when maternal motivation to breastfeed is not strong.
Non-nutritive sucking on pacifiers may be beneficial. Sucking calms and decreases the pain response. Pacifier use is associated with a decrease in the incidence if SIDS. For premies, non-nutritive sucking may facilitate the development and strengthening of muscles used in sucking, and lead to better weight gain and shorter length of stay.
Still, there are several risks of pacifier use. During the first two days after giving birth, the mother’s breasts need stimulation to begin producing milk and the baby’s time spent on the breast should not be limited. However, “the time sent sucking on a pacifier is time not spent suckling at the breast,” said Dr. Wight, “Pacifiers reduce time spent suckling at the breast, thus delay and decrease the milk production, and result in early termination of breastfeeding.” She pointed out that most observational studies show an association of early pacifier use and shorter duration of breastfeeding.
Pacifiers interfere with demand feeding. Some mothers use pacifiers to delay feeding, as a consequence, “less feeding equals to decreased milk supply,” said Dr. Wight, “decreased milk supply leads to supplementation and decreased breastfeeding.” Formula remains in the stomach twice as long as human milk, leading to less breastfeeding.
Pacifiers can alter oral dynamics and cause dental malocclusion. Pediatric Dentists recommend discontinuing pacifier use by two years of age. Pacifiers increase incidence of acute and chronic otitis media, may carry infection, possibly increase the incidence of thrush.
Pacifier also come with possible safety hazards, including chocking on separated pieces of pacifier materials, use of potentially harmful materials in manufacture, and entanglement in pacifier attachments.
Most studies suggest not using a pacifier until breastfeeding is well established. The Ten Steps to Successful Breastfeeding by Baby Friendly Hospital Initiative includes “give no teats or pacifiers, also called dummies or soothers, to breastfeeding infants” as its ninth step.
American Academy of Pediatrics suggests avoiding routine pacifier use in the postpartum period, stating “pacifier use should be offered, while placing the infant back-to-sleep position, no earlier than three to four weeks of age, and after breastfeeding has been well established.”
She reminded her fellow IBCLCs that pacifier use may indicate a breastfeeding problem, not cause the problem. “Pacifier use may indicate a breastfeeding problem that requires intervention,” she said, “or a mother’s desire to stop breastfeeding.”
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