The impulse to suck is so innate, many babies do it in the womb. Since long before Maggie Simpson, pacifiers have been considered a convenient way to keep a baby quiet and happy. The practice is criticized for a variety of reasons: hygiene, orthodontic problems, and interference with breastfeeding. But deprived of a pacifier, many a resourceful infant will realize his thumb is pefectly suckable — an option preferred by Dr. Sears. In the opposite corner, University of Michigan Health System maintains that thumb-sucking should be discouraged, even if that means replacing it with pacifier-sucking.
AVOID PACIFIERS: Dr. Sears "Pacifiers: In or out?"
There are good reasons for avoiding pacifiers, especially in the early weeks while baby is learning to latch on and suck at your breast:
Pacifiers are artificial nipples. They require a different sucking motion at the breast and can lead to problems with nipple confusion.
A baby who is given a pacifier instead of being offered the breast may not nurse enough to gain weight adequately.
Without enough stimulation from baby's sucking, mother's milk supply may dwindle. Comfort sucking at the end of a feeding helps to build mother's milk supply.
A 1999 study reported in the medical journal Pediatrics showed that mothers who used pacifiers during the first six weeks after birth tended to wean their babies earlier.
What do you do when the human pacifier — mom — wears out or is not available?
We suggest offering the baby a clean adult finger to suck on if mother's nipples are sore or her patience is wearing thin. Or try alternative methods of comforting your baby — walking, wearing baby in a sling or front pack, patting her back or skin-to-skin contact with dad.
PACIFIERS COMPLICATE BREASTFEEDING: Pediatrics: "The Effects of Early Pacifier Use on Breastfeeding Duration"In adjusted analyses, pacifier introduction by 6 weeks was associated with a significantly increased risk for shortened duration of full [...] and overall [...] breastfeeding. Women who introduced pacifiers tended to breastfeed their infants fewer times per day, with significant differences noted at 2 [...] and 12 weeks [...] postpartum. At 12 weeks postpartum, women who introduced pacifiers also were more likely to report that breastfeeding was inconvenient and that they had insufficient milk supplies.
Pacifier use was independently associated with significant declines in the duration of full and overall breastfeeding. Breastfeeding duration in the first 3 months postpartum, however, was unaffected by pacifier use. Women who introduced pacifiers tended to breastfeed their infants less frequently and experienced breastfeeding problems consistent with infrequent feeding. Findings from this study suggest that the decreases in breastfeeding duration associated with pacifier use may be a consequence of less frequent breastfeeding among women who introduce pacifiers to their infants.
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Early oral experiences that require sucking mechanics different from those required for breastfeeding are believed to contribute to the development of improper latch and subsequent breastfeeding failure a problem described as nipple confusion.
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Scientific investigation of the effect of early artificial sucking experiences on the ability of newborns to breastfeed successfully is of profound relevance and importance to maternal and child health in the United States. Moreover, because nonnutritive sucking is associated with beneficial effects including enhanced growth in premature infants, possible prevention of SIDS, and coping with adverse stimuli, as well as with detrimental effects including increased rates of otitis media and malocclusion, it is even more important to determine whether pacifier use is detrimental to breastfeeding.
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Pacifier use in the first 6 weeks was independently associated with shortened full and overall breastfeeding duration.
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In our evaluation of breastfeeding problems, we also found minimal evidence of any problems attributable to suckling technique. At 12 weeks, there were reports that breastfeeding was inconvenient and that pacifier users experienced more problems with insufficient milk supplies. It is difficult to reconcile the proposed biologic mechanism of nipple confusion, interference with an infant learning proper latch and suckling mechanics, with maternal perceptions that breastfeeding is inconvenient in the absence of other problems like nipple trauma or breast refusal.
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It is plausible that women who used pacifiers tended to offer the pacifier in an effort to extend the time between feedings. Certainly, those who considered breastfeeding inconvenient might tend to delay feedings through the use of a pacifier, and infrequent feedings are a known cause of insufficient milk supply.
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In summary, findings from this study suggest that pacifier use, through an association with infrequent breastfeeding, mediates the declines observed in breastfeeding duration. Given the infrequency of breastfeeding problems among pacifier users and the lack of an association with breastfeeding duration to 3 months, these data otherwise fail to support the development of nipple confusion in pacifier-exposed infants.
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Parents wishing to use a pacifier may benefit from education about alternative methods to comfort infants, the importance of frequent suckling in establishing and maintaining milk supplies, and the benefits of full breastfeeding during the first 6 months of life and thereafter with the appropriate addition of solid foods for at least 12 months.
BOTH PROS AND CONS: The Mayo Clinic"Pacifiers: Are they good for your baby?"Are pacifiers really OK for your baby? New guidelines from the American Academy of Pediatrics say yes. Here are the pros and cons, plus tips about safe pacifier use.
The pros
For some babies, pacifiers are the key to contentment between feedings. Consider the advantages:
• A pacifier may soothe a fussy baby. Some babies are happiest when they're sucking on something.
• Pacifiers offer temporary distraction. When your baby's hungry, a pacifier may buy you a few minutes to prepare a bottle or find a comfortable spot to nurse. A pacifier also may come in handy during shots, blood tests or other procedures.
• A pacifier may help your baby go to sleep. If your baby has trouble settling down, a pacifier might do the trick.
• A pacifier may help reduce the risk of sudden infant death syndrome (SIDS). Researchers have found an association between pacifier use at naptime and bedtime and a reduced risk of SIDS.
• They're disposable. When it's time to stop using pacifiers, you can throw them away. If your baby prefers to suck on his or her thumb or fingers, it may be more difficult to break the habit.
The cons
Of course, pacifiers have pitfalls as well. Consider the drawbacks:
• Early pacifier use may interfere with breastfeeding. Sucking on a breast is different than sucking on a pacifier or bottle. Some babies have trouble learning how to nurse properly if they're given a pacifier too soon.
• Your baby may become dependent on the pacifier. If your baby uses a pacifier to sleep, you may face frequent middle-of-the-night crying spells when the pacifier falls out of your baby's mouth.
• Pacifier use may increase the risk of middle ear infections. Ear infections are most common in children younger than age 3. However, rates of middle ear infections are generally lowest during the first six months of life — when the risk of SIDS is the highest.
If you choose to offer your baby a pacifier, keep these tips in mind.
• Wait until breastfeeding is well established. Be patient. It may take a few weeks or more to settle into a regular nursing routine. If you're breastfeeding, the American Academy of Pediatrics recommends waiting to introduce a pacifier until your baby is 1 month old.
• Let your baby set the pace. If your baby's not interested in the pacifier, try again later — or skip it entirely. Don't force the issue.
• Choose the one-piece, dishwasher-safe variety. Some pacifiers have been recalled due to the risk of breaking into two pieces, which poses a choking hazard. The shape and firmness is up to you — or your baby.
• Buy extras. Once you've settled on a favorite, keep a few identical backups on hand. Many babies refuse a substitute pacifier.
• Keep it clean. Before you use a new pacifier, wash it with soap and water. To keep fungus at bay, soak your baby's pacifier in equal parts white vinegar and water for a few minutes a day. Allow the pacifier to air dry thoroughly before returning it to your baby. Resist the temptation to "rinse" the pacifier in your own mouth — you'll only spread more germs to your baby.
• Watch for signs of deterioration. Replace pacifiers often. A worn or cracked nipple can tear off and pose a choking hazard.
• Use caution with pacifier clips. Never use a string or strap long enough to get caught around your baby's neck.
• Let sleeping babies lie. If the pacifier falls out of your baby's mouth while he or she is sleeping, don't pop it back in.
• Try other ways to calm your baby. Don't use a pacifier as a first line of defense. Sometimes a change of position or a rocking session may be all that's needed. If your baby is hungry, offer the breast or a bottle.
• Know when to pull the plug. Most kids stop using pacifiers on their own between ages 2 and 4. If you're concerned about your child's pacifier use, consult his or her doctor for suggestions.
The bottom line
The decision to use a pacifier — or not — is up to you. Let go of any guilt or pressure as you learn what works best for your baby
PACIFIERS USEFUL TO SOME: Dr. Greene"Pacifiers Don't Cause Early Weaning"Studies have not shown whether pacifier use causes early weaning or vice versa. An excellent randomized, controlled clinical trial, published in the July 18, 2001 issue of The Journal of the American Medical Association, concluded that pacifier use does not cause early weaning, it merely becomes more common among babies who are already weaning. This fits with what I have observed in working with families: as long as pacifiers are not used as substitutes for meeting babies' needs, they can be offered to soothe fussy young babies without interfering with nursing.
GOOD CALMING TECHNIQUE: University of Michigan Health System "Pacifiers"Some babies suck on their thumb or fingers almost constantly. If you have a baby like this, you may want to try to interest him in a pacifier.
To be accepted as a substitute for the thumb, the pacifier has to be introduced during the baby's first 2 months. The orthodontic type of pacifier allegedly is best because it prevents tongue-thrusting during sucking, but the regular type also is fine.
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The biggest advantage of a pacifier is that if you can get your child to use one, he won't suck his thumb.
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Also, you can control your child's use of a pacifier as he grows older. In contrast, it is much more difficult to stop your child from sucking his thumb because the thumb belongs to him.
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Start the pacifier by 1 to 2 months of age if your baby shows a tendency to become a thumbsucker.
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During your child's first 6 months, give him the pacifier whenever he wants to suck but isn't happy.
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Do not use the pacifier to help your child fall asleep. Never use a pacifier as a sleep transition object (except in cases for calming a colicky newborn).
Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.