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Research questions impact of pacifiers on disrupting breast-feeding
April 30th, 2012
12:05 PM ET

Research questions impact of pacifiers on disrupting breast-feeding

Pacifiers can soothe agitated infants, but some experts - including those at the World Health Organization (WHO) - discourage pacifier use in the first six months of life because of concerns that it may interfere with breast-feeding, widely seen as the best way to feed a newborn.

New research, however, casts doubt on the notion that pacifier use disrupts breast-feeding. In an analysis of feeding patterns among 2,249 infants in a single maternity ward over a 15-month period, researchers found the proportion of infants who were exclusively breast-fed dropped from 79% to 68% after pacifier use was restricted in the ward.

Meanwhile, the proportion of infants who needed formula in addition to breast-feeding jumped from 18% to 28% after the change in policy, according to the preliminary results of the study, which were presented today at the annual meeting of the Pediatric Academic Societies, in Boston.

"We were surprised - even disappointed - to find that our exclusive breast-feeding rates went down and supplemental formula feedings went up," says Carrie Phillipi, M.D., senior author of the study and an associate professor of pediatrics at Oregon Health & Science University, in Portland.

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The conventional wisdom is that pacifier use creates "nipple confusion" in newborns, says Pete Richel, M.D., chief of pediatrics at Northern Westchester Hospital, in Mt. Kisco, New York, who was not involved with the study.

The theory is that infants suckle their mother's nipple differently than they do a bottle or pacifier, and may have difficulty latching on to the mother if they're given too much exposure to artificial nipples.

In addition, the body produces breast milk according to demand, so frequently giving infants a pacifier may in some cases compromise the mother's milk supply, Phillipi says.

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Prohibiting the use of pacifiers and artificial nipples is one of the 10 steps for encouraging breast-feeding that hospitals in the United States must take to earn a "baby-friendly" designation from the WHO and the United Nations Children's Fund (UNICEF).

As part of its efforts to qualify for this baby-friendly status, the Doernbecher Children's Hospital at OHSU curtailed the use of pacifiers in its mother-baby unit in December 2010. After that date, the hospital required nurses and doctors to sign pacifiers out and use them only for "medically appropriate reasons," such as when a baby undergoes a painful surgical procedure or is withdrawing from drugs the mother took while pregnant.

The policy change provided Phillipi and her colleagues with a handy way of assessing before-and-after changes in pacifier use and breast-feeding, but their analysis lacks the rigor of a carefully designed and controlled study.

For instance, the hospital allowed visitors to bring their own pacifiers into the mother-baby unit, which is specially designed to accommodate mothers, infants, and family members. The researchers have no way of knowing how many outside pacifiers were brought it, or how often the infants used them.

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Moreover, the analysis didn't take into account the mothers' demographic profiles and the hospital's staffing levels, in particular the availability of doctors and nurses to give breast-feeding advice, Phillipi says.

Despite these weaknesses, the findings add another wrinkle to the already confusing recommendations for pacifier use in newborns. In contrast to the WHO, which discourages all pacifier use in the first six months of life, the American Academy of Pediatrics recommends giving babies pacifiers as they fall asleep beginning at the one-month mark, because this practice has been linked with a lower risk of sudden infant death syndrome (SIDS).

"It's very logical to think that pacifiers might interfere with breastfeeding, but there isn't really strong evidence that pacifiers are the problem, and they do turn out to be beneficial for reducing the risk of SIDS," Phillipi says. "Maybe we could approach mothers and their infants on a more individual basis… We can't make blanket recommendations about complex things."

Copyright Health Magazine 2011


soundoff (14 Responses)
  1. www.healthy24.net

    Thanks a lot to the writer of this article for the strong support for breast feeding.

    April 30, 2012 at 12:54 | Report abuse | Reply
  2. Dana

    People need to back off of "breast fedding only" as a panacea to long-healthy life, slim bodies and high intelligence versus bottle-fed babies being obese, unhealthy, and of marginal intelligence. Enough already! Getting good nutrition is what counts – not whether it is breat exclusively or bottle fed.

    April 30, 2012 at 16:38 | Report abuse | Reply
  3. chunkymunkie

    There really isn't anything better than the natural way of doing things. Did God give us pacifiers? No, he gave us breasts. Whether or not pacifiers are a problem I don't know, but breastfeeding IS the best way.

    April 30, 2012 at 18:51 | Report abuse | Reply
    • dx2718

      God, or nature, or whatever...gave us breasts AND fingers. My son loves to suck on fingers when he's not hungry. He's not big into pacifiers but will suck on occasion. My daughter, on the other hand, loved pacifiers, AND the breast. Her story is below.

      May 1, 2012 at 00:23 | Report abuse |
  4. sikes

    Comment if you're SMA and here for a current event :)

    April 30, 2012 at 18:56 | Report abuse | Reply
    • rainnbow

      heyy SMArty over heeee-yerrrr!! Lol oh La Rue ;p

      April 30, 2012 at 19:07 | Report abuse |
  5. mary

    More health news that's not news?! This has been known forever. I was told this 4 years ago at a La Leche League meeting.

    April 30, 2012 at 19:15 | Report abuse | Reply
  6. amanda

    Pacifiers make breasfeeding easier because you get a break from a crying baby. When you are constantly thinking the baby is hungry and not getting enough milk, when really he just wants to suck and a pacifier will do, you tend to become frustrated with the whole process.

    April 30, 2012 at 19:30 | Report abuse | Reply
  7. dx2718

    When my daughter was about a week old, she would suck at the breast until she projectile vomited from being overfull. Although professional advice said to hold off on pacifier use until she was older, everyone I talked to said she was probably sucking for comfort and needed something other than the breast to suck on. So, we introduced the pacifier at about two weeks old, and she loved it. Even that young, she knew when she was hungry and full. If she was hungry, she'd refuse the pacifier, but if I held the pacifier next to the breast, she would nurse until she got full and then turn her head to suck the pacifier instead. The pacifier was a lifesaver! My daughter never had a drop of formula after my milk came in at two days old; she switched to whole cow's milk during the day at about 15 months and weaned completely at 17 months.

    May 1, 2012 at 00:21 | Report abuse | Reply
  8. MB

    For cripe's sakes, just let the mother decide. I'm tired of all the guilt attached to every single thing the mother decides for her children. All these stupid studies do is create more paranoid helicopter parents.

    May 1, 2012 at 15:30 | Report abuse | Reply
  9. Ethics Board

    I used to preach to families about the importance of breast feeding: transmission of maternal immunoglobulins for infection prevent, DHA for improve intellect (though those studies are questionable), but after having kids myself... I discovered I was preaching a bunch of trash. It didn't prevent my kid from getting sick constantly and the whole intellect thing is genes and environment, not the about of compound X in a milk vs formula. Parents have the option to choose breast milk or formula, whatever works best for them, but to say one is better than the other is garbage.

    May 4, 2012 at 16:13 | Report abuse | Reply
  10. jillmarie

    My baby is exclusively breastfed from hour one, and the pacifier only, well, pacified her when she was crying during her first days. I think a lot of it is our perceptions, not how our babies actually react.

    May 7, 2012 at 14:57 | Report abuse | Reply
  11. John Amberly

    We used the Ortho-Gibby pacifier to help transition our son from a NUK.

    May 16, 2012 at 22:41 | Report abuse | Reply
  12. younglee1

    It's very easy to be negative about pacifiers until you've been up all night and it's the only thing that will calm the baby.
    I think limited use of them is the way forward. I've written a short blog about my own personal experience here.

    http://dadwithtwokids.wordpress.com/2013/01/03/dont-be-a-dummy/

    thanks
    Younglee

    January 3, 2013 at 08:10 | Report abuse | Reply

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.