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Pacifiers: they don’t suck as much as you thought

It’s no secret that APers don’t like pacifiers. Besides the fact that they’re made out of ‘unnatural’ materials such as plastic or latex, pacifiers serve as ‘mommy substitutes’ for the purpose of non-nutritive sucking, and we know that anything which fills in for Mommy is a bad, bad thing. When the AAP released its 2005 policy statement regarding measures to prevent SIDS, Attachment Parenting International took issue not only with the recommendation against bedsharing, but also because they recommended pacifier use, even though there is quite a bit of evidence to recommend the practice as a SIDS prevention measure ,though the exact mechanism by which this occurs is not known:

The use of a pacifier during the transition-to-sleep is problematic, as this has been shown to undermine breastfeeding. Given that pacifier use can inhibit breastfeeding duration and milk production, API does not support the recommendation of the AAP and recommends that breastfeeding mothers be encouraged to breastfeed during the transition-to-sleep and throughout the night—an activity that promotes sucking and provides important nutrients.

La Leche League does find the use of a pacifier legitimate in some circumstances, but still warns against pacifiers interfering with establishing and maintaining breastfeeding (the AAP also recommends waiting until the baby is 1 month old to prevent this, and to withdraw the use of the paci by the age of a year to prevent dental issues).

However, a recent systematic review in this month’s Archives of Pediatrics and Adolescent Medicine suggests that pacifiers have no adverse effect upon the initiation or the duration of breastfeeding. The apparent effect is seen (in observational studies, but not RCTs) because women who plan to wean anyway use the pacifier to satisfy their infants’ need for non-nutritive sucking, or women use the pacifier as a too to help them wean their infants. The authors state:

In conclusion, the strongest current evidence on pacifiers and breastfeeding indicates that pacifier use is not detrimental to breastfeeding outcomes.

Mind you, I tried very hard to get all 3 of my children on a pacifier. All of them pretty much refused to take it. I think I managed to get Eldest and Youngest hooked on the thing for about 3 weeks in their 8th or 9th month, but that was about it. I even had to use a stock photo above to depict a child with a paci, because the only picture I have of a child of mine with one is the photo below, where a relative is holding my daughter, and also holding the paci she kept spitting out:

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16 Responses

  1. Interesting. I did my own unofficial systematic review a while back, just out of interest, and found – hmmm, going from memory so don’t quote me on this one, but as far as I can recall, four RCTs on the subject of which three showed no difference and the fourth showed a difference in total breastfeeding duration but not in duration of exclusive breastfeeding (which made me think that the difference couldn’t actually be due to nipple confusion as that would have affected exclusive breastfeeding duration as well). So it didn’t seem to me that that particular AP dogma holds water. I’m curious as to what the study said – have to order it some day, though there are so many other things I want to order right now that I think I’ll give the hospital library a bit of a break!

  2. Funny, I’ve never seen a definition of AP that says that pacifiers are wrong. I consider myself staunchly AP and I used pacifiers with both of my kids.

    I do think that they can contribute to nipple confusion in cases where the baby is having latch trouble and it would be useful to avoid them in those circumstances. I also think that if a baby is not gaining weight as well as it should be, putting the baby to the breast when he needs to suck is perhaps a better alternative to a pacifier. I also think that if you habitually shove a pacifier in the baby’s mouth every time it makes a peep, that isn’t exactly responsive parenting. But beyond that, I think it really is a matter of parental and baby’s preference.

    Both of my kids had intense needs to suck. I wouldn’t have been able to go anywhere in the car, have a shower, or unlatch them once they were asleep if it weren’t for the pacifier. So I am thankful for it. I think it is more a matter of not overusing or abusing the pacifier, rather than avoiding it completely.

  3. The other problem with pacis and breastfeeding is nurses who stick in the bink to save themselves the trouble of having to bring the baby to mom. As a hospital policy, “no pacis” is probably still a good idea.

    I did have nipple confusion issues (not from a pacifier), so I’ll avoid them initially next time, but after that it’s fair game. With #1, the binky was magic. (A little too magic. We had to do a forcible separation.)

  4. Phdinparenting, the “ecological breastfeeding” folks are firmly anti-paci. They even claim, without AFAIK any actual evidence to support it, that not using sucking substitutes is a key component of using lactational amenorrhea for birth control. (No mention of how lactational amenorrhea works for children who suck fingers/thumbs instead.)

    Kellymom also says: “As long as you keep the above in mind and only use a pacifier sparingly, it is up to you whether and when you wish to comfort baby yourself or with a pacifier. However, keep in mind that there is no scientific evidence that suggests that babies have a need to suck independant of the need for food. When a baby is indicating a sucking need, it’s generally best that baby be encouraged to nurse.”

    Given that Kellymom is the foremost AP-oriented breastfeeding support site on the Internet, I think it’s fair to take that statement as evidence that the AP crowd are not big fans of pacifiers. I vaguely recall that Sears says something similar about pacifiers, although I could be wrong. While the major tenets of AP may not mention pacifiers, I don’t think I’ve ever seen them discussed as anything but an inferior alternative, and the implication is that mothers who use them do so for selfish reasons rather than as the best way to meet the baby’s needs.

  5. @Emma B.

    I don’t doubt the fact that some, even many, AP supporters prefer not to use pacifiers. I also don’t doubt that Kelly Bonyata (aka kellymom) in her capacity as a lactation consultant, does suggest that pacifiers be avoided at the initiation of breastfeeding and in certain circumstances.

    I just wanted to point out that not all APers hate pacifiers. In fact, there is another article on the kellymom site that talks about AP being a frame of mind (not a list of rules) and it says:

    “Some of the earliest posts to the AP online community have been from parents who question and berate themselves for not adhering to what they perceive to be the practicing requirements of AP. Depending upon the mood of the discussion, these might be the use of slings, extended breastfeeding, co-sleeping, or perhaps the avoidance of strollers, cribs, playpens, vaccinations, circumcisions, television, synthetic fabrics, allopathic medicine, disposable diapers, plastic toys, pacifiers, or bottles. Each time a parent questions whether she is truly an AP parent because they have chosen not to follow one or another of these methods, it is a heartbreaking blow to the essential self-assurance that all parents deserve. The fact that there seem to earmarks of Attachment Parenting makes so many of us think that if we do not practice all the “correct” AP methods, then we cannot call ourselves an AP parent. I heartily disagree. I believe that being AP is a frame of mind.”

  6. Sears discourages reliance on the pacifier. But, unlike Kellymom, he acknowledges some babies’ need for substantial non-nutritive sucking, and recommends the pacifier for that use. He admits to getting annoyed with it, but then acknowledges its use.

    I have a personal theory that bottle fed babies are more likely to genuinely need the paci–breastfed babies get more sucking time. I also think that this leads to some BF mothers (especially ones who are very strict about on demand and not setting limits) just not getting the pacifier or understanding some babies’ need for it. Binkaholics and all night nursers… hmmm… can’t see any similarities there.

  7. Annie: “Both of my kids had intense needs to suck. I wouldn’t have been able to go anywhere in the car, have a shower, or unlatch them once they were asleep if it weren’t for the pacifier. ”

    Silly – you’re not SUPPOSED to do those things, selfish mama!

    I’m pro-bink myself and in my limited experience, it hasn’t affected breastfeeding. DD1 didn’t breastfeed for very long, but while she did we had no supply issues or nipple confusion, and she had a pacifier from very early on. DD2 sleeps with her bink and she’s been breastfed for 9 months and counting.

    I will say I am grateful for the time when they finally learn to find it and put it back in by themselves.

  8. no paci for daughter here. she just didn’t take it and I had no opinion either way, I, naively thought it was one of those things that each kid chose.

    Fast forward 2 years and living in Israel. I’m still shocked to see kids over 4 and sometimes over 5 and even bigger with the paci 24/7. Moms seem to think of the paci as the toddler prozac. Kid opens mouth, stick the paci in. Once in the park I told the other moms that DD never took the paci, and they couldn’t believe I manage to calm her down without it. I witness all the time moms discussing how to force the paci on a reluctant baby to get them hooked on it ASAP. My daughter now has an imaginary pacifier because of the 14 kids in her group 12 have pacifiers (and almost every other kid in the block).

    So the end result is that now I am very anti-pacifier for reasons that have nothing to do with breasfeeding and that other garbage. Let’s hope future kids won’t want a paci or thumb, otherwise I’m in trouble.

  9. Annie – I said APers don’t like pacifiers, not that they are verboten – but that they see non-paci use as an ideal to strive towards. And mind you, I’m not sure sticking a breast in a baby’s mouth every time it makes a peep is any more responsive parenting than sticking a binky in there. Either way, you’re implementing a one-size-fits-all solution to a variety of problems.

    There is really very little research on this as far as I can tell, but I think nipple confusion is hyped an awful lot. Sure, if a significant proportion of your child’s feedings come from an artificial nipple from day one, you’re going to run into problems (and if there’s a latch issue, you might run into them regardless). I have yet to see a baby develop nipple confusion from a single bottle or from non-nutritive sucking on a paci – which is a different kind of sucking, anyway. Also, if a baby is really hungry, a pacifier (or a finger, which my kids would take – and better mine then theirs!) is at best a short-lived stopgap until they get the real thing. Which is why, I suspect, you might get babies who are fed in the nursery before the scheduled visit to breastfeeding Mom.

    Rachel – I’m not a huge binky fan myself, and in any case intended to ‘lose’ them for my kids by the time they were a year old or so. It’s a lot easier to lose a binky than the kid’s own thumb, though – and I kept on taking their thumbs out of their mouths and replacing with my own until they got the idea. I have to tell you, though, that at least in my area, I see a lot fewer die-hard binky addicts (at least not during the daytime) than I did when I was growing up. The dentists have, apparently, gotten through to some of the population…

    Sarah – the paper mentions 4 RCTs, and one of them (this one) fits the description of the study you mention. I’d email the review to you, but I have it printed out (I got it through my work computer and didn’t think to save it as a file, not that I could email it from there anyway). Sorry.

  10. I don’t have much to add to this save for anecdotes. Before I had my child, a friend told me to look out for this issue as *a lot* of people of *a lot* of opinions and they feel free to offer them and they do seem to break down culturallly. Her German mother was adamantly opposed to them, but her French Canadian in-laws were practically offended that she didn’t use the paci on her daughter. After all, they had raised four boys with it and they turned out perfectly. Her child made the decision for everyone in that she did not take it, ever. Oh well.

    We had a meeting of my mommy group one lovely summer day, the kids ranged in age from about 6-9 months, and the woman who managed to kind of ruined it across the board for everyone made her feelings known. Upon one mommy walking into the park with her cherub-with-a-paci, she blurted out, ‘I hope I don’t have to rip that thing out of his mouth’ and then went on to talk about how self-soothing was the only way to go. She had sucked her thumb until she was eight and she turned out fine (except for ripping things out of other people’s children’s mouths, that is).

  11. Boy will not take pacifier. I am the pacifier!

  12. I was the pacifier too, Julie. But for the sake of my nipples, I (literally) gave them the finger (to suck on) quite often as well. And I might just have had relatively non-sucky kids, for some reason.

    Now that I think about it, my eldest son came upon one of his old, long-lost pacis in a basket full of toys when he was about…oh, maybe 18 months old. I remember he put it in his mouth briefly, made a disgusted face, and flung the offending bink across the room. That was it with him and pacis! :lol:

  13. Both of my children hated the pacifier but loved sucking on my fingers. It was odd, but it worked. ;-)

  14. Esther: it must be a perifery thing, here in the north there are plenty of die hard pacis, and sadly the dentists can’t get through the parents to even get routine dental care for kids or grown ups on a regular basis. So I don’t think the dentists have much say on pacis. I guess if future kids have a need to pacifiers I will simply have to be a mean mom and take it away at around 1, before peer pressure

  15. Thank you for another interesting article. Once again, I’ll share the experience of my children.

    My first child was breastfed and used a paci. We never had a wonderful breastfeeding relationship because it always hurt. Did I use a pacifier to hold her off until the 2 hour feeding mark was up? You bet. Nursing her hurt my nipples for nearly a year, and I didn’t want to have her on my breast anymore than necessary. Maybe it hurt because she used a pacifier. Maybe I used a pacifier because it hurt. I’ll never know which came first.

    Fortunately, my chunky baby thrived in spite of me giving her an artificial nipple, although I was very tired from giving endless midnight paci-pops.

    My second baby never used a pacifier for 2 reasons- I wanted to be sure the pacifier was not the cause of nipple pain, and I hated having to get up at night to pop it back in the mouth. After several weeks of nursing, I had no pain, and we went on to have a wonderful breastfeeding relationship for a year and a half. Oddly enough, as an infant, she was slow to gain weight and was diagnosed with failure to thrive. She nursed whenever she desired and sucked on her fingers in between. She was simply a skinny kid, and pacifier use can’t be to blame. Now if we could just get rid of those fingers. . .

    My husband tried to give my third child a pacifier on several occasions. I could always feel it the next day because nursing hurt a bit. The pacifier never caught on, and my son fortunately does not suck his fingers either. We also continued to nurse into toddlerhood.

    Three kids=three different methods of pacifier/non-pacifier use. There is not one right way that suits every family’s situation. I wish more new moms had the confidence to decide what works well for them rather than feel coerced or guilty because they listened to or didn’t listen to parenting “experts.” . . .Unless, of course they want to listen to my expertise. . .

    Apologizing in advance for my sentence structure,
    RedOne

  16. I have used a pacifier with both of my boys and mixed fed (breastfed AND formula fed) – tut tut – without any problems – no nipple confusion etc. My three year old went from breast to bottle to paci without a murmur until he was just over a year and my 12 week old is doing the same…

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