There is an organization in North America , relatively new, who calls itself P.A.P. It stands for Pediatricians Against Pacifiers. Whenever I read about this organizations efforts, I wonder if I should take them seriously or not.
All four of my children experienced the benefits of breast feeding, yet they were also introduced to pacifiers at some point during the breast-feeding period. It appears that we may have been fortunate that pacifiers did not undermine the breast-feeding's success.
The World Health Organization discourages the use of pacifiers in order to enhance breast-feeding practices. The effects of artificial nipples on breast feeding duration is poorly defined.
A study published earlier this year in Pediatrics, gave me the answer, more or less, as to why pacifier use in my own children did not sabotage breast feeding.
The authors studied 700 breast fed newborns in the Rochester , New York State Area. All the babies weighed more than 2200 grams and were born after 36 weeks gestation. They were randomly assigned into one of four intervention groups:
- bottle supplementation and early introduction of pacifiers
- bottle supplementation and late introduction of pacifiers
- cup-feeding and early pacifier introduction
- cup-feeding and late pacifier introduction
These babies were then followed at 2, 5, 10,16,24,38 and 52 weeks after birth. The outcome was filled with interesting findings. Regardless of the methods of supplementation, cup or bottle, there was a detrimental effect on breast-feeding duration. This is less surprising, obviously.
When comparing cup feeding and bottle feeding supplementation, there was no difference; both were equally bad in undermining the duration of breastfeeding. But the surprise was that among infants delivered by caesarean section, cup feeding significantly prolonged exclusive, full and overall breast-feeding duration. Why prolonged? Nobody knows for sure, but theories abound.
Exclusive breast-feeding at 4 weeks was less likely among the babies who had early exposures to pacifiers. However, when pacifiers were introduced later, it did not sabotage the duration or success of breast-feeding. The message then may be that early use of pacifiers are bad in terms of their effect on breast-feeding. But what happens later when the older baby gets cranky? (And who has not used a pacifier to pacify the screaming-at-the-top-of-his-voice little bundle of nerves; soothing him or her; sticking the “Dummy” in the baby's mouth? Thus the other names of pacifiers: Dummy or soother)
Another paper published a few years ago, with few subsequent similar studies I may add, alarmed some parents when it suggested that babies who use pacifiers tend to get more episodes of middle ear infections. Even later there
may be potential risks associated with pacifier uses. Non-nutritive sucking indeed tends to calm babies. It appears it may do more than calm them, they may get confused at an early age; (meanwhile I remain confused that busy pediatricians have managed to find the time and money to form P.A.P.) This confusion is also known in some circles as “nipple confusion”. Dr M. Neifert and her colleagues described this condition in detail in a paper published in 1995 in the Journal of Pediatrics, (Nipple confusion: Toward a formal definition. Vol 126.:S125-S129)
Where does all of this leave a parent? If breast feeding is going well, feel blessed. Remember that although it is natural it is not always easy; in some cases it takes perseverance, which pays high dividends later. I tell mom's that similar to learning how to dance with their partners, they need to learn how to co-ordinate their breast-feeding “dance” with the baby.
When breast-feeding is a challenge, consider cup feeding instead of bottle supplementation. Even better, ask for a referral to the Lakeview Breast feeding clinic, one of the best clinics for that issue in North America . Breast-feeding a baby until 6 months of age remains the golden goal. However only a third of mothers achieve that goal according to figures on the American
Academy of Pediatrics ' web page, ( www.aap.org ). Canadian figures are no better and the Canadian Pediatric Society has useful information on establishing good infant feeding practices at www.caringforkids.cps.ca.
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