Friday, November 2, 2012

The Pacifier Question

I can't tell you how many times I've been working with a new parent when they sheepishly tell me that their baby uses a pacifier. Often it's an admission they don't even want to make, assuming lactation consultants are intensely anti-pacifier, or worse, that using one means they're failing as parents.

So I want to take this opportunity to officially state that I am in no way against the use of pacifiers! What's more, I want to dispell the myth that lactation consultants believe that all of baby's sucking needs should be taken care of at the breast and that mothers who use a fake nipple aren't "doing it right."

I can see no reason why a baby who is breastfeeding well and gaining weight shouldn't be given a pacifier for non-nutritive sucking. Babies, especially very young babies, have an inherent need to suck. It's very comforting to them, and it doesn't always indicate a need to eat. Babies who have gastroesophageal reflux (GER) often benefit from sucking on a pacifier between feedings, and there is sound research that suggests that pacifier use may reduce the risk of SIDS.

Regarding feelings of "ineffective parenting," I would encourage you to relax and ground yourself in reality. While new mothers are often hyper-pressured to exceed attachment parenting guidelines in meeting their baby's needs, allowing your body to be baby's pacifier simply may not be appropriate for your lifestyle. For one, many mothers experience severe nipple pain/trauma from non-nutritive sucking (sucking without making a milk transfer). Others simply cannot be there to meet their babies' sucking needs 24/7. There is no reason to feel guilty about using a pacifier to calm your baby when you can't be there to do so yourself; while parenting certainly requires a high amount of selflessness, you're not going to be able to be an effective caregiver if you've given away all of your personhood in the first year of your baby's life!

On the other side, mothers are often told that acting as baby's pacifier will "spoil" them and impede their independence. This is also a completely unfounded notion; there is absolutely no evidence that responding to a baby's needs on demand will in any way contribute to an unhealthy dependence on their mother. If a mother has no nipple pain, then there is no reason not to forgo the pacifier for more breast time if it fits into mom's lifestyle and desires.

My only recommendation for pacifier use is that parents wait at least three weeks before introducing them or any other artificial teat (unless supplementation with a bottle is indicated, as directed by a lactation consultant). I recommend this for several reasons. For one, I want parents to learn how to read their babies' cues. Are they hungry, or do they just need to suck on something? This learning tends to take several weeks as parents adjust to having a new baby around. Secondly, the first two weeks after birth is critical in establishing mother's milk supply for the long term. If the delicate dance of supply and demand is interrupted by early pacifier use, mom's supply could suffer. Lastly, while true "nipple confusion" is rare, I do like to see babies demonstrate that they have gotten the hang of breastfeeding (generally, they get back to their birth weight in two or three weeks) before putting anything else in their mouths. This is especially true for babies who for whatever reason were slow to start or had any difficulty getting a grasp on feeding from the breast (pun totally intended).

Using a pacifier for your baby's non-nutritive sucking needs is nothing to be ashamed of or worried about. As a parent, you are capable of making the best decisions for you and your baby, and so long as your baby is nursing well and gaining weight, there is no reason to avoid pacifiers if you wish to use one.

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