Pacifier Use Does Not Interfere With Breastfeeding

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MAM BabyToday please welcome my friend Kristine Brite McCormick, an amazing newborn heart screening advocate. Kristine lost her baby Cora to a congenital heart defect, and now focuses all of her energy on saving the lives of infants so that other mothers will not have to suffer as she has. Kristine attended an important conference focused on preventing SIDS and stillbirth, and learned some promising things about the use of pacifiers. She’s sharing them here today. This post is sponsored by MAM.

When I gave birth to my daughter, I was a self-labeled “SIDS fanatic.” I was petrified of finding my baby unresponsive in her crib. I studied all of the recommendations and had a list of dos and don’ts for my entire family to follow. Little did I know that something else would kill my daughter, Cora. She died of a congenital heart defect. I’ve since become an advocate for newborn heart screenings, which can detect congenital heart defects and save lives.

I never planned on becoming an infant health advocate, but my advocacy work has connected me with other grieving mothers, health professionals and nonprofit organizations. While I focus my efforts on pulse-oximetry testing advocacy, my fear of SIDS hasn’t waned.

As a guest of MAM (the babycare experts and makers of BPA-free pacifiers, bottles and teethers) and a contributor to Postpartum Progress, I recently attended the 2012 International Conference on Stillbirth, SIDS and Infant Survival hosted by First Candle, the nation’s leading nonprofit organization dedicated to safe pregnancies and the survival of babies through the first year of life.  First Candle supports research, education and advocacy in the fight to eliminate SIDS and I was honored to attend the event.

I was particularly eager to learn more about the connection between pacifier use and SIDS prevention. Over the past few years, I’ve been hearing more buzz about the topic. I’ve read that pacifiers reduced SIDS, but I’ve also read conflicting research  about whether or not pacifiers interfered with breastfeeding. Like many issues related to parenting and motherhood, pacifier use is a polarizing issue. On blogs and internet forums, moms debate each other about nipple confusion and when or if to introduce a pacifier. I was interested to learn about the newest research and to hear what the panel participants had to say about this sometimes controversial topic.

In a panel discussion on pacifier use and breasfeeding, Dr. Alejandro Jenik, of the School of Medicine, Hospital Italiano de Buenos Aires, and his fellow panelists shared some interesting research that may help put to rest some of these concerns.

The panelists found that introducing a pacifier at 15 days does not decrease breastfeeding rates or the duration of breastfeeding. Since pacifier use can reduce SIDS, Dr. Jenik and his collaborators concluded that recommending a pacifier at 15 days postpartum is appropriate, stating, “The recommendation to offer a pacifier at 15 days does not modify the prevalence and duration of breastfeeding. Because pacifier use is associated with reduced incidence of sudden infant death syndrome, the recommendation to offer a pacifier appears safe and appropriate in similar populations.” 

While the research on pacifier use in reducing SIDS is well-known, many moms continue to worry about when and how to use pacifiers.  Many lactation consultants recommend waiting nearly a month to introduce a pacifier in order to establish breastfeeding first.  I was relieved to learn that because the risk of SIDS is very low during the first month of life, according to the experts at First Candle, it is in fact safe to choose to delay introducing your baby to a pacifier until breastfeeding is established and as early as 15 days.

If you are experiencing symptoms of postpartum anxiety or depression, you may have even more concerns. It can be difficult for mothers to filter the numerous reports and new stories to determine what is scientifically-proven versus an old wives tale.  For parents struggling with the pros and cons of pacifier usage to help prevent SIDS, the findings shared at the International Conference on Stillbirth, SIDS and Infant Survival may help alleviate some of their concerns.

For example, in another panel discussion, experts revealed that even limited pacifier use was enough to reduce the risk of SIDS, which is welcome news for anxious moms.  Dr. Fern Hauck, Professor of Family Medicine and Public Health Sciences at the University of Virginia, presented an article which summarized several studies stating that it’s normal for babies to only use their pacifiers for a few minutes during sleep.

Well-meaning but sometimes misguided advice from friends and family as well as conflicting research and alarmist news reports can add to the stress new moms may feel. Sleepless nights and worry about SIDS and nipple confusion definitely doesn’t help.

I was really happy to hear the same recommendation over and over at the First Candle conference. If your baby doesn’t accept a pacifier, don’t freak out about it. If your baby spits out a pacifier while sleeping, you don’t need to worry — the new research shows that even brief pacifier usage helps reduce SIDS risk. And if you want to offer a pacifier to soothe your breastfed baby, the new research shows that pacifier use does not work against nursing moms when a pacifier is introduced after 15 days.

For more information about the work of First Candle, please visit: www.firstcandle.org.  To learn more about MAM pacifiers, please visit: www.mambaby.com.  If you’d like more information, please join the conversation on Twitter using #firstcandle, @mambaby and @kristinebrite.

Disclosure: Kristine Brite McCormick attended the First Candle International Conference as a guest of MAM (http://www.mambaby.com) on behalf of PostpartumProgress, but the observations in this post are her own. MAM Baby was a sponsor of the First Candle Conference.

Katherine Stone is an ambassador for MAM, the babycare experts and makers of BPA-free pacifiers, bottles and teethers. She is grateful for their donation to the nonprofit, Postpartum Progress Inc., to help support its work supporting moms with postpartum depression. 

 

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About Katherine Stone

is the founder & editor of Postpartum Progress. She was named one of the ten most influential mom bloggers of 2011, a WebMD Health Hero and one of the top 25 parent bloggers using social media for social good. She also writes the Fierce Blog, and a parenting column for Disney's Babble.com.

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  1. Thank you for a well-written and very thoughtful article, Katherine. This surely will empower mothers already successful with breastfeeding and wanting to do everything they can to care lovingly and ensure the greatest safety for their little ones!

    However, I feel that it is important to note that the study abstract describes the moms selected for the study as “highly motivated to breastfeed” . . . pacifier use after 15 days may not cause problems for nursing dyads that are “HIGHLY MOTIVATED” . . . but I still feel that it is irresponsible to tout the results of this study as applicable to ALL moms. If the moms in the study were “highly motivated”, then the result is technically only applicable to highly motivated moms, not to all moms. The atmosphere in our society regarding breastfeeding makes for many barriers that can quickly discourage a mom from “highly motivated” to “slightly motivated” to “hoping she’ll succeed” . . . and so on.

    Moms who are not feeling confident in their nursing relationship, or who are still having trouble nursing at 15 days, or who are nursing but supplementing via bottle, or who are nursing but have non-supportive friends or family members, or who are nursing but are returning to work (and thus may be beginning to use a pump or supplement formula for feeds when mom is separated from baby) may not fall into the same category as the “highly motivated breastfeeding moms” who were the subjects of the study on which the pacifier-use news is grounded.

    Again, I thank you for a great article. It is wonderful news for moms to which the study is applicable!

    • Hi Amy,

      Really great point! This was only one of the studies presented that morning. Other researchers talked about findings of studies that looked at long term (6 months, 1 year) and how pacifiers affected both highly motivated and not so motivated moms and breastfeeding with similar results. I’m going over my notes from the presentation tonight and will try to pop back in with links to relevant studies.

      One of the researchers said that he felt the WHO recommendation back in the 90s to limit pacifiers for the baby friendly hospital initiative was based not on evidence-based care, but the principle of possible nipple confusion. I found it really interesting, and look forward to digging more into the issue.

      Thanks!
      Kristine

      • Thanks for looking into the other studies, Kristine! I look forward to hearing what other studies were discussed!

        I’m not disputing the usefulness of pacifiers to help reduce the chance for SIDS. Since pacifiers are a substitute for the breast, having a paci in a baby’s mouth during the night will have a similar effect that breastfeeding through the night does – engages baby in suckling. . . which in turn does reduce the chance for SIDS. Suckling at the breast being the natural deterrent from SIDS susceptibility and the pacifier simulating the breast. . .

        But I am just concerned about the recommendation that introducing a pacifier at 15 days of age is a good thing on a comprehensive level. At 15 days of age, babies are still waking frequently to breastfeed. Breastfeeding relationships are still being formed at that point. The study simply isn’t applicable to comprehensive use if the study was done with only “highly motivated” moms, and introducing a pacifier a 15 days is really early in the breastfeeding relationship, especially for one that is still being established and having all the kinks worked out of the “dance” of nursing :)

        I’m looking forward to hearing about the other studies from the conference! Thanks for digging in to the issue, Kristine!

        Amy

        • Have to agree with Amy on this one. The study was done in a country that has FAR more support for breastfeeding mothers, and a current rate of exclusive breastfeeding at 3 months that is literally double that of the US. If the study on if artificial nipples increase bf failure rates is performed in a country that is not prone to breastfeeding failure, I have to wonder at the logic of this, other than that Mam found a study to endorse that encourages the sale of their product. I would like to see studies in the US that yield the same results before I’d be willing to be paid to write a post that could jeopardize anyone’s breastfeeding relationship.

  2. Since one of my peeves with pacifiers is that I often see babies and toddlers with a pacifier in their mouth what seems like all the time, I’m wondering how many minutes a day on average the pacifier was in the mouth for this study. Perhaps, this group was super vigilant regarding amount of time, restrictions on use and so on, which would indicate that their behavior was different than what seems average use is like. Any information in the study or other research regarding usage?

    • The researchers at the conference talked about that and the consensus seemed to be to use the paci when laying baby down for naps and sleep, and not to worry about putting it back in, so limited amount a day.

  3. Well, isn’t that great. A pacifier company wants us to know it is ok to use a pacifier. Pacifiers are an artificial substitute for the breast, end of story. They have no advantages over access to the breast for baby. While it may be beneficial for ease of life for parents, and that is a perfectly valid reason, you can achieve similar SIDS reduction with safe co sleeping arrangements. (http://www.nd.edu/~jmckenn1/lab/articles/McKenna_why%20babies%20should%20n.pdf)

    So, IF the study cited was valid (though I think Amy^ has some valid points) then really the point is just “If your life would be made better by substituting a pacifier to soothe your child, then there is some evidence that says doing so may not have the negative impact on breastfeeding that we have been taught.”

  4. Excellent information! I was a little worried that Aaron might get confused since he got confused when he sucked on my husband’s finger before we went home from the hospital but thankfully, now that breastfeeding is well established, he’s fine going back and forth between the two.