Pacifiers And Breastfeeding: New Study Challenges Conventional Wisdom

Think binkies are bad for breastfeeding?

You may have to think again.

Hospitals across the U.S. have stopped giving pacifiers to newborns in order to encourage breastfeeding, but a new study casts doubt on the usefulness of that practice. Researchers found that when Oregon Health & Science University (OHSU) implemented a policy to remove pacifiers, breastfeeding rates fell, while the use of supplemental formula went up.

"Our observations suggest routinely removing pacifiers may negatively impact exclusive breastfeeding rates during the birth hospitalization," said Dr. Carrie Phillipi, a pediatrician with Oregon Health & Science University and co-author of the study, presented Monday at the Pediatric Academic Societies' annual meeting in Boston. Major health organizations, including the American Academy of Pediatrics, have recommended exclusive breastfeeding for a baby's first six months.

To look at the impact of pacifier removal on breastfeeding, researchers considered data from more than 2,200 infants born at OHSU between June 2010 and August 2011. Midway through that time period, the hospital instituted a policy preventing nurses from regularly giving pacifiers to breastfeeding newborns in an effort to qualify as a so-called "Baby-Friendly" hospital. That initiative, sponsored by the World Health Organization and United Nations' Children Fund, recognizes institutions that promote breastfeeding by adhering to 10 steps, such as not giving infants outside food or drink unless medically indicated, and not providing pacifiers or artificial nipples. Groups like the American Academy of Pediatrics also recommend delaying introduction of pacifiers until babies are one-month old.

Notably, breastfeeding rates dropped substantially after pacifiers were restricted. Nearly 80 percent of infants breastfed exclusively in the months prior to the restriction, versus just 68 percent in the months after.

At the same time, the proportion of infants receiving supplemental formula also increased, jumping from 18 to 28 percent.

"As pediatricians and mothers who have breastfed our own children, we know first-hand there are a variety of opinions on pacifier use," Philippi said, admitting that she was surprised by the results.

"It's really hard, with newborns, to say that there's one rule that works for everybody," agreed Diane Asbill, a registered nurse and lactation consultant with the University of North Carolina's Women's and Children's Hospital, which recently earned the Baby-Friendly designation.

She explained that when it comes to full-term, healthy babies, the belief is that pacifiers may cover up feeding cues in the first few crucial days of learning. It may also make it harder for some babies to discern that they need to suckle not just to self-soothe, but also to get food.

Asbill's colleague, Kim Novak-Jones, a registered nurse who works at the maternity care center, also expressed surprise at the new study's findings. At UNC, she said, breastfeeding rates have jumped substantially since the hospital took steps toward becoming a Baby-Friendly hospital, including limiting pacifier use.

"I don't think we can prove a direct correlation, but we have seen what we think is a really nice increase in breastfeeding rates, and we think this is one of the factors," Novak-Jones said.

The authors of the new study said they do not yet understand the mechanisms underlying the shift they found in their hospital, nor do they claim that their findings should prompt a radical shift in hospitals' policies regarding pacifiers.

Instead, they say the findings highlight the need for continued research on the role of pacifiers in breastfeeding so that hospitals -- and, more importantly, parents -- can make informed decisions about how to proceed.

"Taken together, the 10 steps [required to become a Baby-Friendly hospital] have been shown to improve breastfeeding rates," Philippi said. "However, the individual contribution of removing pacifiers as one of the 10 steps hasn’t been as well studied."

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Comments

[Marshalact]

09:23 AM on 05/06/2012

This observational study hardly qualifies as a reason to institute the use of pacifiers for breastfed infants in the hospital. Too many other factors were not controlled for. This is not a peer reviewed study. What else was missing here? Perhaps mothers who used pacifiers in the past on that unit did so as a substitution for effective breastfeeding. Too many unknowns here to think that pacifiers are necessary for breastfeeding. Jumping to conclusions based on shaky evidence is not warranted.

[Adam Bair]

10:31 AM on 05/03/2012

"Major health organizations, including the American Academy of Pediatrics, have recommended exclusive breastfeeding for a baby's first six months."

How is that supposed to happen when there are only 12 weeks of leave, unpaid at that, protected by law? I'm sure it's no problem for some well paid people afford to live on one salary. The rest of the country is apparently just supposed to have less healthy kids, because the first six months of exclusive breastfeeding will only happen if the family can afford for the mother to have those six months off. Look at how much healthier, both physically and mentally, the young parents in Sweden are.

[jessiernut]

01:25 PM on 05/07/2012

Pumping is an option. it isn't perfect, but it is doable. I did it when I went back to work.

[Lmurwood]

12:45 AM on 05/02/2012

My three breastfeed babies reject them. We have on on hand just incase but the only time my children use then is when they are teething. They are great gum soothes for chewing on.

[labbok]

04:43 PM on 05/01/2012

This study, with sudden removal of a crutch without intensive training on how to alternatively comfort infants, was doomed to have this result. It is not the lack of the pacifer itself that is the problem, but the fact that it had been used to substitute for time at the breast compounded by the fact that we have lost other comforting techniques.
In the first days of life, the baby intends to be at the breast; if it is left aside, it becomes upset, and folks have forgotten that we need to comfort the newborn with skin to skin and breastfeeding.
A new mom can become very discouraged if she does not know how to comfort her breastfed baby,and may readily attribute the fussiness to breastfeeding!
I think this study needs to be redone, offering alternative comforting techniques and the kind of breastfeeding support that UNCH offers, as mentioned by Ms Asbill and Novak.

[Antidiot]

03:11 PM on 05/01/2012

What is appropriate for a newborn and what is appropriate for a toddler are two different things. I see all these comments generalizing so much. I just felt like that needed to be said.

[saliza4356]

01:22 PM on 05/01/2012

I am currently nursing my newborn and i use a pacifier. It helped in the begininng to teach him to stop pushing his tongue to the roof of his mouth when latching. Now he doesnt even seem to want it. I suppose it depends on the baby...I dont mind being a pacifier anyway.

[Jenny-Ann]

01:10 PM on 05/01/2012

My problem with pacifires is I've known way to many people who have used them as baby-sitters. I also hate seeing 3/4/5+ y/o's running around with them.

[Vanderbil Covington]

01:08 PM on 05/01/2012

First off, babies -- all babies -- are born with a instinctual propensity for breastfeeding. They don't have to be taught if given to the mother shortly after birthing cleanup. I can only imagine what effect on the baby may have when a pacifier is shoved in it's mouth and nothing comes out.
Bottle feeding came in vogue during WWII when mothers served in munitions factories and breast feeding was not a convenient option. The dairy companies filled this profitable market by promoting bottle formulas from cow's milk. It is little wonder children today have so many mental and physical ailments due to being denied their mother's own milk. Human breast milk contains enzymes especially formulated prior to birth. No machine or other animal can produce this. The other problem is the truly unfortunate attitude of a society that is so twisted, they feel offended at seeing a mother breastfeeding her baby in public. Far too many think breastfeeding is an act of molestation! How sad

[Freedom Mama]

03:05 PM on 05/01/2012

I think your post is not only inaccurate, but potentially hurtful to mothers whose breastfeeding experiences didnt go well. It is certainly not true that ALL babies can breastfeed well, and some not at all. Back in the day, it was not uncommon for a baby to starve to death due to not being able to breastfeed. Bottlefeeding has certainly saved the lives of many such babies in the past 50 years. There are many medical issues that interfere with a baby being able to adequately breastfeed. Breastfeeding is wonderful for those babies and mothers that can do it. For those who cannot, bottlefeeding is a perfectly acceptable alternative. Pacifiers are fine for either, and are personal preference.

[Vanderbil Covington]

03:28 AM on 05/02/2012

There are always exceptions to any norm, but for the majority of babies, breastfeeding is best and not a problem. I still insist cow's milk and formulas are inferior substitutes. Milk from other sources than mother's own, contain cattle growth hormones, medications, antibiotics -- formulas: preservatives and many additives not beneficial to infants. Before these products came to market, there were 'wet nurses' that at least offered human milk

[66readerwriter]

09:52 AM on 05/01/2012

I guess now is not the time to invest in binkie stocks.

[zmfts]

09:31 AM on 05/01/2012

I think the problem with pacifiers is that a lot of inexperienced parents use them for the wrong reason. I don't think they should be sold over the counter. You should be required to demonstrate a medical need for one and you should have to get a prescription for it.

The whole reason babies have a suckling instinct in the first place is because there was a time when they needed to nurse in order to survive. Now, we have formula that greatly reduces the evolutionary need for mothers to breastfeed, and yet the sucking instinct persists, so we've developed fake plastic boobs for babies to suck on instead. This is progress?

It bothers me when I'm shopping somewhere and I see a mom shopping, completely ignoring her baby as he fusses and cries. He clearly needs her attention, but she just shoves a pacifier in his mouth and goes back to shopping. To me, that's not what a pacifier is for. It's not your babysitter.

Makes you wonder how many kids ended up with delayed speech because they were always sucking on a pacifier rather than practicing their word sounds. Or, for that matter, how many kids ended up getting braces because their teeth came in crooked.

[Vanderbil Covington]

01:10 PM on 05/01/2012

Very, very true

[fabesbabe6755]

08:03 AM on 05/01/2012

Infants need pacifiers to learn how to suckle? My goodness, how did mankind survive all these thousands of years without them? When I had my children 40 years ago the breast feeding movement was in it's infancy so most babies, mine included, were bottle fed. That being said I only used a pacifier in the first few months when they were fussy or when it was time to get them to sleep through the 2 am feeding. They never really took to it anyway. If a baby needs something in his/her mouth they will eventually find their fingers or fist. My goodness, what do you think mothers and babies did before pacifiers were invented?
Then there is the tendency to let the kids suck on them forever. I can't believe it when I see 2 and 3 year olds in the park with pacifiers in their mouths! And parents who think their babies should be sucking on them every waking moment. The paci drops out (or the baby pushes it out) and the parent sticks it right back in. Heaven forbid the child should fuss a little. They were meant to sooth temporarily not permanently.

[junelee0319]

07:50 AM on 05/01/2012

It just amazes me how women managed to deliver - care for - and raise children - before all
of the wonderful studies ( and it was actually done better )

[Vanderbil Covington]

01:15 PM on 05/01/2012

Please, don't rely on "experts" advice. You can find as many different opinions on any given subject, as there are experts,-- none of which know the truth

[Ryan Hartford Stanley]

09:17 PM on 04/30/2012

I'm going to guess that the reduced breastfeeding rates (once pacifiers were removed) are the result of a lack of education. Babies who are not given a pacifier are naturally going to nurse more. If a new mother is not prepared for the constant sucking that newborns are bound to do at the breast, especially when given no alternative, that mother may be more likely to give up on breastfeeding either because she thinks she is not satisfying her baby's need or because it's too physically demanding.

[Maire Prabhakar]

11:20 PM on 04/30/2012

I was thinking exactly the same thing!

[ncnole90]

08:08 AM on 05/01/2012

I am not sure that I agree with your first guess about lack of education Could be true.. But I agree with the rest. Bottom line is everyone needs to let the individual mother decide what works best for her and her baby. I am a bedside NICU nurse with 21 years of experience. I am all for breastfeeding. What I do not like is the act that a lot of mothers feel very, very,very pressured to breastfeed. We highly encourage mothers to pump to provide breastmilk for her baby and we also use donor milk.Breast milk is best for babies. No doubt there. Many moms feel like a failure when they are unable to produce enough milk. My frustrations lie with the people (LCs,nurses,whoever) that see breastfeeding or anything in black or white...all or none. Those people who are not flexible with their ways of thinking. BTW we have about 8 of our NICU nurses who are Certified Lactaton Consultants. They are wonderful

[Ryan Hartford Stanley]

08:59 AM on 05/01/2012

Look at the breastfeeding rates for women who give birth out of hospital and you'll understand what I'm talking about. I believe moms feel like they have failed because we have come to a place where breastfeeding is not seen as the normal way to feed a baby. There is too much pressure, you're right, but from my experience, as a postpartum doula and lactation counselor, hospitals are watching the clock, scale and blood tests instead of allowing nature to take it's course. Pumping is never an adequate measure of production. Women should be allowed to be skin to skin, nursing their babies as often as baby requests, even in the NICU. When women are told, "It's okay, breastfeeding is hard, here are some alternatives" and every single one of those alternatives is shown to undermine the nursing relationship, I'm not sure that's the kind of flexibility I would be looking for.

[Antidiot]

10:52 AM on 05/01/2012

The lack of education is that some babies will need to nurse constantly ( yes - constantly meaning rarely taking the baby off the boob at all) not every 2 hrs or even every 30 minutes but continuously for the first few weeks. Many baby animals do this and it is perfectly normal for human babies too, but when this happens a lot of women don't go with it. They think they aren't producing enough or their baby isn't satisfied. It could be that the baby just needs to suck more and/or the mother needs more stimulation so that she'll make more milk. I have seen at least two of my neighbors with healthy babies concerned about low production yet unwilling to walk around all day with their boob out while their baby sucks for a minute then stops and starts again. In real life as opposed to on a message board it is difficult to tell someone they may have to do something like that, so we don't say anything at first and then when we do say something they take offense and think they are being "judged". I would really like to see better education on these kinds of things. I think it should be taught in high school health class so both girls and boys learn about it before they are on the spot and need to use that knowledge.

[Alison Carabajal]

08:24 PM on 04/30/2012

I breastfed my 2 older boyos and am currently breastfeeding my 7 month old. Darn straight I gave them a paci though! The reason? My breasts aren't pacifiers. They are there for food. Paci's soothed all 3 of them when I knew they weren't hungry but wanted something in their mouths. My oldest stopped using the paci and discovered his thumb at about 2 months old then stopped with the thumb at around 4 months old. Middle child was the toughest to get off the paci. My baby stopped using a paci when he was about 3 months old and sometimes just sucks on his fingers. Never did using a paci hinder my breastfeeding any of them.

[Bud Moon]

10:21 AM on 05/01/2012

You sound like a sensible mom. As an old nurse with lots of post partum experience, I know that a hungry baby will suck on anything; the breast is for food, not play. Lactation specialists are the scariest people in the world, and the social pressure to breast feed is counter productive. So is the "feed-on-demand" advice. Babies fed on demand grow up to be demanding eaters. I advise moms to be in charge of their families, condition the demand to be at regular intervals -- see that baby gets a full meal at feeding time and don't respond to every cry with food. This method makes for contended babies who become confident their needs will be met.

[Antidiot]

11:04 AM on 05/01/2012

I disagree that attitude that the breast is for food not play is why many women end up not making enough milk and giving up. Breast make great pacifiers but many women are unwilling to give their newborn their breast when they aren't "serious about eating"(babies do not need to be serious about anything). Newborns do not need to get milk consistently nor is that the only reason for the constant suckling. Not only is the skin to skin thing very comforting, but to allow the baby to get on and off the breast at will in the newborn stages encourages better milk production. It is a symbiotic relationship and it works if we let it. By not encouraging this type of thing and letting them know that it is normal to expect, you are setting many nursing mothers up for lower production or frustration with the lactation process.

[Jenny-Ann]

01:15 PM on 05/01/2012

"So is the "feed-on-demand" advice. Babies fed on demand grow up to be demanding eaters. "
I don't agree with this. All four of my kids were fed on demand and none of them are demanding eaters now.

[Jenn Riedy]

03:18 PM on 05/01/2012

Sigh. I really have no problem with a mother choosing to use a pacifier with her baby if she feels "touched out." However, when a baby sucks for comfort the baby is NOT using the mom as a pacifier! The baby is using the mom as a ... MOM. A source of comfort and nurture. It is the pacifier that is the replacement mother!

[Alison Carabajal]

06:35 PM on 05/01/2012

If a mom gives her baby a paci and then holds, rocks, bounces, whatever to get him soothed how is that paci replacing the mother? It makes no sense to me. Moms don't need to lose all their identity and just become the MOM when a baby is crying. Yes the baby needs to have his or her needs met. But it doesn't have to be with the breast all the time.

[hazyafternoonsunshine]

08:11 PM on 04/30/2012

I breastfed 4, never used a pacifier. I never even tried one, so I really do not understand why someone would give one to a child. I don't have anything against them, I just do not understand the need.