What's Wrong with Pacifiers?

I received a question from a reader recently:

"Should a natural mama ever consider using a pacifier?"

I know there are experts who disagree with me, but the short answer is Yes. Every baby is different and some simply have very strong comfort sucking needs. Most of the time, those needs are met by breastfeeding, but there are plenty of breast-fed babies who still need to suck their thumbs. And while a thumb is definitely a more “natural” choice than a pacifier, there is one clear way in which a pacifier trumps a thumb. But I’m getting ahead of myself.

Pacifier manufacturers were given a blank check recently when the American Academy of Pediatrics released a recommendation that babies be given pacifiers at naptime and bedtime through the first year of life because studies show that pacifiers decrease the risk of SIDS.

The recommendation specifies that pacifiers should not be introduced until after one month of age in breastfeeding infants, when, presumably, nursing is well established and the pacifier won’t cause nipple confusion. The artificial nipples of both bottles and pacifiers are easier for a baby to latch onto than breast nipples, which may undermine an infant’s ability to correctly latch onto the breast. In addition to giving mom sore nipples, babies can get so frustrated and upset they refuse to nurse.

Are pacifiers necessary to protect against SIDS?

However, many breastfeeding experts are challenging the AAP recommendation. Their argument? SIDS is thought to result from an infant falling into too deep a sleep before his body has gained the ability to regulate its own arousal. Sucking on a pacifier while sleeping keeps the baby from sleeping as deeply, thus guarding against SIDS. However, Mother Nature has already designed the perfect way to help babies regulate their arousal systems during the early months of life: waking frequently at night to nurse, and sleeping near Mama. In fact, co-sleeping and breastfeeding have both been shown to have a protective effect against SIDS, because the baby’s physiology is kept at a higher level of arousal. His sleep cycles even parallel his mother’s. SIDS was probably unknown before separate bedrooms and cribs were invented, and as both co-sleeping and breastfeeding have increased since 1992, SIDS has decreased.

Given that pacifiers do not offer any particular benefit against SIDS for babies who are already breastfeeding, most breastfeeding experts continue to advise against pacifiers, even after nursing is well established. Why? Frequent nursing is the best way to create a good milk supply, which remains a necessity long after the first month. Babies drink 1/3 of their daily food intake during their night feedings, so using a pacifier to calm a crying baby at night can lead to poor weight gain as well as plugged ducts, mastitis, and a decrease in milk supply. In other words, pacifiers can easily sabotage nursing.

Bonding experts also worry that a baby’s cry is meant to initiate connection, and pacifiers could take the place of love. From a bonding perspective, nursing is not just about feeding a baby, it's about emotional nurturance, or just plain comfort. When a baby cries, she needs to be held and comforted.

In answer to the worry that the baby is just "using the breast as a pacifier," most natural mamas would retort “Isn’t that how nature designed humans? Which would you rather your baby see as her source of comfort: You, or a piece of plastic?”
So if a pacifier is a risk factor for breastfeeding and can even undermine mother-child bonding, why do I say that a natural mama might consider a pacifier?
Simply because I think being dogmatic and judgmental is a disservice to mothers. We know that every baby is different. Some babies need much more comfort sucking than others. Even some breastfed-on-demand babies suck their thumbs or fingers. In fact, some infants suck their thumb or fingers in utero and come out ready to find their thumbs again.

You might argue that a thumb is more natural than a pacifier, and I would have to agree. I would also point out that in the middle of the night, a baby can always find his thumb, when he almost certainly will not be able to locate his pacifier by himself. Toddlers who suck their thumbs are famously the best sleepers. However, neither thumb nor pacifier should be used past the age of five, when the arrival of the permanent teeth nears. And that’s where the pacifier trumps the thumb.

The pacifier habit is far easier to break than the thumb habit, simply because it doesn’t stay on your child’s hand, beckoning. Pacifiers get thrown away, the child mourns, has a tough week, and goes on with her life. But the siren song of the thumb is always there, leading to feelings of shame and anxiety as the poor child tries hard to please her parents, peers and the dentist by giving up her comfort habit.

Of course, there are many kids who give up their thumbs easily. I personally remember doing so, and I would absolutely choose a thumb over a pacifier for my own children. (I breastfed each child well into toddlerhood, and early on with each I rooted for them to find their thumbs, but they never did.)

What is the pacifier made of?

If you’re considering offering your baby a pacifier, there’s one other critical element we haven’t discussed. What is the pacifier made of? Many pacifiers have BPAs in them, although I predict their rapid extinction given all the recent publicity. But other pacifiers aren’t necessarily safe, either. Latex pacifiers leak low levels of nitrosamines, a known carcinogen. Some pacifiers are still made with diisononyl phthalate (DINP) or phthalate esters, which can be released during sterilization. Silicone pacifiers were considered safe for a long time, but are now highly suspect. The only safe pacifier on the market seems to be Natursutten’s rubber pacifier, which has no synthetics or additives, but the instructions say they have to be replaced every five to seven weeks to stay safe, which is costly and inconvenient. And while the Natursutten is currently claimed to be safe, there’s always the problem that what's considered safe today might not be considered safe tomorrow. After all, most of us hadn't heard of BPAs a few years ago.

Author,

Dr. Laura Markham.

Breastfeeding Baby Refuses Bottle

QUESTION:

I'm trying to get my 3-month-old son to take a bottle for when I have to go out, and he absolutely refuses. I've tried every different nipple on the market, and he just won't drink from them - even when it's my breast milk. How can I get him to do this so that I can leave my son with his dad, or anybody for that matter, without worrying that he is screaming because he's so hungry?

Name Withheld

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JAN'S REPLY:

I understand your concerns - in fact I remember when I had this same question years ago. I'll try to give you the information that helped me to better understand and to meet my son's needs.

It can be worrisome for loving parents to think that their baby may be in a situation in which an important need such as hunger cannot be satisfied. However, a bottle is not a good solution. Many babies will suck only from one or the other, breast or bottle. One reason for this is that the sucking method is, surprisingly, quite different. A baby who is breastfeeding successfully can become confused by something that requires a different sucking method. But I would not recommend that you teach him how to drink from a bottle, even if you could do so. If he were to successfully learn to suck from a bottle nipple (or a pacifier), that could bring about what is termed "nipple confusion" and interfere with his ability to nurse properly. As there are literally hundreds of benefits of breastfeeding, both physical and emotional, for both baby and mother, anything at all that might interfere with this extremely beneficial relationship should be avoided.

Your son has good survival instincts! While his resistance to bottles may be frustrating for you, your baby is strongly communicating his legitimate need to be with you as much as possible. Bottles, even when filled with breastmilk, cannot satisfy a baby's emotional need for the mother's presence. For the early months and years, it is essential that he have full opportunity to bond first with his mother - only then can he successfully move on to bonded relationships with his father and, later, with other persons.

Breastfeeding, beyond all of its many physical benefits, has the added bonus of requiring the mother's presence. A baby has no sense of time and no way of knowing that an absent mother will ever return, yet he understands that her presence is essential. Thus her absence can be quite terrifying. For this reason, it is imperative to keep absences to the barest minimum (in terms of length of time and number of times), and if it is absolutely essential to leave him, try to be gone as short a time as possible, and to schedule things so that you are gone between feedings, or during naps, rather than during a time when he is apt to be hungry.

If a separation is absolutely unavoidable during a time when he is hungry, perhaps he will accept expressed breastmilk from a spoon. In a relatively short time, he will be able to drink from a cup. However, I offer these suggestions reluctantly and definitely not as a routine solution, but only as something that might be used in a rare, emergency situation. It would be far better to avoid separations as much as possible, and to carefully schedule any departures that cannot be avoided. In fact I urge you to make every effort to avoid such departures altogether if possible. Not only do alternate feeding methods interfere with his ability to nurse from you, but more significantly, all separations can interfere to some degree with his developing sense of trust and security.

I would like to stress an important practical consideration that is often overlooked. Sometimes parents assume that a baby will not be welcome or appropriate in a certain situation, when in fact they may be pleasantly surprised if they ask to bring the baby along. Many parents have had the frustrating discovery of attending a function without their baby or child, only to find that others have brought theirs along. If a mother must attend a function where babies are definitely not allowed, she can ask that the baby be brought to her for nursing breaks. Requests like this can even help others in society to become more aware of the critical importance of breastfeeding and bonding. With such a request - even if it is denied - a mother can contribute to the process of social change. In many countries of the world, babies and children are far more welcome in "adult" settings than in North America. It is time to request and advocate change in this area!

It is not only the baby who finds separation difficult. Breastfeeding mothers quite naturally find that they also become uneasy when separated from their baby. The following is excerpted from the La Leche League book, The Womanly Art of Breastfeeding (New York: Penguin Books, 1991):

"You won't want to leave your baby any more than you have to because babies need their mothers. It's a need that is as basic and intense as his need for food. 'That's all well and good,' you may be thinking, 'but what about me? I have needs too.' Of course a mother has needs, and sometimes other responsibilities and obligations cause a mother to be away from her baby more than she wants to be. But you may be surprised to find how strong the bond is that develops between you and your baby. A mother often finds that when she does leave her baby for that long-awaited 'night out', she worries so much about how the baby is getting along that she doesn't really enjoy the occasion!"

I also recommend Dr. Kimmel's short book, Whatever Happened to Mother?, which explores the nature and importance of mother-child bonding.

Author,

Jan Hunt

Best 6 Pacifier Safety Tips

Not all babies need or like to have pacifiers but for some, a pacifier can be a source of comfort. In any case, if you do choose to get a pacifier for your baby, there are a couple of safety tips that you need to consider.

Don't Accessorize

Most pacifiers that have been directly released by companies have been made with an eye on safety features. The worst mistake that any parent could do would be to accessorize pacifiers or buy ones that have been modified or accessorized.

Pacifiers with unnecessary decorations and accessories would include those with dangling chains, jewels and decorative sticks protruding from the handle. Pacifiers of this kind being sold by merchants have already been recalled but some parents might still attempt to do the decorating themselves. Decorations on a pacifier could become detached and mayExamples of these decorated pacifiers are those with decorative stick on jewels or dangling attachments on the pacifier guard or handle. become choking hazards.

Don't Attach on Baby

Some parents find it inconvenient that pacifiers get lost or fall off so easily and are thus tempted to attach them on their babies with either a pin or string. Resist the urge to do this. Your baby could find a way to open a regular pin and get injured or worse, he might just ingest a detached pin. A string or ribbon on the other hand could become entangled and could strangle your baby.

Check the Pieces

Pacifiers can have multiple pieces. In such cases, make sure that you've checked all its assembled pieces together and that they're properly and firmly attached. You should test the nipple in particular by tugging at it. A teething baby might suck too aggressively and detach the nipple, thus making it a choking hazard. Watch out for recalled models especially among multiple piece pacifiers.

Do Not Make Your Own

Just as it is not safe to attach decorations to your pacifier, it is also not safe to modify anything into a pacifier. Do not attempt to reconfigure old nipples or pacifier parts into another pacifier. Your creation might not hold together well enough, and you may thus end up with a bunch of choking hazards. Store sold pacifiers have been carefully designed and tested to withstand repeated sucking and biting and should therefore be the only items that can be safely used.

Steer Clear of Liquid-Filled Pacifiers

Although it happens rarely with liquid-filled pacifiers, still, your baby could bite through the nipple and get all the liquid out. You should also avoid coating pacifiers with sugar, honey or anything sweet. This would encourage your baby to gnaw harder on a pacifier and may bite through it or develop an attachment for it.

Buy Standard Size

Standard-sized pacifiers usually have a stopper or shield that is more than one inch across an average baby's mouth. This is to prevent your baby from ingesting the whole pacifier and choking on it. The shield however should have small holes on each side to allow moisture out and air onto your baby's skin.

Author,

Jb Anthony