Pacifiers: Detrimental or Beneficial?

I'm so pleased to have Tanya Cunningham back as she discusses another popular medical myth-- or is it? Do pacifiers cause difficulty with breastfeeding.

I think it's important on a couple of levels for an author dealing with these issues to be aware of both sides. A seasoned, nursing professional keeping up with research is going to know this information. Our responsibility as nurses is not to sway the patient to our belief (though, of course this does happen) but to present unbiased information to the family so they can make the decision that best suits their needs.

Welcome back, Tanya!

Pacifiers have long been vilified as major disruptors between infants and successful breastfeeding. Have they been given a bum rap, or are the accusations substantiated? Is it actually true that pacifiers
interfere with breastfeeding? If you asked me this a few months ago, I'd say, “It depends.”

Being a postpartum mother/baby nurse, I want all my patients who endeavor to breastfeed to be as successful as possible. I would discourage pacifier use if the mother had “flatter” or “inverted” tissue. However if her anatomy were similar to the pacifier (everted and firm), the risk of “nipple confusion,” I felt, was decreased.

I would relay my own experience with my two children, who I had breastfed for a year each. I had used pacifiers with them, but only if they were fussy and needed to suck for soothing. Then when they were calm, I'd take it away, not letting the pacifier, “just hang out” in their mouths. Neither of them used pacifiers beyond a couple to a few months old.

In medicine and healthcare, we want our practice to be evidence or researched based. If we do or recommend something, it's because it has been proven by research studies. Do you feel like medical recommendations are always changing? You're right. In medicine, we are always learning and growing.

With new research, established ideas can be challenged, sometimes causing us to cringe, but forcing us to grow. In researching for this blog post I found intriguing newer evidence concerning pacifier use that I'm excited to share with you.

In 2011, the American Academy of Pediatrics updated its recommendations regarding the prevention of sudden infant death syndrome or SIDS. Interestingly enough, among the updates was offering a pacifier at nap time and bedtime. According to an article by Medscape Education entitled, “AAP Statement Expands SIDS Guidelines on Safe Sleeping Environment,” it doesn't matter if the pacifier falls out of the baby's mouth during sleep. “The protective effect persists throughout the sleep period,” states the article. The reason for this isn't known as of now, but the evidence is there.

At the end of April this year, the Today Show ran a segment on pacifiers actually promoting breastfeeding. Are you thoroughly confused now? The story spoke on how the Oregon Health & Science University Doernbecher Children's Hospital, in seeking to become a UNICEF and WHO

(World Health Organization) Baby Friendly Hospital locked up their pacifiers. This was to be in compliance with the WHO's “Ten Steps to Successful Breastfeeding.” On the Today website you'll find a post by Corey Binns who reports that the hospital's exclusive breastfeeding rate dropped from 80% to 70% after easy access to pacifiers was blocked. The hospital performed an observational study of 2,249 babies from June of 2010 to August of 2011.

This study raises questions instead of answers for me. Are health care workers doing new mothers a favor by locking up pacifiers? Is practicing the suck reflex between feedings promoting breastfeeding in newborns? The truth is more research needs to be done. What do we do in the mean time? I think the only thing I can do is tell new mothers what I know, the current idea of pacifiers causing “nipple confusion” may not be true, the AAP now recommends pacifier use during sleeping times to reduce the risk of SIDS, and newer research may actually show benefits of pacifier use in relation to successful breastfeeding. The new mother can consider the newer evidence with a grain of salt, pending corroborating studies, and make an informed decision on what's best for her and her newborn. 

Each mother and baby are unique and what is true for one pair may not be true for another. If you're

a new mother reading this, and you're now not sure what to do, use your mommy instincts. Trial and
error is a natural process in motherhood. Decide for yourself if using a pacifier for your little one is detrimental or beneficial.

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Tanya Cunningham is a mother/baby RN and lives in Missouri with her husband and two small children. She has been caring for mothers and their newborns for almost four years, before which she was a RN in the USAF. During that time, Tanya worked on a multipurpose inpatient unit for two and a half years (taking care of ortho, neuro, medical, general surgical, and tele) and a family practice residency clinic for a year and a half. Tanya earned her BSN at Oral Roberts University.

Tanya has been writing children's stories for almost 2 years now and is working towards being published. She enjoys raising her children, cooking, and reading medical suspense/mysteries, especially those in Christian Fiction. You can find out more about Tanya by visiting her website.