Huxley and the Pacifier Problem

Posted by Greg Laden on November 30, 2009
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The question of pacifiers (and for that matter bottles) arises when there is a new baby. In the case of Huxley, he will be breast milk fed if possible, but that involves bottle feeding at some point. Also, since our society does not practice cross nursing all Western babies go through a risk period when they begin to starve while the mother’s milk is not yet in. Sometimes that is a couple of days, sometimes longer.

In any event, the question comes up, do you let a baby anywhere near a nipple that is not attached to a human breast, and a related question is do you use a pacifier if the baby seems to like the idea of sucking on absolutely everything?

My sense as both as a parent and as a biological anthropologist with the occasional PhD student doing a thesis on something related is that opinions have changed on these issues. I was very surprised to hear one lactational consultant say that “Nipple Confusion” (where a baby is exposed to bottle nipples and thus becomes bad at nursing because of that) is not an issue.

In general, I started to get the sense that more professionalized, more degreed-up, more academic types … like our pediatrician who actually started out life in Feminist Studies and who has thus had an interesting and complex academic career …. are less la-la La Leche like, while many RN’s and NA’s are more likely to be breast milk purists.

So I made up some data [yes, I'm into climate studies as well :-) ] to express the sense I’ve been getting lately, and put it in the following table. This is a (made up) cross tabulation of reactions I get when I tell people Huxley’s name and when I ask the same people about pacifiers.

“Huxley! What a cute name.” “Huxley? TH or Aldous?”
“Nipple confuzun will Ruinz the Babie!!!11!! 11 0
“Scientific studies have shown that you have very little to worry about” 0 14

It turns out that pacifiers probably do not mess up breast feeding competence or induce higher failure rates, but according to one study there is a link between early pacifier use and cessation of breastfeeding.

Pacifier use was independently associated with significant declines in the duration of full and overall breastfeeding. Breastfeeding duration in the first 3 months’ postpartum, however, was unaffected by pacifier use.

(Citation below)

ResearchBlogging.orgHowever, it seems that the proximate mechanism is in overall behavior by the mother, and that if individuals want breastfeeding to be more successful and last longer (which includes sufficient milk production as an objective) that this can be achieved with good breastfeeding practices, and by keeping track of feeding schedules. Perhaps the pacifier is linked to a cash-rather-than-carry strategy.

_____

Cynthia R. Howard, Fred M. HowardDagger, Bruce Lanphearp, Elisabeth A. deBlieck, Shirley Eberly, & Ruth A. Lawrence* (1999). The Effects of Early Pacifier Use on Breastfeeding Duration Pediatrics, 103 (3)

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Comments

  1. #1 becca
    November 30, 2009

    Possibly relevant anecdotal data:
    *“Bonding? HA! Bonding is just another phrase for ‘mommy gets NO SLEEP’”
    *If you do breastfeeding ‘right’, you can easily end up with a baby in the 90%tile for weight who’s pediatrician says she’s using mommy as a pacifier.
    *If you do breastfeeding ‘wrong’ and introduce binkies and bottles before the fifth day of life, baby gained weight past birthweight before leaving hospital, but you can’t get a free Medela breastpump where they’re trying out models to minimize differences between direct-from-the-source and bottles.

  2. #2 Donna B.
    November 30, 2009

    haha… I’ve never seen a baby with nipple confusion, but I have seen (heard!) some with a definite nipple preference and it’s always for the ones attached to Mommy.

  3. #3 Dacks
    November 30, 2009

    When child #1 was about 4 months old he began to get distracted during nursing and stopped gaining weight at the appropriate rate. We were in the middle of a move, and I was too inexperienced to realize that I had let my milk supply dwindle. He would cry sometimes, and I would either nurse or give him the pacifier, both of which were equally successful in soothing him. (He was a quiet baby.)

    I finally took him in for a checkup, and the doctor took one look and said start supplementing. I had been starving my baby without realizing it! I still feel incredibly guilty whenever I remember that time.

  4. #4 Michael
    November 30, 2009

    There is some evidence that pacifier usage at night reduces the risk of SIDS [citation needed]. As far as nipple confusion my wife and I were told that pacifiers in the first 3 weeks would cause nipple confusion so we waited until 3 weeks until introducing a pacifier. However, we have talked to other parents that gave the pacifier immediately and they said they had no problems. So I have a feeling “nipple confusion” from pacifier may be a myth.

    As far as a bottle though it may be better to avoid those as it is much easier to get milk out of a bottle than a breast and they may prefer the bottle [total anecdote] (at least offer the breast before the bottle).

  5. #5 Kate
    November 30, 2009

    Ha! I’m with Donna B.

    We didn’t use pacifiers, not because we worried about nipple confusion, but because we were uncomfortable with the purpose behind it, which is to quiet a screaming child under the supposed premise that a child has a “need to suck” that cannot be satisfied by breastfeeding alone. I think the rationale comes from a good place, meaning it with the intent to figure out how to make an individual who cannot communicate her needs effectively happy.

    There is good data out there that the reason babies cry is that they need to cry to recover from hurts, that crying is in fact restorative and good for them, and that trying to stop crying through pacifiers (and jiggling, swaying, shaking and shushing) only leads to longer crying episodes (for a review see Aletha Solter’s great book “The Aware Baby” — she actually cites data and though the audience is parents, the scientist in me was quite satisfied). Stopping crying doesn’t stop the hurt, it stops the healing process from the hurt (basically, it stops the baby from restoring its body to allostasis and clearing out cortisol and other stuff).

    Anyway, I know that’s not the exact issue you were talking about above, so apologies if I hijacked the thread. But I do really recommend Solter’s book (as well as her other books, and Lawrence Cohen’s book “Playful Parenting,” which operates on a similar premise but is useful for older kids).

  6. #6 Ms. Mobley
    November 30, 2009

    Anecdotal evidence, so take as you will:

    My daughter had a pacifier by the time she was five days old and never had trouble breast feeding. She didn’t care too much for bottles, but she was fine with the breast feeding.

  7. #7 Kate
    November 30, 2009

    Wow, what an embarrassingly bad sentence:

    “I think the rationale comes from a good place, meaning it with the intent to figure out how to make an individual who cannot communicate her needs effectively happy.”

    What I MEANT was: “I think the rationale comes from a good place, meaning, those who think this want to figure out how to make someone happy who cannot communicate her needs effectively.” Or something like that. You get my drift, I hope.

  8. #8 Amy
    November 30, 2009

    Long ago I was a lactation consultant, and also breastfed for who knows how long…pacifiers didn’t interfere, bottles didn’t, in my case…I think its a matter of the mother sticking out the learning process/initial possible discomfort, and then breastfeeding gets easy for all involved. My understanding is that in many other cultures, babies may not cry much because they have constant access to the breast- so, they use it as a pacifier, play thing, food, etc…pacifiers can provide comfort sucking, so using them is not quieting the baby who needs something, it’s giving the baby what it needs (something to suck on…). Fingers work well too. Thumbs. A blanket. Sometimes, its hard being a baby!

  9. #9 Amy
    November 30, 2009

    I forgot to add: each family needs to make these kinds of decisions based on what works best for their lives! Babies are also very adaptable and will tolerate and thrive on a wide range of parenting behaviors!

  10. #10 mk
    November 30, 2009

    For me, the idea that a pacifier can somehow “stop the healing process”… well, it sounds a little goofy.

    Pacifiers can only pacify. They cannot stop pain or discomfort. They cannot make hunger pangs go way. If a baby is genuinely hungry the pacifier will only have (maybe!) a temporary calming effect. Once it realizes it is still hungry it will spit out the pacifier and continue crying. Same with real pain or discomfort.

    Babies early on associate the body of another human being, the arms around them and a nipple in the mouth with goodness. Warmth and food. Comfort. Babies are fairly insecure creatures, understandably. If you leave one in a crib with no blanket around him/her, nothing to grab onto and nothing in its mouth don’t be surprised if it feels a little out of sorts. A pacifier can help alleviate this insecurity. It may not be the “be all and end all”, but it certainly isn’t harmful.

  11. #11 daedalus2u
    November 30, 2009

    The real question is when is the first time a passifier that has been dropped on the floor be given back without being washed?

  12. #12 sailor
    November 30, 2009

    I picked up a can of baby formula one day thinking it was milk. It tasted horribly sweet. I looked at the contents and they are feeding babies high fructose corn syrup. If you ever have to bottle feed try goats milk.

  13. #13 Irene Delse
    November 30, 2009

    “Nipple confusion”? What will they think of next… But I wonder how the babies who like to suck their own thumb figure in that equation?

    Anecdotal evidence ahoy: I know of at least four babies, all in the same family, who never had a pacifier because their parents were concerned about germs and who began sucking their thumbs at day one. (Or even earlier: one was born with traces of vigorous sucking on her thumb!) ) Of these babies, two were breastfed 6 months and then switched to formula because mommy had to go back to work; one was breast-fed 3 months before lactose intolerance obliged the parents to go with a special formula; and one was bottle-fed since the beginning because mommy had to take medications which made breast-feeding contra-indicated. All four babies thrived.

  14. #14 matt
    November 30, 2009

    I saw the title and at first I thought it was some history of philosophy post about Huxley and agnosticism versus theism/atheism… boy was I wrong.

  15. #15 gb
    November 30, 2009

    4 kids and not 1 accommodationist amongst them.

  16. #16 Dee
    November 30, 2009

    Anectdotal from a doula: I used pacis from day one with both of my kids. My first was a shark of a nurser who could empty me out to the point I looked flat in ten minutes – not per side. BOTH sides. She gained weight fine and was in robust health, showing none of the signs of getting only foremilk. When I pumped, I was getting 15+ ounces per side, a good sign of great milk production, which you don’t get if your baby isn’t a great nurser. She was just such a fast eater that she really didn’t satisfy the suck need by nursing. She stopped using a paci on her own at age nine months. I nursed her till 15 months, when she started asking for a cup instead of me.

    Child two was a slower eater, but adored her pacis. Once again, she was robustly healthy. I was getting a more normal 12 ounces per side with her when I pumped, but that’s still nicely respectable. For her, pacis seemed to be used like some adults chew on pens. She nursed until 19 months of age, when I had to be gone for a week and lost the last of my supply. She used pacis until age three, when we moved and “forgot” to get more.

    Speculation: I think the “nipple confusion” thing applies more to earlier-term babies – 37 weeksish – rather than full-term babies. They seem to have more nursing issues in general. Since my two were both full term (40 weeks and 42 weeks 1 day), they did just fine. Ditto for those of my friends’ babies who were born at term and whose parents used pacis.

    In any case, I would never tell a client Mom not to use a paci when the baby looks healthy, is gaining weight, and simply needs comfort. It’s easier to stop paci-sucking than thumbsucking, and a baby who really needs to suck will go for the latter if the former isn’t available!

  17. #17 Aunrd
    November 30, 2009

    If you do use a pacifier, make sure you break them of the habit before they begin speaking too much. It can lead to pronounciation problems.

  18. #18 military wife
    November 30, 2009

    “nipple confusion” is one of my pet peeves from when my babies were little. don’t listen to the extreme la leche league people and make yourselves miserable…use a bottle if it’s needed, and use the breast when it’s possible, and don’t sweat it at all. it’s hard enough having a newborn in the house without worrying about this issue.

    I had one baby who hated anything that wasn’t skin–she went straight from the breast to a sippy cup because she refused anything else. My second loved his pacifier, and it had to “get lost” when he was 2.5 years old, and he wasn’t exactly thrilled.

    Both kids are healthy now and I regret that I spent so much time worrying about the whole mess.

  19. #19 A Nurse
    November 30, 2009

    Hello, I’m a nurse student and this post is very helpful to me. Thank you!

  20. #20 Monado
    November 30, 2009

    I thought that before the milk came in, there was colustrum, which is full of antibodies from mum. And it’s still a fluid.

  21. #21 Greg Laden
    November 30, 2009

    There is not a lot of volume of colustrum. I’m not sure how much there is, but it is very little compared to what is lost through urination.

  22. #22 momkat
    December 1, 2009

    Both of my children refused the pappy (isn’t it amusing all the pet names for the things). Couldn’t get them interested, so I didn’t try very hard. On the other hand, my grand daughters have liked them. Both have been exclusively fed breast milk, but sometimes via the bottle. The first one turned up her nose at formula (subsequently found to be allergic when introduced to cow’s milk). The second one was born six weeks early and the only time she’s had formula was once in the hospital (didn’t go well at all). Being preterm, she didn’t suck very strongly at first so her mom pumps and then uses the bottle for actual feeding. This allows dad to feed while mom is at work. She definitely finds comfort in the pappy, even when mom is available. For what it’s worth, I say let Huxley tell you what works for him.
    BTW, there are studies about pain management using glucose pacifiers (?) after infant circumcision but I can’t pull them up right now. That must be why lollipops after my childhood immunizations worked so well.

  23. #23 Greg Laden
    December 1, 2009

    Sometimes a binky is just a binky, and a nuk is just a nuk. Pronounced nuke in New England, Nuck (rhymes with Luck) in the Midwest.

  24. #24 Stephanie Z
    December 1, 2009

    Actually, in this particular part of the Midwest, it rhymes with “cook.”

  25. #25 Martha
    December 1, 2009

    I can’t resist this topic! While I was pregnant with my daughter, many years ago, I read Jane Goodall’s book about chimps. It seemed to me that since young chimps do well being carried about most of the time and being fed on demand, human babies would probably do likewise. My daughter was breastfed for almost two years and always refused a bottle or binky. She turned out to be smart, beautiful, well-adjusted, and one of the most self-confident people I have ever known. (But it took its toll on me.)

    A few years later, my son emerged with a callus on his thumb. With a stethascope, we had heard him sucking it before he was born. He, too, was breastfed on demand. But he was never a cuddler, and he became underweight at about 8 months, in the heat of summer. We soon discovered that he preferred cold formula in bottles. He too grew up healthy, smart and good-looking.

    In my opinion, colostrum is just fine for newborns. As evidence, I offer the observation that the human race seems to be in no danger of dying out. The new mother should drink lots of liquids and allow the baby to suckle often, alternating sides, and she will soon produce plenty of milk and all will be well.

  26. #26 Louise
    December 2, 2009

    I agree with the advice @ #25 that the breastfeeding mom should drink plenty of liquids to be successful. Mom should have water or another healthy beverage nearby all the time. My babies all got a pacifier after breastfeeding to satisfy their sucking. One preferred his thumb. One learned to talk with the pacifier in her mouth and gave it to Santa at age three. The last one gave it up more easily around age one because we had learned what not to do. There are times when one’s milk supply seems to be gone and the baby is nursing every two hours, but the supply will catch up in a day or so if the mom just stays the course. Those times coincide with predictable growth spurts in my experience.
    Breast pumps were not very good in my day. I successfully nursed part-time for eight to nine months while the baby got some formula at the sitter and when dad was in charge for a few hours. The first three months were almost exclusively breastfeeding with only a few introductions of a bottle. In my experience one sacrifices some sleep to nurse at night as mine did not sleep through the night like the bottle fed and early cereal eating babies of some of my friends. Every baby is different though. Good luck. I should add I can only remember one ear infection, although my kids had plenty of colds. Maybe we were just lucky.

    Congratulations on the birth of your son.

  27. #27 James Hanley
    December 2, 2009

    We were also warned about nipple confusion. Didn’t happen for any of our three daughters (although one never did accept the bottle, which was a real nuisance at times).

    I looked at it from an evolutionary perspective. Babies that had an instinct for cuddling close to the warm breast were more likely to survive infancy than those easily deterred from the breast. And we all know that most babies love to be cuddled. So it’s not just the nipple–it’s the warmth and softness of the breast and the smell of mommy. It’s got to be the rare baby that actually rejects the teat instead of the bottle.

    Oh, and Greg is obviously from a backwards part of the Midwest where they have strange backwoods accents. Nuk does indeed rhyme with cook. ;)

  28. #28 DuWayne
    December 2, 2009

    I find this interesting. Eldest was breast fed and had a pacifier from day one. He wouldn’t have a damned thing to do with a bottle – even though the bottle was easier and full of breast milk (thankfully we had a neighbor who was breastfeeding – saved our asses when momma was in class). He loved his pacifier though – was fanatical about it even. But at about nine or ten months he rather suddenly got over it. We “lost” his pacifiers for several hours, he was terribly upset about it for about an hour. Then when we went to give it back at bedtime, he didn’t want it.

    Youngest on the other hand, was bottle fed due to lactation issues. He was also on the pacifier from day one – for him mostly because he wasn’t allowed the breast for 36 hours, because of all the painkillers they had to pump momma with. He was off the pacifier at about five or six months. He went from taking anything, pacifier, finger, nose – whatever was about the right shape and size, rather fanatically to getting irate if you shoved something into his mouth that didn’t provide him with formula. Funny thing was, he would keep a bottle in his mouth all night long, sipping a little here and there until it was empty (were talking several hours per bottle) and then would wake up demanding his next bottle – pretty much like clockwork.

    I guess I tend to have a rather cavalier attitude about pacifiers, because we really didn’t have any problems with them. But I also understand that for some kids it is somewhat traumatic.

  29. #29 Nathan Myers
    December 2, 2009

    I have nothing to say about nipple confusion, but I note that I call those things that others call pacifiers or binkies “stoppers“. It seems more a more appropriate name on any number of levels. Everyone knows instantly what I’m talking about when I use the word.

  30. #30 Darren
    December 2, 2009

    So you never answered the burning question…Aldous or Thomas ;)

    My thoughts on this are:

    1) Nipple confusion? OMG help us all! Having raised 3 anklebiters to middle school thru adulthood, I cannot for the life of me remember any issues with the use of pacifiers, bottles, or teats. I do recall, however, one had all of his “binkies disappear” one by one when he was about 2 1/2 yrs old as he’d become a bit too dependent on them.

    2) The evidence for breastfeeding as long and often as possible is fairly overwhelming and should be practiced if one has a willing and able mother. I could only convince my ex- to breastfeed for about 6 weeks; I regret not having been more…forceful??

    3) The bottle and breastpump were fantastic, mayhaps I have a skewed idea of just HOW fantastic given that I carry a Y-chromosome but hey, there it is :)

    Lastly, congrats on having thrown your genes into the ring…enjoy it every single moment for the time when they are young passes far too quickly

  31. #31 Greg Laden
    December 2, 2009

    Huxley, since it is a family name, would refer to all of them with an emphasis on T.H. and leaving off any bad ones if there are any.

  32. #32 angeles
    December 3, 2009

    Well, I can only talk from my experience of mother of two (one is 3.5, youngest is 7 months). I’ve probably been quite lucky, as none of them needed any formula supplements, and we only started using it with the oldest after 6 months (and she wouldn’t take it, which was hard on me at times).
    With our first one, I had heard about nipple confusion, so didn’t want to introduce anything other than breast before 10 days. In any case, our baby rejected the dummy when we tried, as she really wanted the breast.
    Our second one is a very mellow baby, and this time I’ve decided not only not to use the dummy (I don’t see him needing it), but try to avoid formula at all (maybe from one year, to mix with cow’s milk when we introduce cow’s milk).
    I think if your wife has loads of patience, a vaginal birth (c sections cause problems with early milk supply), then don’t worry too much, and do as you feel. If you don’t like dummies, then don’t force one into your son, but if you feel he needs it, then don’t kill yourself about him using it.
    By the way, I come from dummyland, i.e. place where pretty much all babies are given dummies from birth, and my partner’s culture is more “babies who use dummies grow to be idiots” (very harsh). Somehow I think whether you use it or not has a lot to do with the background opinion on dummy use…

  33. #33 Hank Roberts
    December 3, 2009

    Side question: does the mother’s melatonin level come through in breast milk? I’ve wondered after seeing discussion of using low- or no-blue light to maintain nighttime melatonin levels and sleepiness (for both nursing mother and baby).

  34. #34 Kate
    December 10, 2009

    Sorry mk if it sounded “goofy” but it happens to be an evidence-based statement. You can check out work by Solter and Piaget, among others, for more info.