TUESDAY, July 17, 2001 (HealthDayNews) -- Pacifier use does not harm breast-fed babies, but it may not soothe their fussing and crying, either.
Those are the findings of a new Canadian study, which offers fuel for both sides of the debate on breast-feeding and pacifier use.
Some medical authorities, along with the World Health Organization (WHO) and the United Nations Children's Fund, discourage pacifier use by nursing mothers because research has shown pacifiers lead to a premature transition from breast to bottle. But many nursing mothers use pacifiers to reduce their baby's fussing and crying.
Researchers at McGill University Faculty of Medicine in Montreal examined the question of whether pacifier use was behind early weaning. In the July 18 issue of the Journal of the American Medical Association, the authors write: "Pacifier use is a marker of breast-feeding difficulties or reduced motivation to breast-feed, rather than a true cause of early weaning." But there were no beneficial effects on infant crying and fussing, they add.
For their study, Dr. Michael S. Kramer and his colleagues recruited 258 new mothers, with healthy, full-term infants, who planned to breast-feed for the first three months. All the new moms were counseled on the benefits of breast-feeding. Half were told to avoid using pacifiers when their baby fussed or cried and instead breast-feed, rock or carry the child around. The other half were told that using a pacifier was OK, along with other options, to soothe their child.
The mothers kept logs of their infants' crying, fussing and pacifier use. After three months, they were asked if they were still breast-feeding; those who had stopped were asked why.
The percentage of women who stopped breast-feeding during the first three months was almost identical in the two groups. Of those who used pacifiers, 18.9 percent had stopped; of those who didn't use pacifiers, 18.3 percent had stopped. And carrying or rocking a crying baby was just as effective in restoring calm as a pacifier, the researchers say.
Women who used pacifiers almost every day were more likely to stop breast-feeding. But the use of pacifiers in those cases was a sign of the difficulty in breast-feeding, not a cause of that problem, the researchers say.
So, should a breast-feeding mother use a pacifier? That depends on what the mother -- and the rest of the family -- wants, experts say.
"We would discourage it," says Katy Lebbing, of the Center for Breast-feeding Information of La Leche League International. "But when pacifiers are used judiciously, a mother can have it both ways."
Dr. Nicholas Cunningham, professor of clinical pediatrics emeritus at Columbia University and Children's Hospital of New York, says "my bias is against routine pacifier use" because it may be associated with an increased risk of middle ear disease.
But again, the decision can go the other way, he adds.
"I find out first what the mother wants to do," Cunningham says. "If there is a strong belief in using it, I would go along with that. If she doesn't want to use one, I would support that."
Cunningham's emphasis is on the basics of breast-feeding, and the interaction between mother and child. Mothers often fail to realize that a baby must be breast-fed every 90 minutes or so, he says. And from his work in Africa, he thinks the best results come when a mother spends most of her sleeping and waking hours close to the baby.
"You need to sleep with the baby, to carry the baby," he says. "You need more skin-to-skin contact."
What To Do
If you're going to use a pacifier, don't use it too early, Lebbing advises. Studies show the baby may encounter "nipple difficulty," in which confusion between the pacifier and the real nipple makes feeding difficult. A 1997 statement by the American Academy of Pediatricians echoes the thought: "Pacifier use should be avoided whenever possible, and if used at all, only after breast-feeding is well-established."
To learn all about breast-feeding, consult the American Academy of Pediatrics or the La Leche League International.
