Exclusivity of Breastfeeding & Pacifier Use

Exclusivity of Breastfeeding & Pacifier Use

After my son was born, and my previously defined OCD ” tendencies” became a clearly engrained part of my person, I spent a lot of time reading about how to change my thinking– how to not react to fleeting thoughts, how to manage my propensity to ruminate and how to end catastrophic thinking. It is so easy to see only the extremes when you are anxious about something- the black and the white, with very little appreciation for the multitudes of grey.

I have found the discussion of breastfeeding often resonates in extremes as well. Exclusivity of breastfeeding is prized and the occasional supplementation with formula deemed a failure. I have had newborn parents tell me that they may as well wean their baby because they had been giving an occasional bottle of formula anyway; as if the formula depleted the breast milk of its many benefits. In my experience, the pressure of all or nothing is rarely conducive to lasting success.

Most of what a new parent reads regarding breastfeeding is about exclusivity of breast milk, and the benefits associated with this practice for both mom and baby. The implication exists, in not so subtle form, that breastfeeding most or some of the time will not garner these same benefits. In fact, the immune boost, IQ points and SIDS prevention still occur in babies fed some, but not all, breast milk. For example, a comprehensive review from the journal Pediatrics notes ‘our meta-analysis of 18 studies reveals that breastfeeding to any extent and of any duration is protective against SIDS, although the protective effect is even stronger for exclusive breastfeeding. The summary multivariable odds ratio (way of defining a real relationship between two things – the effect A really has on B) suggests that breastfeeding itself is protective and not merely a marker of other potentially protective factors such as the absence of smoke exposure or sociodemographic factors.’ 2

I acknowledge the research that babies given formula early on are less likely to be breastfeeding down the road, but I wonder if the hard lined approach we are taking with our parents is really helping increase breastfeeding rates or creating undue stress on exhausted mothers. Pacifiers are discouraged until at least 1 month of age, letting the baby rest in the hospital nursery at night is frowned upon, and bottles are completely off limits, even as a means of giving expressed breast milk until at least 1 moth of age. Some parents believe that if their baby takes a pacifier or gets a bottle that they will never latch correctly to the breast again. I really don’t see this effect in my private practice patients. A baby will simply not favor a synthetic nipple that doesn’t produce milk to mom’s breast. Pacifiers used to calm baby via their inherent need to suck for nonnutritive reasons can be a real game changer for a lot of us. Likewise, a bottle substituted for a feed can give mom a much needed break. Of course, bottle nipples should be slow flow and multiple breaks taken to help baby easily move between breast and bottle.

In a relatively recent feature article in Contemporary Pediatrics, ‘pooled data from two studies revealed no significant difference between pacifier use and no pacifier use in the proportion of babies who were still exclusively or partially breastfeed at both 3 months and 4 months. The finding did not change according to the timing of pacifier introduction, either before or after lactation was established.1 Another article from the journal Pediatrics, purports that ‘although some observational studies have revealed an association between pacifier use and decreased breastfeeding duration,36,–,38 this association was not borne out by several randomized clinical trials39,–,41 and 1 systematic review.42 The American Academy of Pediatrics policy statements on breastfeeding and the use of human milk35 and SIDS43 both indicate that pacifiers can be used by breastfed infants.’ The Pediatrics article mentions that pacifiers are great to introduce once breastfeeding is well established but the truth is pacifiers are helpful for a lot of families before a month of age. If we are seeing data that indicate that it doesn’t really matter when pacifiers are introduced, with regards to duration of breastfeeding or success of latch, then why are we setting this arbitrary timeline and forcing parents to abandon a well-known means of soothing in the first (often difficult) weeks of a newborn’s life.

I know that my patient population is very unique, almost all my moms breastfeed for at least 4-6 months, and the majority of these moms feed exclusive breast milk. It is a very well educated lot and the benefits of breast milk are actively discussed during office visits. What concerns me is all of the tears, the pressure, the exhaustion… I really think occasional supplementation is ok and may even promote a longer duration of breastfeeding. I also think occasional supplementation and/or pacifier use may also make the stressful times easier to manage – it’s ok to run out and do something for yourself – even if the baby gets a bottle in place of a breastfeed. He will be ok and so will you. It is one thing to help educate parents on the benefits of breatfeeding and support their endeavors to do so even in difficult times—it is a much different thing to make them feel as though any deviation from a “family-friendly” protocol is harmful to their baby. It is just not so black and white.

So, what are a few strategies for a grey approach-?

  1. If your newborn is crying and you’ve fed, swaddled and are rocking and she is still upset, try a pacifier! It’s worth a shot and it really is ok!
  2. Get a four to five hour stretch of sleep at night starting at 2 weeks (or earlier if baby’s weight is on the rise) – maintain good frequency of feeds during the day (approx. 2-3hrs at most from start of one feed to start of the next) to allow for a single longer block at night. If baby wakes every 2 hours at night, despite swaddling in a cool room with good air circulation and soft ambient noise, have Dad give a bottle of expressed breast milk or formula if need be… A single longer stretch of sleep for mom is a sanity saver.
  3. Work on a good strong latch at the breast, don’t settle for a superficial hold. Try nipple shields IN BETWEEN feeds, rather than with feeds, to help heal macerated nipple tissue and extrude the nipple for an easy latch with feeds (remove shields just before feeding), and always use a level 1 or slow flow nipple with any bottles.
  4. Know that breastfeeding hurts at first, even if you do everything right – our nipples although meant for this are not used to this!! It just takes time – Lanolin, nipple shields, cold cabbage leaves etc. – will help pull you through.
  5. Don’t let any “expert” overwhelm you with the dos and the don’ts behind breastfeeding success– as long as you keep putting baby to the breast and engaging her to stay awake and feed, you’ll get there – maybe you have to pump, supplement some or cut dairy from your diet – no one deviation from the so-called “norm” is going to ruin your efforts – in fact, it will just define your experience as a very human one.

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