Dear colleagues:

I am still nomail from Lactnet, but felt the urge to share in the discussion on the AAP's new recommendations on pacifier use.

I support continued efforts to reduce the rates of SIDS. I applaud the AAP for considering this important issue worthy of their attention and effort. I also find the new recommendation another example of cultural bias in the interpretation of research and in the development of policy. I believe that recommending an artificial substitute (pacifier use for all infants) for biologically normal behavior (breastfeeding infants to sleep and on cue throughout the day and night) does not make biological sense and will likely expose many infants to the multiple risks of premature weaning due to pacifier use. I am reminded of the concluding sentences I wrote in one of my articles on sunlight deficiency, vitamin D supplementation, and breastfeeding (Good Mojab 2003): 

"Breastfeeding is the foundation of normal health and development, the original paradigm for nourishing and nurturing young human beings. Health policies and healthcare systems must first and foremost protect breastfeeding. Otherwise, they will ultimately serve to undermine the health they seek to enhance. "

Advance research on the impact of policy statements on breastfeeding initiation, exclusivity, and duration would be an ethical approach to ensure that maternal and child health and development are not inadvertently undermined by policies addressing too small a piece of the big picture. I am not aware that such research is ever done. Improving the cultural competence of those who develop policy is also an ethical approach and is sorely needed. This is also true for all of us who are working in any capacity with breastfeeding mother-child dyads. Greater cultural competence among our professionals will help us better recognize cultural bias in research and policy.

Good Mojab, C. Sunlight deficiency and breastfeeding: A review of the literature. March-April 2003; 117:52-55; 57-63.

Please carbon copy me ([log in to unmask]) if you wish to reply.

Cynthia

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Cynthia Good Mojab, MS clinical psychology, IBCLC, RLC, CATSM 
Ammawell 
Website: http://home.comcast.net/~ammawell 
Email: [log in to unmask] 
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