I can think of some reasons why I might suggest a pacifier as a clinical
solution, just as I can think of exceptions to just about every other
breastfeeding "rule" I've ever heard.  Handouts or books that come down
heavily on the "always and never" side of rationality just make my job more
difficult.  Then I have to talk people around to looking at their situation
differently before I can help them.

A pacifier may be very important to provide non-nutritive sucking (NNS)
opportunities to a premature or ill baby who is not receiving oral feeds.
(NNS helps with state stability and promotes early growth.) Use of a soft
air or gel filled pacifier can help strengthen the oral musculature of a
weak or low tone baby.  A pacifier might help train the tongue (much like
finger training) into the proper central groove.  Some literature associates
pacifier use with decreased apnea (see archives re:  pacifier use and
negative causality with SIDS).  I've used pacifiers of different lengths to
help aversively conditioned babies to accept objects at increasing depths in
their mouths preparatory to transferring them to a nipple shield in order to
coax them to breast.  Occasionally you have mothers with extreme over supply
whose infants really need to suck more but can't, due to over-feeding.
Pacifiers can be judiciously used in such circumstances.

The wording of any anti-pacifier handout should be very careful lest we make
statements that can't currently be supported and thereby jeopardize our
credibility as a profession.  Note the words of the authors of a new study
that did a review of the lit on the subject:

"The relationhip between exposure to artificial nipples and pacifiers and
the development of the aversive feeding behaviors associated with nipple
confusion is neither refuted nor supported in the research literature.
Despite this, recommendations given by health care providers to avoid bottle
feeding continue to be driven by the belief in the phenomenon of nipple
confusion.  Concern that exposure to artificial nipples will inevitably
interfere with breastfeeding has even resulted in ...legal action.  Clearly,
from this [current] review of the literature it would be appropriate for
health care providers to take a more moderate position when they educate
parents."

D. Dowling, W. Thanattherakul, Nipple Confusion, Alternative Feeding Methods
and Breastfeeding Supplementation:  State of the Science, Newborn and INfant
Nursing Reviews 2001, 1(4):217-223.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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