Just a reminder that we have data to support the idea of improved growth and
better state organization of preemies using pacifiers during gavage feeds,
and that we think that sucking helps release CCK which soothes and calms
babies.  The association between SIDS and pacifiers appears (so far as
current data suggests) to be a negative one:  i.e. that removal of pacifier
use was associated with an INCREASE in SIDS episodes.  This may fit in with
Japanese research which describes thumb sucking as a survival response of
babies prone to apnea who are trying to keep an alternative respiratory
control center switched on when the main center is (for some reason) too
depressed to maintain normal respiratory function.  The new Clinics in
Perinatology June 1999, 26(2) contains a remark by Marianne Neifert (pg 287)
that I find provocative and worth considering: "Infant pacifier use has been
related to a shorter duration of breastfeeding, although it remains unclear
whether this association is causal or a marker for other undetermined
causes."

We don't need to be randomly or universally encouraging pacifier use in the
early pp because most nursing babies would be better off BREASTFEEDING  very
frequently for all the reasons we generally give.  However, SOME babies can
profit from pacifier use.  These babies might include those who are not
orally feeding but need the comfort of sucking, and babies who have low oral
tone or paralyzed tongues and who need the exercise.  A lot of times, these
babies can't yet do too many things at once, and it's good to have them
doing non-nutritive sucking to strengthen oral motor function without having
to concentrate on simultaneously managing swallowing fluids.

I suspect that really experienced post-partum and neonatal nurses may have a
strong sense that pacifiers DO serve a theraputic purpose in the management
of some babies, and I think they may be rightly suspicious of a policy ( or
a policy maker) making blanket pronouncements about "never" or "always".
This is exactly where we got into trouble on nipple shields, which also have
a limited but important clinical usefulness.  Of course the challenge is to
make sure each baby is managed as an individual, and that the nurses aren't
simply resisting the move to end the use of the pacifier as a "storm plug".

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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