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Date: | Fri, 6 Jan 2006 11:37:49 -0500 |
Content-Type: | text/plain |
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Regarding recent discussion about Step 9 of the BFHI, pacifiers may be used
where there is a medical indication for their use, i.e, in a sick or preterm
infant whose mother is unable to be present for comfort and nutritive feeds
around the clock. Pacifier use is known to be soothing and growth-promoting
in these specific situations. However, pacifier use is not appropriate as an
institutional standard for the healthy, full-term infant. Its use has been
associated with a shorter duration of breastfeeding, less exclusivity of
breastfeeding, and low milk supply.
(www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract
&list_uids=12612229 and
www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&
list_uids=12949292.
The use of a pacifier to reduce pain during circumcision and other
procedures is not forbidden, rather it would be considered an acceptable
medical indication, provided that mothers are encouraged to hold babies
skin-to-skin and/or breastfeed for comfort when feasible during the
procedure.
However, facilities must find a way to assure that pacifiers do not
"migrate" from this use into general practice. Assure that pacifiers are
discarded after use for this purpose. Of course, when it is possible,
mothers should be encouraged to hold and breastfeed their babies for pain
reduction. (Skin-to-skin contact and breastfeeding has been demonstrated to
reduce pain also – see
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=10617751 and
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Ab
stract&list_uids=12511452)
If parents bring their own pacifiers into the hospital, staff should educate
parents about the rationale for avoiding pacifiers, and document this in the
medical record.
Cindy Turner-Maffei
Baby-Friendly USA
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