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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