Oops Sorry Nikki asked the question about pacifiers, and Trish the one  
about the used pump!
 
In case it's interesting, here is part of an email I wrote to a mom who  
doesn't call me, but always emails. I prefer talking on the phone for its give 
 and take possibilities, but she just won't do it, so this is how I 
responded to  her question about pacifiers for her baby. Baby is post-frenotomy.
 
"  
The part of your email that makes me cautious about introducing a pacifier  
is the part where you mention she still doesn't open her mouth wide enough 
and  sometimes has trouble controlling milk flow and gags. Though her tongue 
is freer  the bony shape of her palate is still changing over the next 
months. If she is  still gagging sometimes it may be because her palate still 
needs to broaden and  flatten and this takes time. Introducing a pacifier may 
delay the change ( which  in the end can have an impact on future breathing 
and sleep issues) or it  can promote the palate staying higher and more 
arched. Breasts are larger and  broader in the babies mouth so they actually 
help reshape the palate. The other  problem with all pacifiers is their length, 
they tend to just end at the base of  the pacifier itself, which means that 
Noemia's tongue is not encouraged to  extend as fully as when she is 
breastfeeding, since the breast doesn't just end  in a hard shelf. See if this 
picture helps:
 
(http://www.google.com/imgres?imgurl=http://www.babble.com/CS/blogs/strollerderby/2009/03/pacifiers.jpg&imgrefurl=http://www.babble.com/CS/blogs/stroll
erderby/archive/2009/02/28/the-paci-debate-continues.aspx&h=433&w=337&sz=22&
tbnid=NiWWaf3m5Te5nM:&tbnh=126&tbnw=98&prev=/images?q=pacifier+pictures&hl=e
n&usg=__zVPsvtjKWWdSuulyxLBIAuRzNNw=&ei=UgUUS_fBKcejlAfontmRBA&sa=X&oi=image
_result&resnum=5&ct=image&ved=0CBgQ9QEwBA)   The bulbous shape can make the 
tongue shape  weirdly around itself, this is exactly how you do NOT want 
your nipple to look  when she's done feeding, it hurts and it's an efficient 
latch and a poor way to  control flow. We don't want to encourage this at 
all. Pacifiers that are not  preshaped like this are better. Straighter is 
better.
 (http://astore.amazon.com/soothie-pacifier-20/images/B000W1M2EY)  This  is 
a better shape in terms of not leading to the smushing training of her  
tongue, since it is straighter and then broadens gently. Still the other 
problem  persists. The baby's tongue can but up against the base of the pacifier,  
leading to the tongue being held back during nursings, which means poorer 
latch,  and less control of milk flow. If you were going to introduce a 
pacifier, this  would be preferable in terms of lowering the risk of it 
interfering with her  latching and coordination of swallowing. The other thing to 
consider is that if  she does not have painful reflux, she can get her needs 
met by simply being at  breast, where there is no risk of delaying palate 
reshaping and messing with  tongue function. Babies who are bottlefed often need 
a pacifier because the  total nature of feeding and calming has been broken 
into the transfer of  unchanging liquid/food without the milk changing at 
breast as it does normally  during breastfeeding. Babies who are bottlefed 
therefore often cannot meet their  sucking needs on the bottle without 
overfeeding, whereas the breast is designed  to meet every need ( at this age, I 
mean.) If Noemia's need to suck begins to  outstrip her need for food, she may 
find her own finger/thumb, she can suck on  yours or Tony's or you could 
try the green Soothie kind of pacifier above and  see if it doesn't mess with 
her feeding skill development. The other thing to  consider is some 
CranioSacral Bodywork to help her release the tissues that are  keeping her from 
opening her mouth wider and controlling her tongue better. If  this is 
something you want to pursue, I can recommend someone who works with  lots of babies 
with issues around feeding, especially after frenulum releases (  I may 
have mentioned this before, if I did, I don't mean to beat a dead horse, I  
just didn't write in my notes whether I did or not.)
 
In the end, pacifiers are not without risk ( as I mentioned above, plus  
they are related to ear infections), but for some babies who cannot soothe  
themselves while nursing they can be helpful if used carefully. Nursing to 
sleep  can help a lot since we have evidence that nursing and sleeping in  
proximity lowers the risk of SIDS, and though pacifiers are recommended as  well 
that is only if they stay in the baby's mouth the entire sleep episode,  
otherwise you are getting up repeatedly to make sure they are back in since 
the  risk of SIDS increases in babies who go to sleep with a pacifier then 
lose it  during the sleeptime. When pacifiers are used in this way, they need 
to be used  for every sleep episode, daytime and nighttime. In some ways, 
just letting the  baby nurse is easier.
 
Isn't modern mothering a lot to deal with?  :)"
 
END of my  email response on this issue...
 
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA



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