I am off this morning to weigh a FTT infant and assess and work on latch.
He was born prematurely and initially gained well.  Mom was fully
breastfeeding him but using a nipple shield.  When they finally got the
infant in for his four month check, he had not gained anything from his two
month check. (Not adjusted for prematurity).  The infant had been settling
with a pacifier after every feeding and was a content, starving child.
There are more issues with this infant, but the pacifier is what kept the
infant home and starving.  This infant also was using a nipple shield, is
tongue tied, and was not doing good milk transfer. So this one will be
challenging, but the first move was to drop the pacifier.
There is also a nice study done about morbidity and mortality associated
with pacifiers, I have it here somewhere but I am sure the reference can be
found in the archives. I always ask parents if they have ever seen anyone
pick up a pacifier off the floor and put it in their own mouth and then give
to the baby.  They have all seen this more than once.  I then ask if they
have ever seen anyone wash a pacifier with soap and water, and almost none
of them have ever seen this.

Pat Thomas PHN IBCLC
Winona County Community Health
Winona, MN

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