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 *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html