March 3, 2003 -- The use of pacifiers may help calm newborns, but new research indicates that it could lead to breastfeeding problems that hurt both mother and child -- although researchers aren't sure why.
Still, they note that the use of pacifiers and other artificial nipples during an infant's first month decreases the likelihood that the child will nurse exclusively on breast milk, which most researchers say provides optimal nutrition. In addition, newborns who use pacifiers typically breastfeed for shorter periods and consume less breast milk -- requiring supplemental feedings with infant formula. And they are more likely to hurt their mother's nipples and breast milk production.
"There are a lot of theories, and we looked at all sorts of these problems related to the use of pacifiers, but couldn't come up with definitive answers," says researcher Cynthia R. Howard, MD, MPH, of the University of Rochester School of Medicine and Dentistry. "Based on our study, we can't explain why pacifiers impact breastfeeding, but it does."
Her study, which involved some 700 healthy, full-term breastfed newborns, also found that supplemental feedings with nipple-clad bottles or cups provided no benefit to their breastfeeding, but it did appear to help infants who were delivered by cesarean section.(Infants in the study born by cesarean section who received supplements by cup breast fed significantly longer.) These findings are published in today's issue of Pediatrics.
The use of pacifiers in newborns has long been debated, as many researchers believe that they impair the ability of babies to properly learn how to attach and suckle at their mother's nipples during their first few weeks of life. The World Health Organization discourages the use of pacifiers, as well as supplemental bottle-feeding, but solid scientific evidence to support this advice is lacking.
Some experts believe pacifiers lead to "nipple confusion," a term used to describe the mechanical differences between a pacifier and a mother's nipple.
"The theories are that a baby conforms his mouth differently to artificial nipples, and when they try to breastfeed, they're more ineffective," Howard tells WebMD. "They may not extract as much milk, or they attach to the nipple in a wrong way and end up hurting their mothers, traumatizing their breasts. What is known is that when parents introduce pacifiers at this early age, the baby doesn't spend as much time at the breast because it may get its suckling needs taken care by sucking on pacifiers."
Her study did not examine the use of pacifiers in infants older than one month. However, Howard says that previous research suggests that those babies who routinely use pacifiers are more prone to ear infections, as well as later tooth problems that may require orthodontic braces. Still, she notes that other studies indicate that the use of pacifiers helps premature babies increase their suckling ability.
Whether their children are born full-term or premature, many parents introduce pacifiers to help calm babies between feedings.
"For parents who aren't sure they want to use pacifiers, I would say, don't. But if you're set that you want to use a pacifier, it does it make a difference on when introduce it," says Howard. "You should wait at least one month from the child's birth."
There are other ways to calm newborns without relying on artificial nipples. "Being held close -- especially skin-to-skin contact -- is very effective," she tells WebMD. "So is carrying the infant, or wrapping him tightly in a blanket."