The baby friendly initiative has been a force for improving breast-feeding rates, with many sensible parts to the program. Unfortunately some of it isn’t evidence based, such as the prohibition of what I will call soothers. I’m originally from England where they are dummies, in the US I guess a lot of people call them pacifiers, in much of Canada they are soothers, in Quebec they are ”suces”…. all of which goes to show they have been around a long time, and many cultures have a familiar name for them.
Step 9 of the standards for being called baby friendly states that you must give no soothers to breastfed babies. I don’t know where this ever came from, there is no evidence that soothers have an adverse effect on breast-feeding success. Now there is a study suggesting the opposite, that they are actually beneficial. Kair LR, Kenron D, Etheredge K, Jaffe AC, Phillipi CA: Pacifier Restriction and Exclusive Breastfeeding. Pediatrics 2013. In this before and after study there was a deterioration in exclusive breastfeeding when they instituted a ban on soothers.
There are actually 4 RCTs that have looked at soother use and a systematic review that confirms no beneficial impact on breast-feeding from trying to reduce pacifier use. Of course doing an RCT of this is rather difficult, anyone can easily buy a pacifier or get one as a gift from a helpful relative. The largest trial was Michael Kramer’s PROBIT, done in Belarus. This was a fascinating cluster randomized trial that is still producing results. One of the comparisons was that mothers who received the educational breast-feeding promotion intervention either got extra advice to not use a soother or they got no such advice. The intervention was partially successful, there was quite a bit less pacifier use in the group who got that advice, but that had no effect on the breast-feeding rates. In case you don’t know the trial, it is among the best evidence we have for the benefits of breast-feeding on reduction of intestinal infections, and prevention of atopic eczema. As well as a brand new publication showing no effect on obesity (Martin RM, Patel R, Kramer MS, et al: Effects of promoting longer-term and exclusive breastfeeding on adiposity and insulin-like growth factor-I at age 11.5 years: a randomized trial. JAMA 2013, 309(10):1005-1013)..
This has some importance in neonatology, as we know that soothers decrease pain during minor invasive procedures such as a heel prick, especially when used together with sucrose. So we routinely use soothers with our preterm babies unless the mother doesn’t want us to. That makes it problematic to receive the baby friendly label. Even though we really are friendly to babies! Really, really friendly.
Hi Keith, I remember having to fight with administration to have soothers included in the budget and having actually lost the battle. This was we were working to stop offering the babies makeshift dummies (nipples plugged with cotton) following the reports of infant deaths from same. For a period of time, the only supply was whatever the parent could bring in or a stash I provided for those babies whose parents weren’t around or hadn’t got to it. Eventually I think it was sorted out and pacifiers became a line item. Silly thing to have to deal with.
So, even if pacifier use is a small issue compared to the many grand topics in the neonatal literature, it’s good that someone has taken the time to address this. There will always be administrators who are looking to cut costs at every opportunity and having research to support what seems intuitively to be correct is a good thing. L