Pacifiers in babies and children: Encourage or discourage?

There’s a lot of debate about pacifiers and since it’s Children’s Dental Health Month I thought I’d tackle the issue. Many parents are apprehensive to start one with a baby, yet many babies need to suck. Sucking is a natural reflex. Sucking on thumbs, fingers, pacifiers or other objects may make babies feel secure and happy and help them learn about their world. They can even be sucking on a hand or arm when still in the womb. Many babies find their thumb or a finger to suck on and self-soothe if not offered a pacifier.

Baby friendly?

pacifiers, thumb suckingI personally was unhappy to hear of the “baby friendly” initiative at our local hospitals that discourages any pacifier use during hospitalization.  I think it makes parents fear the pacifier even more than they had before and they have benefits as well as cautions.

I’ve seen more mothers get frustrated with breastfeeding when they can’t use a pacifier. I have rarely seen a problem with breastfeeding when babies are allowed to use a pacifier.

Studies do not support the thought that pacifiers affect breastfeeding rates.

This Cochrane Review also failed to show problems.

Things to love about pacifiers:

Babies have a natural desire to suck.

Even in the womb we can see babies sucking. A pacifier allows them to fill this need, which allows parents to have a much needed break.

Pacifiers can help with pain relief.

There’s a natural pain relieving property to sucking. Think about how addicted older kids are to sucking on a thumb or pacifier. It is soothing. Adding sugar to the pacifier for painful procedures helps pain even more.

Don’t give your baby sugar at home. It’s not good for them and can lead to cavities once they have teeth.

Pacifiers help prevent Sudden Infant Death Syndrome (SIDS).

We don’t know why they help, but studies show that pacifier use decreases the risk, along with sleeping alone on a firm, flat surface, on the back, without soft bedding.

Parents can control use.

Pacifiers can be weaned gradually and kids tend to outgrow them earlier than thumb-sucking.

Infants over about 4 months of age can develop other self-soothing abilities, so you can use them just for sleep in older infants and toddlers.

Keep them in the crib to decrease the risk of germ spreading from displaced/replaced pacifiers.

 

I like pacifiers better than thumbs

If a baby wants to suck, he will find his hand if something else isn’t offered. Babies eventually find thumbs or fingers if they want to suck on something.

Thumbs are always with a baby and child, so they can suck on them whenever they want, not just in the crib when a parent gives it.

Thumbs can get red, dry, and cracked with sucking behaviors – especially in dry weather. This can be painful to the child. The drive to suck is so strong they continue to do it despite pain. It can also lead to infections of the thumb.

Most kids will stop a pacifier habit by 3 years of age. If a pacifier is limited to sleep time only, kids are already not in the habit of sucking on something all day long. They only have to learn to fall asleep without sucking.

Thumbsuckers continue their habit more often and much longer. Often it’s not until they’re teased at school that they decide they want to quit. Until they make the decision to quit it’s hard to make it happen.

Thumbs are never clean. At least you can wash the pacifier and keep it in the crib. Kids play with their hands and you can’t keep the thumb out easily after they’ve touched everything.

a few cautions to pacifier use:

 

Don’t use them instead of feedings

Don’t use a pacifier to try to limit the number of breast feedings in a day, especially early on. Newborns need to eat quite a bit. Trying to “hold them off” with a pacifier will only limit your milk supply and could cause them to not gain sufficient weight.

Work with your pediatrician or a lactation consultant to be sure your baby is feeding enough if you’re feeling a need to breastfeed less.

Latch problems

I find that most babies can go back and forth from breast to pacifiers easily.

Most isn’t all.

If your baby seems to have trouble latching on the breast after using an artificial nipple (either a pacifier or a bottle) then stop the artificial nipples and focus on breastfeeding. (If you need to supplement, you can use a syringe, a supplementing system, a spoon, or other methods.) Continue avoiding artificial nipples until breastfeeding is going well.

Work with a lactation consultant if you have continued problems.

Pacifiers can spread infections.

Ear infections and other illnesses can spread easily from pacifier use.

Wash them regularly.

Keep them in the crib for babies over 6 months of age to avoid exposing it to germs from other kids.

Choking risks.

Pacifiers can crack and come apart as they age. Be sure to check it regularly to make sure it’s not damaged. You don’t want it to become a choking risk.

What about teeth?

After permanent teeth come in, sucking can cause problems with the proper alignment of the teeth. It can also cause changes in the shape of the mouth.

Both finger or thumb-sucking and pacifiers can affect the teeth in the same ways, but pacifier use is often an easier habit to break.

General recommendations about stopping the sucking habit

Be careful how you approach stopping a thumb-sucking habit or pacifier use. If you are too harsh or negative it will probably make the habit worse.

Use positive rewards.

Have your child come up with goal ideas and things to earn. Rewards don’t have to be expensive. It can be a trip to a special park or the ability to pick dinner or what book to read. You can also get stickers, trinket toys, an

Sticker charts are a great way to keep track of times that there was no sucking!

For thumb-sucking

Think about making it more difficult for your child to suck his thumb. Keep the hands busy with crafts, toys, etc.

For the older child, talk about germs and how important it is to keep the thumb out of the mouth unless she just washed her hands.

Consider sewing socks or mittens onto long sleeve pajama tops. This will keep the thumb out of reach. (Unless your Houdini takes the PJs off.)

Using a “bad” tasting polish or tabasco doesn’t really keep kids from not sucking their thumbs unless it’s only a reminder to stop. If they really want to suck, they don’t care about the taste. But if they do want to stop and need reminders throughout the day to keep it out of their mouth, the bad tasting nail polishes can help.

For pacifiers
Plan a countdown to not using the pacifier any longer.

Make getting rid of the pacifier a big deal, like any other special event. Find a fun name for the day, like “Big Kid Day” or “Give to baby day”.

Put the chosen date on the calendar and do a count down every day by crossing off dates. Or make a paper chain and tear off one chain daily until the big day.

Find a replacement for the pacifier, such as a new stuffed animal or blanket. The stuffed animal can even be from Build-A-Bear. Put the pacifier inside so the child knows it’s there when he hugs his bear. Whatever you choose, be sure it can be snuggled or used to replace the pacifier for comfort.

Fill a box with all the pacifiers on the big day and leave it out for the “binky fairy” to take to new babies. The fairy can leave the new comfort item. Or you can just have your child put all the binkies in the box and seal it shut with tape when he’s ready to earn the new comfort item.

The big thing is you need to get rid of all the pacifiers. If your child finds one hiding somewhere, he will sneak it and return to the habit quickly.

Books that might be helpful

Note: These are Amazon Affiliate links and I do get paid a small amount for the referral.

In this book for toddlers,Little Brown Bear finds some tricks to help him stop sucking his thumb. It can help put the idea into your child’s head.

This is not specific to thumb-sucking, but the Berenstain Bears always teach kids in a fun way. Sister bear has trouble biting her nails in this story.

Thumb Love is appropriate for the older child who wants to stop sucking his or her thumb. If your school aged child has been the object of teasing due to thumb-sucking, he or she will relate.



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Help! I’m sick and I have a baby at home.

When we have newborns we don’t want them exposed to germs. We avoid large crowds, especially during the sick season. We won’t let anyone who hasn’t washed their hands hold our precious baby. We might even wash our hands until they crack and bleed.

infection precautionsBut what happens when Mom or Dad gets sick? What about older siblings? How can we prevent Baby from getting sick if there are germs in the house?

In most circumstances it is not possible for the primary caretaker to be completely isolated from a baby, but there are things you can do to help prevent Baby from getting sick.

Wash

Wash hands frequently, especially after touching your face, blowing your nose, eating, using common items (phone, money, etc) and toileting.

Wash Baby’s hands after diaper changes too. Make this a habit even when you’re not sick… you never know when you’re shedding those first germs!

Wipe down surfaces

Viruses that cause the common cold, flu, and vomiting and diarrhea can live on surfaces longer than many expect.

Clean the surfaces of commonly touched things such as doorknobs; handles to drawers, cabinets, and the refrigerator; phones; and money frequently when there is illness in the area.

Avoid touching your face

Avoid touching your eyes, nose and mouth – these are the “doors” germs use to get in and out of your body.

Pay attention to how often you do this. Most people touch their face many times a day. This contributes to getting sick.

Kiss the top of the head

Resist kissing Baby on the face, hands, and feet.

I know they’re cute and you love to give kisses, but putting germs around their eyes, nose, and mouth allows the germs to get in. They put their hands and feet in their mouth, so those need to stay clean too.

Cover your cough

I often recommend that people cover coughs and sneezes with their elbow to avoid getting germs on their hands and reduce the risk of spreading those germs.

When you’re responsible for a baby, the baby’s head is often in your elbow, so I don’t recommend this trick for caretakers of babies. Cover the cough or sneeze with your hands and then wash them with soap and water or use a hand sanitizer if soap and water aren’t available.

Vaccinate

If you’re vaccinated against influenza, whooping cough, and other vaccine preventable diseases, you’re less likely to bring those germs home. Encourage everyone around your baby to be vaccinated.

If you get your recommended Tdap and seasonal flu vaccine while pregnant, Baby benefits from passive immunity.

See Passive Immunity 101: Will Breast Milk Protect My Baby From Getting Sick? by Jody Segrave-Daly, RN, MS, IBCLC to better understand passive immunity.

Breastfeed

Breastfeed or give expressed breast milk if possible.

Mothers frequently fear that breastfeeding while sick isn’t good for Baby. The opposite is true – it’s very helpful to pass on fighter cells against the germs!

Again see Jody Segrave-Daly’s blog for wonderful explanation of how breast milk protects our babies.

Limit contact as much as possible

If possible, keep Baby in a separate area away from sick family members.

Wash hands after leaving the area of sick people.

If the primary caretaker is sick and there is no one available to help, wear a mask and wash hands after touching anything that might be contaminated.

Smoke-free

Insist on a smoke-free home and car.

Even if someone is smoking (or vaping) in another room or at another time, Baby can be exposed to the airborne particles that irritate airways and increase mucus production.

These toxic particles remain in a room or car long after smoking has stopped. If you must smoke or vape, go outdoors.

Change your shirt (or remove a coat) and wash your hands before holding Baby.

Final thoughts to avoid exposing Baby

It’s never easy being sick, and being a parent adds to the level of difficulty because you not only have to care for yourself, but someone else depends on you too.

As with everything, you must take care of yourself before you can help others.

Drink plenty of water and get rest!

Most of the time medicines don’t help us get better, since there aren’t great medicines for the common cold. Talk to your doctor to see if you might need anything.

Don’t be falsely reassured that you aren’t contagious if you’re on an antibiotic for a cough or cold. If you have a virus (which causes most cough and colds) the antibiotic does nothing.

You need to be vigilant against sharing the germs!
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Breast is best… Unless it’s not

We’ve all heard the well-intentioned slogan “Breast Is Best” in reference to supporting breastfeeding. Breastmilk is made just for our babies, so yes, it is a great source of nutrition. But it isn’t the only option and there are many reasons mothers give formula and even with exclusive breastfeeding there comes a time that infants need additional sources of nutrition.

I decided to write on this topic because I see so many mothers struggle to feed their baby and they feel like a failure if they don’t exclusively breastfeed.

And then to top it off I saw a blog that encouraged exclusive breastfeeding without any foods or supplements until one year of age.

I knew someone had to counter that thought before it becomes popular.

It shouldn’t be a badge of honor to breastfeed to the point of potential harm to the infant, and some ultra-crunchy moms are bragging about it as if it is.

Mom Guilt Has Gotta Stop

You’re not a failure if you feed your baby, regardless of what you feed your baby as long as it’s age appropriate.

Your baby needs nutrition and hydration.

While most babies under 6 months of age can get all their nutrition from breastmilk, some need a boost, especially at the beginning of life.

If you’re not producing enough milk, you’ll need to give your baby some formula as well (or use a milk donor). Usually this is temporary – just until your own milk supply increases or until your baby starts enough solid foods that the supplement isn’t needed.

I’m not suggesting that every newborn who struggles at the breast should be supplemented, but if your doctor says the baby’s blood sugar is low or the baby is losing too much weight, it’s not only okay, but it’s necessary to supplement.

Benefits of Breast Milk

Most of us have heard by now the many benefits of breastfeeding for the baby, including:

  • Immune system benefits. (Which means fewer infections, meaning not only helping babies stay healthy, but also leading to fewer lost work days for working parents and fewer sleepless nights for all parents.)
  • Decreased risk of Sudden Infant Death Syndrome.
  • Decreased risk of asthma in a child who has breastfed.
  • Decreased risk of diabetes when the baby grows up.
  • Decreased risk of obesity as the baby grows up.
  • Decreased risk of certain cancers in the child, such as leukemia.
  • Improved cognitive development of the child.

Benefits for mothers include:

 

  • Less bleeding, both in the immediate postpartum period from contracting the uterus after birth, and fewer menstrual cycles during breastfeeding.
  • Decreased risk of getting pregnant while breastfeeding – though this is not 100% effective! If you’re not wanting to get pregnant don’t rely on breastfeeding alone.
  • Easier return to pre-pregnancy weight.
  • Decreased risk of ovarian and breast cancers.
  • Decreased risk of Type II diabetes.
  • Decreased risk of postpartum depression.
  • Decreased risk of heart disease.
  • Less missed work (see immune system benefits above).
  • Cost – breastmilk is free and formula is expensive. Breast pumps should be covered by insurance.

When Breast Milk Isn’t Enough, Isn’t Desired, or Isn’t Safe

Feeding your baby is most important, not what you feed your baby.

Despite the benefits, breastfeeding not always possible or desired.

In the US, 8 out of 10 mothers start breastfeeding during the newborn period.

Only half are still nursing at 6 months, and less than a third are still nursing at 12 months.

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months, followed by continued breastfeeding for 1 year or longer, as mutually desired by mother and child.

Some AAP sources indicate starting foods at 4-6 months.

The American Academy of Allergy, Asthma & Immunology (AAAAI) recommends introducing foods between 4 and 6 months to prevent certain allergies.


There are very few contraindications to breastfeeding:

Classic galactosemia

Classic galactosemia is a rare genetic condition in which a baby is unable to metabolize galactose.

It is one of the conditions we screen on the newborn screen.

Galactose is the sugar made from the lactose in milk. When galactose is not metabolized, it will reach high levels in the blood and become toxic, causing cataracts in the eyes, damage to the liver and kidneys, and brain damage.

The galactosemic baby will fail to thrive on breast milk or formula based on cow’s milk. The treatment for this condition is to remove all sources of lactose from the baby’s diet and give soy formula.

HIV

Mothers who have HIV and are able to feed formula made with safe water should not breastfeed according to current guidelines.

However, there is growing evidence that HIV positive mothers who take proper medications can safely breastfeed.

Untreated active tuberculosis

Treatment makes a difference, so if you’ve potentially been exposed to tuberculosis, talk to your physician and get tested.

Chemotherapy or radiation treatment

There are times that you need to take care of you.

If you require chemotherapy or radiation, do these to improve the chances your baby will have you as a mother. If that means he needs to have formula, that’s okay.

Certain drugs

Most medications are compatible with breastfeeding.

You can look on Lactmed to learn if a particular medicine is safe or what other options are recommended.

Some mothers do not want to breastfeed for various reasons.

That’s okay. It isn’t for everyone.

No one should say things that make these mothers feel guilty. They brought new life into the world. That alone is an amazing feat. As long as the baby is fed age-appropriate and formula that has been approved for use in infants, it is great.

Babies can thrive on formula.

Just be careful of the many alternate formulas and milks that are advertised online.

Discuss with your child’s pediatrician if you plan on making your own formula or giving another alternative milk. There are many concerns with these, as discussed in Please Don’t Feed Your Baby Homemade Formula!

Some mothers really want to exclusively breastfeed but they have problems.

Working with a lactation consultant and physicians (both mother’s and baby’s doctors) might help if there is a correctable condition, such as

  • insufficient breastfeeding attempts per 24 hours – not feeding frequently decreases supply
  • tongue tie treatment can improve latch and milk transfer from the breast into baby
  • jaundice, which makes baby sleepy and not feed as effectively
  • identifying and treating hormonal problems in mother
  • identifying and stopping medicines or herbs that might be inhibiting milk supply
  • stopping nipple shields as soon as possible – the use of nipple shields can decrease breast stimulation and lower supply
  • avoid unnecessary supplements – supplementing with formula can decrease supply overall because the mother’s breast makes milk based on how much is used (This does not mean you should avoid formula if it is medically necessary.)

Even when breastfeeding goes well for both Mother and Baby, it is not sufficient to be the sole source of nutrition for the entire first year of life.

There are some mom blogs that support exclusive breastfeeding for the first year of life, and that is not safe.

I’m not linking any of them here because I don’t want to promote them, but if you don’t believe me just do a quick search and you will find some.

Nutritional needs

While breast milk is fantastic for young infants, it does not have the nutritional components to exclusively feed for the second half of the first year.

Iron

Babies need a source of iron after about 4-6 months of age.

If they are not eating foods rich in iron (meats, legumes, egg yolk, leafy greens) they will need an iron supplement.

Many of the bloggers who support exclusive breastfeeding do not want any supplements at all. Just breast milk. It simply isn’t enough to support the older infant’s growing brain and body.

Vitamin D

Vitamin D is important for us all, but it is not passed through breast milk well unless a mother is taking at least 6400 IU/day.

Historically we could make vitamin D with the help of the sun, but we now know that sun damages our skin so it is safer to protect against excessive sun exposure. This puts us at risk for vitamin D deficiency.

The AAP recommends that newborns begin supplementing with 400 IU/day of vitamin D soon after birth, and increase to 600 IU/day at 6 months of age.

The supplement should continue even if they transition to Vitamin D fortified cow’s milk at 1 year of age.

Motor skills

Feeding with food from fingers or a spoon also encourages healthy development of fine motor skills.

It is important for older infants to learn to eat from a developmental standpoint.
Once they can sit fairly well, turn away from food or open their mouth in response to food, they are showing signs that they are ready to start eating.
They don’t need teeth to move foods around in their mouth and make chewing motions.

They are much less averse to new things typically when they’re younger, so if babies are delayed past a year they are much more likely to be picky eaters and not get the nutrition they need during childhood.

Allergies

Then there’s the research that shows that delaying certain foods past a year increases the risk of allergy. If you’ve ever seen a child with anaphylaxis to peanuts, you won’t want to increase this risk for your child! See the AAP’s guidance on introduction of high-risk allergenic foods.

 

Any problems feeding should be discussed with your child’s doctor

If your baby struggles with feeding, whether it’s breastfeeding, formula feeding, or eating foods, please discuss it with your child’s doctor.
There are many reasons feeding might not go well, and we need to insure that your baby is being adequately fed.
We will look at your baby’s overall growth and development in addition to discussing the specific details of the problems.

Resources

Related Blogs on Quest for Health

Over and Under Supply of Breast Milk

Breastfeeding: Easier for Working Moms with New Insurance Rules

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