When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician’s guide
Abstract
Background: The use of pacifiers is an ancient practice, but often becomes a point of debate when parents and
professionals aim to protect and promote breastfeeding as most appropriately for nurturing infants. We discuss the
current literature available on pacifier use to enable critical decision-making regarding justifiable use of pacifiers,
especially in the Baby-Friendly Hospital Initiative context, and we provide practical guidelines for clinicians.
Discussion: Suck-swallow-breathe coordination is an important skill that every newborn must acquire for feeding
success. In most cases the development and maintenance of the sucking reflex is not a problem, but sometimes the
skill may be compromised due to factors such as mother–infant separation or medical conditions. In such situations
the use of pacifiers can be considered therapeutic and even provide medical benefits to infants, including reducing
the risk of sudden infant death syndrome. The argument opposing pacifier use, however, is based on potential risks
such as nipple confusion and early cessation of breastfeeding. The Ten Steps to Successful Breastfeeding as
embedded in the Baby-Friendly Hospital Initiative initially prohibited the use of pacifiers in a breastfeeding friendly
environment to prevent potential associated risks. This article provides a summary of the evidence on the benefits of
non-nutritive sucking, risks associated with pacifier use, an identification of the implications regarded as ‘justifiable’ in
the clinical use of pacifiers and a comprehensive discussion to support the recommendations for safe pacifier use in
healthy, full-term, and ill and preterm infants.
Summary: The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere
with it. Justifiable conditions have been identified as: low-birth weight and premature infants; infants at risk for
hypoglyceamia; infants in need of oral stimulation to develop, maintain and mature the sucking reflex in preterm
infants; and the achievement of neurobehavioural organisation. Medical benefits associated with the use of pacifiers
include providing comfort, contributing towards neurobehavioural organisation, and reducing the risk of sudden
infant death syndrome. Guidelines are presented for assessing and guiding safe pacifier use, for specific design to
ensure safety, and for cessation of use to ensure normal childhood development
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