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Nipple confusion: Does it really exist?

New mothers have heard the mantra for years — don’t offer a pacifier to a breastfed baby, or she will suffer nipple confusion. It turns out that the doctors giving this advice may have been the ones who were confused.

Doctors at the Oregon Health & Science University recently found that pacifiers may actually help the breastfeeding process. Keep reading to see if nipples are still confusing.

Common practice with breastfed newborns has been to recommend against the use of any artificial nipples (pacifiers or bottles) at least for the first month of life, preferably longer. This is to prevent babies from using the different sucking technique that is used for bottle-feeding or pacifier use. Babies use their mouths differently when they are breastfeeding, and doctors have speculated that the confusion between techniques causes babies to reject the breast.

Confused about nipples?

Apparently parents and doctors may be even more confused about them than the babies, according to a recent study of more than 2,200 infants born at Oregon Health & Science University (OHSU). Doctors at OHSU were interested in increasing the already-high rate of breastfeeding newborns in their hospital as part of their efforts to qualify for the coveted “Baby Friendly Hospital” designation. This designation is sponsored by the World Health Organization and United Nations Children’s Fund, and has only been achieved by about 10 percent of U.S. hospitals.

Pacifiers under lock and key

In an attempt to increase the percentage of newborns who were breastfed in their mother-baby unit, doctors at OHSU greatly restricted the use of pacifiers for newborns, locking them in a cabinet. Pacifiers were still available, but only allowed for certain cases — circumcision and other painful procedures, and for babies suffering withdrawal symptoms due to drug-addicted mothers. Hospital staff expected that the percentage of babies being exclusively breastfed would increase well beyond the already-high level of 80 percent.

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What they found

Laura Kair M.D. and Carrie Phillipi M.D., co-authors of the study, looked at data on more than 2,200 infants born at OHSU between June 2010 and August 2011. Halfway through this time period, restrictions were implemented on pacifiers being given to breastfeeding newborns in the hospital. During that time period, breastfeeding rates dropped substantially — from nearly 80 percent to about 68 percent — and the percentage of breastfed babies being supplemented with formula rose. During that same time period, the rate of formula-only fed babies remained statistically constant.

“Our observations suggest routinely removing pacifiers may negatively impact exclusive breastfeeding rates during the birth hospitalization,” said Dr. Carrie Phillipi, who is also a pediatrician with Oregon Health & Science University.

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What now?

The authors of the study do not feel that these results alone should prompt a shift in pacifier policies. More research into the relationship between pacifiers and breastfeeding would be helpful for parents — and their doctors — to make more informed choices. “Our goal with publicizing this data is to stimulate conversation and scientific inquiry about whether there is sufficient evidence to support the universal recommendation of not offering pacifiers to breastfeeding infants in the first few days to weeks of life,” says Dr. Kair.

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When should you stop breastfeeding?
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