EPISODE 64

Demystifying Pacifiers

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Episode Transcript

July 02, 2021

Pacifiers...yes, no?! Maybe so?! What is the deal?!

This is Maureen Farrell and Heather O’Neal. And this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

So join us for another episode. Hey guys. Welcome back to The Milk Minute. I am actually here without Heather. We’re over the internet today cause she’s sick. Sorry, Heather. I didn’t want to be stuck in the alcove with you guys coughing on you and baby Lyra. I didn’t that you’d be very keen to that so we’re recording separately today.

I’m in the alcove and Maureen’s in a hotel. So today we’re going to be talking about pacifiers and all the things that go along with that, all of the misconceptions about pacifiers, the myths, and also the controversy surrounding pacifiers. But first, of course, we’re going to answer a listener question and then we’re going to do an award in the alcove, which I’ll be giving alone today.

So stick around to the end of the episode so we can give that award, cause you never know, it could be you. But today’s question is from Destiny P. She says, why is it that I can pump for like a half hour until the milk stops flowing? But after, I can hand express milk out when I’m done pumping, like a lot? I know you’re never actually empty, but they always feel full.

So, okay. What are your thoughts, Maureen? I’ve got a couple of thoughts. One is that this might depend how far postpartum we are. Right? A lot of people report that they kind of just feel full all the time for the first two to three months. As we see that supply regulating, but more to the point, why can you still hand express after you’re done pumping?

So since we don’t know all of the details of this, we’re just going to kind of have to take some guesses. But one thought might be that the way that you’re pumping isn’t as efficient as the way that you hand express. So maybe we’re not quite using the settings exactly right or we don’t have quite the right flange size or something.

Yeah, that could be it. You know, the pump is never going to be as good at removing milk as baby. And then actually when you’re hand expressing you can feel where the harder, fuller spots are, cause your milk fills up in your breasts like spokes on a wheel. And so when you feel like maybe after you’ve pumped that you have one area that maybe didn’t get emptied as much, you can really focus on that area manually with your hand and you’re able to express more.

There’s also the other possibility that you need to change your pump parts. So we didn’t hear in that question, if you were actually removing milk, you know, like, are you pumping for 30 minutes and getting three ounces? Cause that’s pretty great. Are you pumping for 30 minutes and getting half an ounce? Because maybe that means your pump is not functioning the way it should be. Might want to look into replacing your pump parts, or if you’re using a used pump, it might be that the motor is worn out.

So looking into that, but then there’s a possibility that you truly do have an oversupply. So, you know, if you, and that’s kind of tough to deal with on your own. I usually recommend people work directly with a lactation consultant, either me or Maureen, because we both take individual clients one-on-one. But just as long as you’re working with somebody closely, as you try to downregulate to make sure everything goes well, and you know, baby’s not too affected and you don’t end up with mastitis and clogged ducts and things like that.

So those are just some things to think about. Yeah. And I, the last thought I have too, is that sometimes people will run their pump kind of on the automatic settings. They start with this fast and soft suction, right, for a few minutes and then do the slow, harder section and just leave it on that setting.

But when we hand express, we tend to do faster and less suction, right? Like that initial expression mode. So it might be that if you just repeat those settings about 15 minutes into pumping that you’ll get more. I love it. Yes. Do that. So I just, I think we should maybe have a hand expression clinic because everybody does it in a different way.

You know, there’s not one right way to do it. So I would love to see how people hand express differently. Wouldn’t it be such an interesting observational study? Yeah. And I, so I’ve done like gone down the YouTube rabbit hole of hand expression before, and every video I’m like, wait, she’s doing something different that I don’t do.

She’s doing something different that I don’t do. Well, I know that you and I do it completely different. So you’re like an overhand hand expressor and I’m an underhand hand expresser and when I first saw you do it, I was like, hold on. So, you know, maybe you’re just really, really good at hand expressing Destiny, who knows?

I mean, send us a video. Show us your ways. Maybe you’ve like cracked the hand expression code. Totally. Yeah. And honestly, if you guys are listening out there and you’re like, I’ve never tried hand expressing, just go do it. It’s, it’s kind of weird at first, but it’s also fun because you can adjust what you’re doing.

You know, immediately in response to what your body’s doing, right. Versus a pump. It just does one thing. So yeah, like, you know, sit there, put a bowl in front of your boobs. So you have like a wide area to rain, to aim at, you know, cause the first time you’re going to do it, it’s hard to like aim right into a cup.

You know, one thing though, now this is turning into a hand expression episode, but you know, they, the research shows that if you use a pump, you are more likely to get more out if you’re doing both breasts at the same time, but I don’t know anybody that hand expresses two boobs at a time, you know, have you ever thought about that?

It’d be interesting to see, like doing hand expression on both breasts versus one. If you’re able to remove more. I feel like that would be a two-person job. For sure. I mean, like, who’s going to hold the milk cups for me while I’m shooting from two hands? Sounds like we can do a case study. Perfect. All right, Destiny. Well, thanks for bringing this case study to our attention. We will be hand expressing both of our boobs at the same time just for fun later, to see if we can do it.

Let’s take a quick break to thank our sponsor,¬†Aeroflow. Aeroflow is your one-stop shop to get the most popular breast pumps and accessories through your insurance. Yeah. So don’t let your insurance go to waste. Why don’t you let Aeroflow do all the dirty work for you? You never have to call your insurance when you use Aeroflow and they remind you when you’re eligible for free replacement parts.

Yep. So when you’re tired in your postpartum period, and you’re wondering why your pump isn’t working as well, you might get a text that says, did you know you need replacement parts? And you say, I did not know that. You push a button and boom. They show up at your door. Thanks, Aeroflow. Thank you so much. Go ahead and check out the¬†link to Aeroflow¬†in our show notes and order your pump through them.

All right, Maureen, let’s talk about pacifiers. Yeah, let’s talk about it because I wonder about this every day with this baby I have. You know, pacifiers get a bad rap. And, you know, maybe some of it is deserved. Maybe some of it is not deserved. The problem with most of this research as all of the research that we talk about, is that there are so many variables in play when you’re looking at mother-baby dyads and it’s kind of hard to eliminate the confounding variables when doing research.

So. You know, you can do correlation studies and with the pacifiers, there have been a couple of random controlled trials, which are pretty strong evidence, but they’re, they’re small and there’s not that many. So I looked at a ton of research and also, I looked at the World Health Organization and the American Academy of Pediatric recommendations.

And I’m going to be giving all of you the information that I found. And we’re going to summarize it at the end, and then you can make your own decision as always. So if you’re using a pacifier currently, don’t feel like you can’t listen to this episode because you’re going to feel shame. You will not, it will be fine.

So listen on. Are you going to tell me the history of pacifiers? Cause I’m excited for that. Oh girl. Yes. So I actually got this information from a¬†New York Times article by Dashka Slater called, “Who Made That Pacifier?”¬†I love the New York Times. They always have such a good way of turning something that could be potentially boring into something that’s pretty freaking interesting.

So, so the pacifier was quote unquote invented at the beginning of the 20th century, but not really. People have been using different things to soothe their babies since forever and ever. One of the earliest representations we have of this is in a 16th century painting of the Madonna and child. Jesus has a soothing rag cause that he’s sucking on in this painting, which is fascinating to me.

So some of the other things that they’ll use are corn cobs knotted rags dipped in honey or Brandy, wooden beads, which sounds really fricking dangerous. And then teething toys. Also like Brandy, Brandy sounds dangerous, but like possibly very effective. Totally. And then they’ll have teething toys also, which they’ve made of bone, ivory, or even coral, which sounds very rough on gums.

Yeah, a bone. I get. Coral? Like ow! That would definitely help to help that tooth erupt out of there. Just scrape the whole gum off the top. I don’t understand that one. I mean, maybe there are smooth corals? I don’t know, like most of the coral I’ve seen are kind of rough, but who knows? I don’t know shit about coral. I’ll be honest with you.

I gotta stay in my lane here. Yeah. Yeah. I have done a lot of scuba diving, but we usually, like, you’re not encouraged, but you’re not supposed to touch the coral, you know? So I don’t really know what it all feels like. Well, someday I’ll have to hear about your scuba diving adventures. I’ve never been, but I’d like to go.

But that painting I was talking about is by Albrecht Durer. And it’s called¬†Madonna with the Siskin¬†and it looks like Jesus is holding the cloth pouch type of soother and there’s speculation that maybe it was filled with poppy seeds or sugar. And I’m like, poppy seeds? Isn’t that like an opiate? Wow. Really?

Really, sir? I mean, again, I don’t know. I don’t know. Interesting. Isn’t that weird? I mean, maybe it just like molds to their mouth though. Yeah. Oh, maybe. If it’s full of poppy seeds. Maybe, but like poppy seeds probably have a flavor that’s not, you know, too offensive. Right. And possibly relaxing. It tastes good. Yeah. Very relaxing depending on your poppy.

That’s what you make heroin out of, right? It’s poppy. Yeah, pretty much. Yeah. Poppies make opium. Yeah. I told my mom. My mom is very Catholic and I was telling her about this pacifier research. And I was like, yeah and they’ve got this whole situation with Jesus sucking on a cloth with poppy seeds in it. And I said, maybe that’s how he got all his great ideas.

And she’s like, that is sacrilegious. And I was like, oh, sorry, my bad mom. But I was going to say, if it was painted in the 1500s though, like maybe that’s what they were doing for babies then? Just like getting them high off of opium poppies. Yeah. I’m like, mom, don’t be so offended. There was still cocaine in all of your cough medicine when you were little, so yeah.

Yeah, you got the real Coca-Cola so yeah, let’s not judge. Yeah. So the first recognizable pacifier was patented by a dude named Christian Meineke, Meineke. Okay. Well, Christian Meineke in 1901. So of course this is after rubber was invented because, you know, they would need to be able to make the shape and he called it the baby comforter. And it consisted of a nipple made of India rubber and a disc shaped shield.

Can I just say though, I like that better than calling it a pacifier. I’ve always hated that word. Like let’s pacify our children, like comforting them. I like that. I, I never thought about that, but this might be a good time to mention all of the different things that people call them, like they’re dummies in the UK.

Why do they call it the dummy? I don’t know, but it probably means something different colloquially. But yeah, people call him a Binky and ninny. I don’t know. I can’t think of other ones, but. Yeah. Oh, my brother called it a Pyre. You’d say where’s my Pyre. Write in and tell us if you’re from the UK, why they call it a dummy, please.

Yeah, please. That’d be great to know. So the later innovations of this added a ring to the pacifier, so the babies could try to hold it themselves. And then the nipples were processed with sulfur and some were tinted white, which actually contaminated the pacifier with lead. I can’t imagine sulfur tasted good.

What? No. Yeah. I don’t know why they did that. And then also they used bone ivory and aluminum for the shield part of it, which that sounds very high dollar. Like, oh, look at my ivory Binky. Like, so at that time, ivory was being just like wholesale stolen from Africa, so it probably wasn’t that expensive.

True, but can you imagine now, like you find 16 binkies under the crib that you’ve lost and they’re all ivory. I mean, it might’ve been like, you know, Victorian era, like fancy baby stuff too. Very well, yes, could have been. So eventually latex and silicone replaced these rubber nipples and plastic was used for the shields and rings.

And the pacifier really hasn’t changed much since the 1950s. They pretty much just have the same thing going on. So now you’re all caught up. That’s how we got the pacifier in our present day. So, what I take away from that is that for centuries, we’ve been trying to figure out ways to soothe our babies. I mean, moms are busy.

We’ve always been busy, even when we were still working within the home and they wouldn’t let us out of the home cause we were kind of imprisoned by our life of domestic work. We’re still busy. We gotta do stuff. So like, if your baby’s super crying and you can’t breastfeed at that moment, because you’re busy hoeing in the fields or whatever the heck you’re doing, you’re going to try to find a way to soothe this baby in a way that is safe and effective.

And yeah, so that, to me sounds like we’re not really doing anything wrong by trying to find another way to soothe our babies. But there are some things that we can worry about with pacifier use. Yes, I have worries. Can you soothe them? I mean, I can pacify them. Yeah. Let’s see. Some of the worries with pacifier use are the anterior open bite.

So that’s a pallet malformation, basically where the teeth kind of flange out. And so even with the mouth shut, the teeth are kind of still like pointed outwards and we’ve all seen it. I mean, I have lived it. I sucked my pinky actually, until my pinky was so long that I was gagging myself because I was like four and I’m giant and I have man hands.

So like eventually the pinky wasn’t working out for me, but my teeth were just like whoa. That’s so funny, my son sucked his two first fingers, like his first finger and his middle finger. But he, I don’t think it messed up his teeth. He didn’t do it that much. I think, so my son’s dentist, just to kind of get off track here for a quick second.

So pretty much, as long as they quit by the age of three, they tend to be a lot more fixable. But okay. So we’ve got the anterior open bite, the pallet malformations. I mean, Jesus choking on a poppy seed is pretty high up on the list for me.

We worry about interrupted breastfeeding. So that’s either via missed feeding cues because they’re sucking on the Binky instead of the breast or nipple confusion, quote unquote, which we’re going to have to talk about. And then of course we worry about the infant’s ability to self-soothe and sleep.

So how connected are all of these things together? Yeah. That’s a lot to think about. And like, I just, the thing that I’m constantly wondering is like, which one looks most like my boob once it’s in her mouth? I’m always like what’s going to work best? I think a lot of people think that, you know, like if this one looks more like a breast, it will be fine.

But let me talk about the mouth structure a little bit and tell you why that doesn’t matter so much. Okay. So first of all, we are not just looking at the tongue. There’s a lot of muscles in the head, face, and tongue. And breastfeeding, just the act of breastfeeding, pretty much activates all of these muscles.

And when you’re activating every single muscle, like even their little foreheads will move up and down as they’re nursing sometimes. And all of these muscles being worked helps them grow and develop in the best way possible. Pacifiers tend to cause this hyper function of the buccinator muscle. And so that muscle is the muscle in the cheek that holds the cheek to the teeth and assists with chewing.

So if you think about the pacifier, it doesn’t require as much muscle to continue it. Like it, it kind of stays in your mouth, especially when you have a stuffed animal attached to it. And the only muscle you’re really using what, well, the only muscle you’re using like aggressively is that buccinator muscle.

So it tends to get really, really strong and tight. And then it also will, it will limit the transverse growth of the mandible, which is the chin. So you can imagine like having a tight cheek muscle is going to limit some other muscles. So also the tongue’s resting position is supposed to be the hard palate of the mouth.

So if you look at a baby that’s kind of a laying down and resting, they will have their tongue against the roof of their mouth. That’s their, that’s the resting posture. But when they’re sleeping with a Binky in their mouth, or they constantly have a Binky in their mouth, their tongue is in this constant low position.

And that can affect the growth and development of the maxillary arch, which is the roof of the mouth. So, if you think about that tongue’s presence constantly pushing against that roof of the mouth and kind of spreading it out and, you know, making that grow properly, you know, that can obviously be a problem. Yeah.

I was actually just reading about one of the easiest interventions for tongue ties, being that we close baby’s mouths when they sleep and that makes their tongue then hit the top of their mouth and rest on the palate. Yeah, it was pretty funny. I was talking to a listener about that and she was like, that’s crazy.

Is that really supposed to happen? And you know, we’re like messaging so I was like, where is your tongue right now? And she was like, oh my God, it’s on the roof of my mouth! So is mine. That’s where it’s supposed to be. Cool, huh? We’re just giant babies. Can you imagine if we all just walked around with our tongues hanging out, like in a low position, we’d be like dogs. It’d be weird. It would not look right.

Which can affect your quality life. So, you know, one of the things we worry about here is that when you look at the research, lower socioeconomic status parents and teen parents tend to use pacifiers more. So when you have that situation, plus the fact that the pacifier use can cause more of an anterior open bite, that affects their quality of life because it’s a very expensive fix to fix that anterior open bite with orthodontia and that can put either a great economic strain on families or the kid just has to grow up with teeth that stick out of their face. And, you know, they either have to deal with bullying or, you know, it’s just not the best setup for them. Plus it could cause speech impediments, which, you know, can also affect quality of life later on.

And that just furthers the gap from a socioeconomic standpoint. So, you know, just thinking, I know it’s so weird when we talk about these issues with babies and then you look 15 years down the road and you’re like, oh yeah, it’s funny the tiny little pacifier is part of the widening gap in our socioeconomic status.

As you know, it’s just, you wouldn’t think that that’s where it starts. It’s where all of it starts. Yeah. And anyways, more research please. And by the way, a lot of research was done in 2016, for some reason. And a lot of research was done in Brazil. Brazil is traditionally, from what I understand, they’re very like they do a lot more interventions in birth.

Like they have a very high C-section rate. Their culture prizes C-sections as like a lot more posh than a vaginal delivery. Like vaginal deliveries are for more poor people. So it was really interesting to me that all these studies were coming out.

There’s an interesting thing about that country as well in that breast augmentation surgeries are very common. So the breastfeeding rate and the issues faced breastfeeding in that country are like totally different. So one study I found was from Brazil and it was a cohort of a couple hundred infants and they evaluated them at seven days of life, 30 days of life, 60, 120 180 and then the last time they looked at them was between three and five years of age at their dental appointment.

And this was really focusing on the¬†anterior open bite and pacifier use and breastfeeding. Basically what I found interesting was that almost half of the children, so 44% presented with an anterior open bite and approximately three quarters of them had used a pacifier at some point. Not super strong data there, cause that’s more like a correlation, but interesting.

So the median duration of breastfeeding was a little below one year, which was interesting. And 32% of the children were breastfed for two plus years. However, only 5.9% were exclusively breastfed for the first six months of life, which is way lower than the rest of I mean, definitely lower than America. I mean, we can’t speak for every country, but when we recorded¬†episode 38, our 2020 recap, New Research and Progress, we talked all about the¬†breastfeeding rates and exclusive breastfeeding up to six months and it was a way more than 5.9%.

So Brazil has definitely seen some kind of interrupted breastfeeding there for that particular statistic when you compare them to other people. But this is where the cultural norms come into play like I was talking about. Where bottles are more widely used and you know, more breast augmentation, like Maureen said.

So that’s why this is more specific to Brazil, but the study of the anterior open bite is still interesting. So the results of this study showed that for each month of breastfeeding, there was a reduction of 2% in the prevalence of anterior open bite, estimated. However, for each month of pacifier use the risk of anterior open bite increased by 5%.

Therefore, it seems reasonable to hypothesize that as pacifier use duration increases the protective effect of breastfeeding against development of anterior open bite decreases. So just in layman’s terms, this basically means if you’re going to use a pacifier, you should introduce it as late as possible into your breastfeeding journey and that you should consider continuing to breastfeed to protect the mouth against malformations.

However, breastfeeding alone may not be enough to protect your baby from a malformation, especially if aren’t exclusively breastfeeding. So that makes sense to me that cause you know, breastfeeding is still activating all of those muscles. So if your baby is strictly bottle feeding and pacifier that buccinator muscle is going to be super tight. There’s going to be no protective mechanisms to help the other muscles function, to help grow and develop those crania facial muscles the way they should be.

But if you are breastfeeding at least a little bit, like every month that you breastfeed, it’s going to offer more and more protection because you’re working those muscles, you’re expanding that palate and the tongue motion is really helping to kind of preserve that structure. So regarding that, regarding that facial muscle strength, we need to talk quickly about NICU babies and premature babies, and why sucking on the pacifier is actually very helpful for them.

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So they’re not probably breastfeeding at that point. Some NICU babies are, but if they’re like a legit NICU baby, that’s been there for quite a while, they are going to actually need to suck on a pacifier in order to work some of those muscles and also work their neurological suck, swallow, breathe process, and help to mature neurologically as well.

So that’s one of those times that we’re like, Hmm, this might actually be a good thing. So some of the things that people say about pacifiers and how they quote unquote, could interrupt lactation. Like we said, the missed feeding cues, using the pacifier to increase the length of time between feeds, which could affect your supply. Nipple confusion, which is very highly debated, even among lactation consultants and missed opportunities for bonding based on soothing behaviors from parents, which could interfere with the biofeedback of breastfeeding.

So if you’re, if your baby is crying and you decide to use a pacifier instead of taking that opportunity to pick them up, maybe do some skin to skin, do a little bit of breastfeeding, which may be not even for food, but can be used for comfort, you’re kind of missing that biofeedback of breastfeeding. So that could be another way, but these are all super, highly debated among researchers.

Like I’m not even going to get into it cause it’s just confusing and like literally nobody has an exact answer. And so much of this is like, you can’t even objectively measure half of that, you know, if not more. I mean, like, how do you measure interference of biofeedback from breastfeeding? Right. Exactly.

Yeah. So these are just things that like, these are observations of lactation consultants. These are things that have been passed down that could potentially affect it. But, you know, we’ll put that in the summary at the end when we make this a little bit less confusing. Okay. Because I’m confused. You know, I’m just gonna put it out there guys.

Yeah. I mean, and that’s the whole, that’s the whole point of doing this episode honestly. It’s like, let me highlight the fact that this is confusing and we’re going to give you the research and then you can make your own choices and we’ll give you the positives and negatives that we do have. So here’s some interesting things that I found though.

So I did find a peer reviewed meta-analysis where they kind of look at a bunch of different research that has been going on. So the meta-analysis was from 2016, so all of the research that they were looking at was, you know, somewhere between 2007, 2008. What, what happened in 2016? Is that, was that just like? Dude I don’t know. So weird. But you know, I do think sometimes a lot of these like research kind of correlating organizations work on like a four-year schedule though.

So maybe it was just like on their schedule, you know, 2016, 2020, whatever. Yeah, maybe. So they did find a correlation between pacifier use and exclusive breastfeeding interruption. So when they looked at all of these different research papers, they did see a positive correlation between pacifier use interrupting breastfeeding.

And at the time these findings were in line with the World Health Organization recommendation, but that has since changed. Okay, so put that in your pocket. And then we’re going to look at the other pocket. So let’s, let’s look at the¬†World Health Organization recommendation¬†now. So the World Health Organization did their own systematic review where they looked at a bunch of research and they now state as of 2021, that when you study women that are highly motivated to breastfeed, there is no correlation between pacifier use and duration of breastfeeding up to four months postpartum. That’s very interesting to me and we’ll get into that. So another interesting finding from this systematic review was that even when pacifiers were restricted, it had no effect on cry or fussy behavior at four, six or nine months of age.

And it also had no effect on the risk of weening before three months of age, which seems like great news all around. You know what I mean? Yes. It’s reassuring. It’s very reassuring that if you are someone that’s highly motivated to breastfeed that pacifiers shouldn’t affect that at all up to four months of age.

So let’s now hop over to the American Academy of Pediatrics. Oh, they’re always exciting. Aren’t they? They actually recommend pacifier use for healthy term babies, which I thought was interesting cause most of them definitely recommend it for premature babies. But the¬†American Academy of Pediatrics recommends¬†pacifier use for healthy term babies at nap and bedtime while placing the infant in back to sleep position in order to help prevent SIDS.

And they also recommend waiting until breastfeeding is well established, which is usually about three to four weeks of age. So if sucking, when you go to sleep would help prevent SIDS, wouldn’t breastfeeding to sleep, do the same thing? I don’t think they will do a study on that because of SIDS. Yeah. Hmm. Well, yeah, I mean it, and anyway, interesting.

I just wonder, like, because the AAP doesn’t recommend bed sharing, but then they recommend when your baby sleeps by themselves, that you give them a pacifier so that they’re sucking when they fall asleep. Then if sucking, while you fall asleep is protective, would that, can I, I don’t know, you know, I’m just like, wow! There’s a lot to think about there.

Yeah, there’s a lot to unpack there. And also, I can tell you that that recommendation used to be to wait until two weeks. They used to say that breastfeeding was established at two weeks and now they’ve moved it to three to four weeks. I would argue that it’s probably not well-established until six weeks.

Yeah. I feel like six to eight weeks is when most people. It’s hard to say because like what, what does it mean to have a well-established relationship? Right. I think on our end we often think about like, when do our clients actually feel like they know what the fuck they’re doing? And like they’re in a rhythm and their baby’s in a rhythm and they have a good milk supply.

And that is definitely more like eight weeks. But you know, the AAP focuses really just on the infant. And so like maybe that’s the age that most infants have coordinated suck, swallow, breathe. And I think it’s actually also to do with the hormones CCK, and it’s a very, very primitive of hormone in newborns.

And that basically gets released when the infant is sucking on anything. So whether it’s a breast with milk in it, a bottle, a Binky, a finger, when they’re sucking this primitive hormone CCK is released that tells their brain, oh, we’re eating. We’re full. So if your baby is crying and is actually hungry and you give them a pacifier in the first three days of life, and they suck on that pacifier for 30 minutes and they go to sleep, your grandma says, see, I told you that baby just is too oral and needs a nap. When really it needed a boob and it thinks it had a boob.

So then they wake up 15 minutes later screaming. Yeah. Starving to death and you’re like, oh yeah, yeah. And, and that relationship is really the heart of when we talk about pacifiers and missed feeding cues in our breastfeeding relationship. Right? Like we really don’t want you to replace a feeding cue in the first couple of weeks with a pacifier, because it does release that hormone.

It makes the baby feel like they’re full at least for a little while. And, you know, when we really want your baby to be nursing, to be cluster feeding, et cetera. Right. So that hormone eventually does go away. It’s a, it’s a transient hormone. It’s very primitive. And eventually as your baby neurologically matures and hormonally matures other more well-established hormone processes are put into place. As you know, like, as baby learns what being full means, you know, things like that, which we talk a lot about with bottle feeding. So there’s, there’s different things that we like to try to stay away from if possible in those first couple of weeks.

And one of them for me is a pacifier for this reason. Yeah. It’s definitely tricky. I feel like this is such an individual choice because, you know, even if we don’t have a NICU baby, sometimes we have these babies that come out without like really good muscle tone. So we’re like, oh yes, we want them to use a pacifier to build that up.

You know? And, and sometimes we, you know, have parents who have like nipple trauma in the first few days. So like maybe we’ll recommend a pacifier to help, like alternate the comfort you know, and it’s yeah, it’s complicated is kind of the, the conclusion that we’re going to come to in a few minutes.

Well, you know, another thing that I actually didn’t include in here, but you just made me remember, is that, do we, here’s just a question. Do we want to train our babies to, non-nutritively suck as a habit? You know, why do we want that? You know, it’s interesting and there’s no right answer. It’s just something to think about.

And also if you look at first time moms compared to multiparous moms, are we training the mothers in a different way by using pacifiers? You know, like, are we interrupting maternal behaviors by use of a pacifier? Yeah. Who knows? Like it’s really interesting to think about also, if you’re at home looking at your like pacifier collection, just maybe don’t worry about that.

It just seems like one more thing to worry about. These are just questions that we’re posing, just, you know, because we’re like nerds when it comes to this stuff. But so another big thing is that people say, well, my baby is going to take a pacifier because it helps them sleep through the night. It doesn’t. So that’s actually a common myth.

Nope. So another study from 2016, showed then. What happened in 2016? Dude, I don’t know. There must’ve been like a big grant pushed through. I bet you anything it was because of the baby friendly hospital initiative, because we’ll talk about that in a second too. So anyways,¬†this study from 2016, showed that pacifiers made absolutely no difference when it came to night wakings.

However finger sucking did seem to decrease the amount of night wakings. So not that you can force your kid to be a thumb sucker. You cannot, that is not a thing. They either are, or they aren’t. But, you know, it showed that pacifier use had no effect on the amount of night wakings. A funny little tidbit was, so we, we hear this in the lactation and sleep training world a lot is that if you put the binkies in their own bed, you know, like put six of them in there so they can grab them whenever they want and learn how to self-soothe.

So a funny tidbit from that study is that most infants were able to retrieve their own pacifier in their crib by seven months of age, however, that independence and being able to grab that binky did not make a difference for night wakings. Interesting. But my follow up question is, okay they still woke the same amount of times. Did they need help soothing to go back to sleep?

Right. Cause that’s really the thing that at least I hope for, with pacifier use is that maybe it will reduce the amount of times that I have to intervene to help my baby go back to sleep. Right. Right. Exactly. And you know, if you compare a pacifier to a cozy blanket, you know, they’re little lovey, like, does that make a difference?

You know, is it the, is it the non-nutritive sucking or is it just being able to have that independence to have something that makes them feel better? So, you know, of course more studies need to be done. Yeah. Interesting. So we all, probably at this point have heard about the baby friendly hospital initiative.

But if you haven’t essentially, you know, this initiative has been trying to change the way that hospital policies influence what happens with babies and their parents in the first couple of days postpartum. So reducing, you know, to increase breastfeeding rates. Right. There’s a lot of different rules that hospitals have to agree to follow, to get the baby friendly stamp of approval.

So if your hospital is quote unquote baby-friendly and they have that certification, that means that you will have, you should have uninterrupted skin to skin for the first two hours after birth. You should not have any formula samples given to you; the babies should be rooming in with you at all times which is controversial.

Yeah, no formula advertising, you know, like formula companies often send out like free name tags for all the nurses, with their logos on them. Like none of that. Yeah, they can’t have any of that. So, and then also they try to decrease the amount of formula supplementation in the first 48 hours of life and you know, all of these good things.

So initially the baby friendly hospital initiative, mixed pacifier use completely based on the research that was available at the time. So probably using the research that I told you about before, that meta-analysis of all of the 2007, 2008 studies that did show interrupted breastfeeding. But after further investigation, the baby-friendly initiative came to the conclusion that there are certain times and conditions that they believe to be, and the word they used is justifiable or potentially medically helpful when it comes to pacifier use.

So these times would be if you have a low-birth-weight baby, a premature baby, a hypoglycemic baby, which I thought was interesting. So I don’t know if like sucking helps release more glucose in your bloodstream, or I’m not sure. Or infants in need of oral stimulation to develop and maintain the sucking reflex in preterm infants like I was talking about.

So like comfort neuro behavioral organization, and then the reduction of SIDS, which is neurological. So basically with all of that being said, I know that was a lot of information and it was a little bit just like samples of every, you know, facet of research and big organizations that have their recommendations.

But here’s my conclusion after reading all of this research, if you are highly motivated to breastfeed, but you would love to use a pacifier, you’re probably fine. You may want to consider waiting until breastfeeding is quote unquote well established, whatever that means for you and your baby. If you have a premature, low birth weight infant, or an infant that needs a little neurological help as far as like the suck, swallow, breathe triangle, you should definitely use a pacifier.

You should not expect the pacifier to be a miracle worker when it comes to long-term fussiness or sleeping. And your kid might need braces or a pallet expander, but you might end up with a thumb sucker and need those interventions anyways. So remember that the longer you breastfeed the less of a chance of needing mouth interventions later, regardless of Binky use.

And if you choose to use a pacifier during bedtime, you can rest assure that the research definitely points to a decreased risk of SIDS. So I hope that conclusion helps you make your decision in some way. As usual, do whatever you want with this information. My personal experience, I’ll tell you right now exactly what I did.

My children refused pacifiers completely. And I tried them. Like I, I tried several different kinds. I don’t know why I tried several different kinds. I just felt like they needed it. You know, like binkies are what you buy for your kid, you know, that’s part of the registry, you know, you just do it. And then my kid was like ” oo, no, none of it. Take them all back. I’m going to suck my thumb.”

And both my kids were just hardcore thumb suckers. My son, who is now almost eight, he quit on his third birthday because his orthodontist, dentist, whatever his dentist told him that he had to stop by the time he was three. And he said, okay, and on his third birthday, he quit.

He said, well, Dr. Bagby told me I had to quit. And he just stopped like that day. That’s hilarious. So weird and his teeth are fine. Like he does not have the anterior open bite. My daughter who’s two and some change, very, very much a thumb sucker. And definitely already has an anterior open bite. I hope it resolves, but if not, like her mommy dearest, she will have to have a palate expander and retainers forever.

Yeah. Oh well. Griffin refused all pacifiers and really didn’t suck on anything but me, except for like six months, he sucked on his two first fingers. And then he stopped. That was like probably six months to a year old.

This time I have tried harder to introduce one, hoping that it will help when I’m away from home more. Because last time I was basically able to stay home all the time, put Griffin to sleep whenever, but I’m going back to work sooner. I’m going to be working overnights. Sometimes I’m like, okay, you know what would be great?

If we could use this to help like initiate. You know, cause it’s going to help my partner. And of course I have like 5,000 pacifiers. I have like six different brands. I just got a new one in the mail today because you know why not? Let’s try another. But right now, basically I’ve just been using them to get her to sleep in the car seat is the big thing. Because we drive a lot, we do a lot of long drives and that’s like a really nice thing to be able to help her get back to sleep so I don’t have to stop and nurse every 20 minutes. Yeah. So like, and so far she hates the ones that are supposed to be like the most popular, breastfeeding friendly, like the¬†MAM¬†and the¬†NUK. She’s like, yeah, screw those.

I can spit them across the room. But the¬†Soothie, she’s okay with, and I just got the¬†Ninni¬†in the mail today, which is supposed to be like the new, innovative most breast-like one that is interesting. It came with this whole pamphlet about how, like, it has a learning curve because it’s really different from other pacifiers.

And we’re trying, it is definitely, I think, based on what, it’s clear, it’s one of those clear ones. So I can like see into her mouth when she uses it, which is really cool. And it definitely looks like her latch is much more similar to what it is on my breasts so far. So like that’s cool. She didn’t use it to fall asleep yet.

She tried it a little bit and she was like, Hmm, this is fun. I’m going to suck on it and push it out with my tongue and look at you. Yeah. I guess the nipple confusion piece of things, like the reason I didn’t even get into that really is because it is a fact that the baby sucks on a bottle and the nipple differently because of the suction alone.

Like they have to constantly recreate the negative pressure around a bottle to get the milk out. Whereas with the breast, they have like two forms of suction. They have their tongue, which is troughed around the nipple against the roof of the mouth. And then they have their outer lips, which creates that constant negative pressure.

And then the tongue undulating inside against the nipple is what actually squirts it in. With a bottle they have to constantly recreate that negative pressure and the same with the Binky. So yes, it does change their sucking pattern, but clearly it’s not significant enough, or we would see that in the data.

Yeah. And I don’t know, I feel positive about this new one I got, but more than anything, I’m going to try to get a good video of her sucking with it cause you can see like her lips and her tongue moving in it, which is just really fun. Yeah. It has nothing to do with anything with my baby. I’m like, oh cool.

Let’s just get a video to share with you guys. That’s awesome. But yeah, I, I will say this is, this one is way different from any other pacifier I’ve ever seen or tried so we’ll see. I’ll let you guys know at some point, if it’s great and if we love it and maybe we’ll interview the people who created it, cause that’s gonna be interesting.

Yeah. And you know, the wider, the wider mouth binkies, that is interesting to me and makes sense. Like, I don’t know if having that wider gape is going to help with the palate formation or at least maybe keep their, their top lip flanged enough that it doesn’t make a difference on your breasts? Yeah. I think one of the big things that makes a difference for that pallet issue based on the information you shared is just like, how, how much is the tongue then going to be pressing on the pallet while they’re sucking. Right? And so with a breast, the tongue essentially shapes it. It shapes the breasts. The breast puts that nice even pressure on the palate. But with a pacifier, especially those ones that are just really rigid, like the rigidity of them really varies. And the very rigid ones are not going to change shape at all.

So they’re going to have a very small point of pressure on the pallet versus the less rigid ones will spread out and evenly distribute the pressure wherever they’re touching it. Right. I can tell you though, that if you talk to any hospital lactation consultant, they absolutely hate those Soothies, the green ones.

They used to smell like vanilla. Like five years ago, they actually had a vanilla flavor. And so of course, a brand-new baby who’s been breastfed like three times total, you put a vanilla flavored, straight nipple in their mouth, and they’re going to be super confused. They don’t have any kind of history of knowing what to do with something that shape or that smell.

And then you try to put them back on a squishy breast and they’re like, what? And I will say that’s one of the ones my daughter will take more readily for whatever reason, don’t know. Maybe the tip of it is more like the tip of my nipples, you know, who knows? But it is one of the more rigid ones for sure.

Well, it might have something to do with the fact that that rigid part pushes against the palate, which triggers a sucking reflex. Yeah. So I will say the interesting thing about the one that I’m trying now is that basically the whole thing is really soft except for the tip. And the tip of it is more rigid.

So I’m hopeful maybe that will be like comfortable for her and also ergonomic and might help me like get through a single drive without her screaming for 20 minutes before she passes out in exhaustion more than anything. And if it helps her self-soothe back to sleep at night, great, but that’s like not even my goal.

Right, exactly. I guess like, just figure out what your goals are as a parent. You know, if you’re like, I want to be exclusively breastfeeding for six months at least. And you know, I have no interest in using a pacifier, great. If you’re really, really motivated to breastfeed, but also you have a very busy life and you’re doing stuff and your baby’s medically well, use a pacifier or whatever. Or try to, right? Your baby might not want it.

Yeah, I think that’s the other important thing to mention is that if your baby doesn’t take a pacifier, it’s fine. Yeah, it will be all right. What’s also normal is that there’s a learning curve with any pacifier because it is, you know, especially once you’ve already introduced either breast or bottle feeding, you know, this is a whole new behavior pattern to learn.

It’s going to be normal for your baby to use their very wonderful and protective tongue thrust to shoot that Binky across the fucking room. And it’s amazing how strong that is. You’re like, oh, look, they’re sucking on it. There it goes across the room. Yeah. That’s why I love those little leashes for them.

I don’t like the one with the stuffed animals, because I feel like at least right now it’s like a little bit heavy and it just, my child’s uncoordinated arm windmilling just like catches it and, and like pops it out of her mouth. But the little ones that you can like clip onto their shirt so when they decide to like tongue thrust eject it, it doesn’t fall on the floor. Yeah, that’s helpful. I like that. It’s really helpful.

Well, you guys, I hope this wasn’t too overwhelming. I hope this helps you make a good decision that you can stand behind with your pacifier use. Yeah. And, and I hope more than anything. It just helps you realize that whatever you’re doing is probably just fine.

Yeah. Probably just fine. Because you know what I did not do was get on here and be like, oh, the research shows that pacifiers are going to ruin your breastfeeding relationship. Not what I found. Nope. So before we get out of here, we have to do an award.

Maureen, did you know that any time I’ve ever tried a lube in my life, my vagina reacts like it’s mad at me? Yeah, you have mentioned that to me before. Yeah, I had, I used to call it ABD, angry vaginas disorder, but the good news is I actually found a product that I really love. And this is serious. I’m not joking.

This is not just something that I am saying to say on an ad. I love¬†Uber lube. It’s a natural product that does not have any like artificial, anything in it. And it works with your body and it actually lasts a pretty long time if you know what I mean? Yes, I do know what you mean, and I know that our listeners need lube kind of more than anything in the postpartum.

Like breastfeeding’s a dry time guys. Yeah. And it’s not your fault. That’s kind of a normal side effect of breastfeeding, but it doesn’t mean your relationship has to suffer. Or even your relationship with yourself. Yeah. So get yourself some Uber lube by clicking the link in the show notes, or you can go to¬†Uberlube.com¬†and enter the promo code MILKMINUTE.

Happy lubing everyone.

Today, our award in the alcove goes to Heather S. Who has an exciting story for us. Heather successfully pumped on a 12-hour tuna fishing trip. The captain of the boat had never seen this before in 30 years of being in business. And the most exciting part was that Heather was about to hook up her pump for the second time, and it was like on her when she got distracted, because there was a tuna on her fishing line.

So she paused her pumping, reeled that sucker in and then went right back to pumping. Oh my God. And let me tell you guys, if you’ve never gone big fish like fishing, like deep sea fishing, this is not just like a two minute I’m reeling in a little fish.

It is a lot of work to reel in a big fish. It is like full body workout. It takes a long time. So this is kind of superhero level multitasking. That’s like one of the most bad-ass things I’ve ever heard. So what award are we going to give Heather? I don’t know the big kahuna tuna. Oh my gosh. Yeah. That’s it.

From one Heather to another, you, you get the big kahuna tuna award. I, I can’t even, I wish I had seen it in real life, but the visuals that I’m getting in my head are, are just as good. I think it’s good for you. You are a bad ass. Yeah, we love this. We love this story so much. I can’t even find words to express it.

All right. You guys. Well, thank you so much for listening to another episode and we will see you back next week. Bye. Thanks for listening to The Milk Minute. If you haven’t already please like, subscribe, and review our podcast wherever you listen. If you’d like to support our podcast, you can find us on Patreon at¬†Patreon.com/MilkMinutePodcast.

To send us feedback, personal stories, or just to chat, you can send us an email at [email protected]

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