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I don't really want my newborn to use the pacifier because I'm afraid it will interfere with breastfeeding. The first week I'd nurse her for an hour to an hour and a half - basically until she was done with me. The pediatrician said to only nurse 15 min. max per breast because the baby was using me as a pacifier. We do have a pacifier that she absolutely loves.

Pacifier-usage seems to me like it could cause nipple confusion? Should I forego usage of the pacifier unless in desperate times ;)

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I believe you got a wrong advice regarding breastfeeding (As far as I know pediatricians get little to no training in breastfeeding so their advice regarding breastfeeding should be taken with a grain of salt). The most nourishing milk is hind milk which takes a while to get to.

You certainly should not limit the baby's time on the breast and you should let him nurse on one breast as long as he likes and then offer second. And there is nothing wrong with using your breast as a pacifier either. It stimulates your milk production. Pacifiers are convenient but they are not necessary and should not replace breast.

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If you think four years of medical school and three years of residency counts as "little to no training" I wonder whose advice you would trust and what their qualifications are. –  Ze'ev Felsen Jul 15 '13 at 6:05
    
I edited my response to specify that pediatricians get little to no training in breastfeeding –  jny Jul 22 '13 at 17:09
    
Doctors vary pretty widely not only in general quality, but also in supplemental training. Breastfeeding may not be something that is part of core pediatrician training (I'm not sure, not being one myself), but surely some have taken it upon themselves to learn more. Our ped is a mother of several kids, and I'd be shocked if she hadn't done any research on the subject. TLDR: saying pediatricians have little to no training may be slightly over-generalizing. –  Beofett Jul 23 '13 at 0:49
    
There's an additional facet here which neither of you are considering which may make the pediatrician's claims valid. Some babies don't really latch on and suck; they will suck lightly at the nipple the way they would a passy, and this is called "non-nutritive sucking". The difference will be clear to anyone with training and experience as a breastfeeding coach. Whether the OP's pediatrician has such training or experience is not for me or for jny to judge; we don't have enough facts. –  KeithS Jul 31 '13 at 23:46
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Here are two sites with the results of research on nipple confusion.

The American Journal of Pediatrics concluded: "Breastfeeding duration in the first 3 months' postpartum was unaffected by pacifier use."

The European Journal of Pediatrics reported the following conclusion, "In our study population fluid supplements offered by bottle with or without the use of pacifiers during the first 5 days of life were not associated with a lower frequency or shorter duration of breastfeeding during the first 6 months of life."

More indepth reading of the research seems to indicate that nipple confusion is related to difficulty nursing or sucking in general.

As a speech language pathologist who works with infants having feeding difficulties, I believe that the infant is not confused. Rather, they are following the easiest option. Newborns have sucked, but never breathed before. Swallowing requires a complex pattern of suck swallow breathe. A pacifier allows sucking with minimal swallowing.

Weakness is another factor. The nipples of pacifiers, bottles, and mom's all require different motor skills to draw out liquid. The breast requires effort by the child. This effort builds strength and skills for later speech and feeding development.

If a child is struggling with breastfeeding, it is understandable that a nipple that produces no flow (pacifier) or one that controls the flow into the mouth (slow flow nipple) or quickly without effort (fast flow nipples) is preferred. These nipples do not cause the confusion, but rather reveal a difference or problem that is already present.

Some of these problems will likely show up later in slower development of feeding and speech skills.

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The studies referenced here 100% correlate with the experience of every single family I know who used a pacifier and also breastfed, which happens to be a lot of families. Any children who did have feeding issues had them regardless of pacifier use. –  justkt Jul 23 '13 at 15:23
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On the opposite tack to @Beofett - we did allow our children to have pacifiers (we didn't want to but they definitely helped) and we introduced a bottle of formula milk after the first week as the last meal before bed - which allowed me to have some bonding time with my children, as well as letting my wife get some much needed sleep.

No confusion at all, and we let them wean themselves off the pacifier at around 2 years old.

I think it helped keep life relaxed.

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Actually, we did allow our son pacifiers. However, he never really showed much interest in them. The nipple confusion came mostly from the syringe itself, rather than the pacifiers. Our son came to expect free-flowing milk with little effort, which caused him to get frustrated very easily when trying to breast-feed, since that required much more effort on his part. –  Beofett Apr 22 '11 at 14:08
    
@Boefett - that kind of confusion, though, is different from that related to pacifiers. The only thing pacifiers do is change the way babies suck (shallower). Expecting free-flowing milk can be solved by always bottle feeding a breastfed baby in an appropriate manner - one that mimics the work required to get milk from a breast. –  justkt Jul 23 '13 at 15:24
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Our experience with nipple confusion (most probably caused by very early bottle feeding during the first days):

As our baby did not really drink at the breast on its first day, it was given a bottle in the hospital. This may have been the beginning of many problems (of course we'll never be sure), as in the following time

  • the baby was not able to quickly get the necessary amount of milk at the breast, in fact it did not know how to suck correctly
  • so it stayed at the breast for a long time resulting in bloody nipples
  • we tried nipple shields to help him
  • we feared it would not get enough and therefore in parallel pumped and freezed milk and fead it with the bottle
  • all attempts of nurses in the hospital and "our" midwife were not successful to teach the baby drinking efficiently

Luckily, the pediatrician had the excellent idea to send us to a speech therapist (specialised in young babies) which stated that the baby just did not know how to suck correctly and efficiently and helped it learning it by stimulation of the muscles in and around the mouth by a kind of "massage" which we also could do at home (I think, it is called the Castillo-Morales method).
She also gave us special bottles which have a nipple much more similar (in its function) to the breast than the "normal" baby bottles. At the moment I don't remember the name of the product, it was something with "play...." and they had a plastic bag for the milk instead of a rigid plastic bottle where the feeding parent could create pressure and therefore help the baby drinking at the beginning.

So finally, after 6..8 weeks with really big problems and very much stress for everyone the baby started to learn being breastfed...

We used pacifiers (I think, already in the hospital), but at least from our experience the bottle feeding might have a much bigger impact on nipple confusion than a pacifier.

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Pacifier use too early, or, indeed, any artificial nipple use too early can definitely lead to nipple confusion. The various advice we had gotten both from out classes, and the lactation consultants, was to wait at least 3-4 weeks before giving any form of artificial nipple to the baby.

Unfortunately, in our case, our son had jaundice, and therefore the doctors wanted to make sure that he got as much nurishment as possible during the first two days. Since breastmilk usually takes a couple of days to come in, this meant we had to feed him formula with a dropper and a bulb. Even that caused serious nipple confusion for him, and resulted in major problems when we tried breastfeeding.

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Thanks for sharing. We introduced the bottle because some nurses pressured me while at the hospital. We've also tried a dropper for the breastmilk too and the baby was sucking it like a straw. I was afraid the dropper was causing some confusion as well so we stopped that too. –  Rhea Apr 24 '11 at 2:56
    
We used a cup with a lip for additional feed, as it causes less nipple confusion, at the cost of more spillage. –  deworde May 20 '12 at 10:01
    
While nipple confusion is the scare phrase of LCs everywhere, I know not a single person who has had problems with pacifier use causing nipple confusion in newborns. I do know people who have had problems with fast flow bottles causing breast rejection, but that was a problem with flow not with the artificial nipple itself. –  justkt Jul 23 '13 at 15:26
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Our daughter was given a pacifier in the hospital shortly after she was born - she was taken to the NICU because of abnormal breathing and was separated from me for a few hours. We were encouraged to bottle feed her in addition to the breast from the beginning so when it was necessary, it would already be familiar. At first there seemed to be no problem - she had one bottle a day from dad and breastfed the rest of the time. At 6 weeks, I went back to work and after a few weeks she refused the breast. Through a great deal of effort (and being laid off and therefore home full time) she returned to breast feeding full time and now will again take either breast or bottle. I do not think she has had any of these issues due to the pacifier, but it is one of those things that is hard to know. I know I wish I had had the opportunity to breast feed her shortly after birth have wondered if it was part of our difficulties in breastfeeding.

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This seems to be two different problems. The pediatrician saying that your baby is using you as a pacifier doesn't necessarily mean that her having a pacifier is bad.

Generally speaking, it's still thought to be best, breastfeeding-wise, for a baby to not be given a bottle or pacifier until they're sucking at mother's breast like a champion. Your daughter apparently got that far, so given that, a pacifier shouldn't be a problem.

What the pediatrician may have been alluding to is that your daughter, at only a few weeks old, may be getting all she needs from you food-wise in a relatively short window, and after that is dropping down to a lighter, shallower "non-nutritive sucking" pattern, the same as she'd use with a passy. The difference between this pattern and the pattern she'll use when she's really interested in food is very different; nutritive sucking is hard, long, and she'll be regularly swallowing and gasping (which is why you have to burp).

At that point when she starts to drop down to non-nutritive suckling, the value of keeping her at the breast is diminished; she's there for comfort, not food, and so you can take her away from the breast, give her a passy, and do something else with your time. An hour to an hour and a half at a sitting, when a newborn typically should be fed once every two hours, theoretically would mean you spend at least half your time nursing, and that's not healthy for you.

If you have a pump, try pumping, and see how long it takes from the moment you turn the pump on to get 2 ounces, or however much the baby books say your child should be eating at her age. My guess is that it will take closer to 15 minutes than to an hour and a half. However, there's no strict time limit here; if she's still sucking hard at the 15-minute mark, then let her keep going. She's a growing girl. Depending on what she weighed at birth, she's likely to quadruple her body weight in the first year, and all that energy and all those protein building blocks are going to come from you, God willing.

I would bring all these concerns to a breastfeeding coach. The hospital our daughter was born at had a breastfeeding clinic literally right across the entry bay from the maternity ward. It was staffed with nurse practitioners who did nothing but counsel new moms on how to breastfeed. I would see if there is any facility like that in your general area; these guys know breastfeeding, regardless of the experience your pediatrician has on the subject.

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There are two issues with your answer. The first is that I believe non-nutrative sucking still has benefits for milk supply. If a mother does not have supply issues then certainly pacifier use in place of non-nutrative nursing is helpful - I had no supply issues and happily gave my daughter a pacifier when she switched to flutter sucks. However for a mother with supply issues any sucking the baby does is helpful if I remember right. –  justkt Aug 1 '13 at 12:08
    
The second issue is that a pump is vastly different from a baby. Yes, a baby can be more efficient because babies use compression plus suction to remove milk. However newborns are a different story. They are still learning how to nurse. They absolutely may take more time then a pump until they are 6 weeks or even much older and their mouths are bigger and their feeding patterns are more established. –  justkt Aug 1 '13 at 12:08
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