Feeding and Pacifiers

If you are interested in breastfeeding:

Breast pump: You don’t need anything fancy.  Manual or electric pumps are available for purchase at drug stores, baby boutiques, Babies’R Us, and Wal-Mart.  I’m sure I’m missing a few places! Cost is quite variable  ($50-400).  Some people suggest that you need a double electric pump……it’s a “not necessary/nice to have” item for occasional pumping. Unless you have difficulty with milk supply, pain, or  a baby who is born early/has medical needs, you will likely be an occasional pumper.  Wait until baby is born to purchase one of these.  If you end up needing a pump in a hurry,   you can always rent one.

Places to rent pumps in Edmonton: Breastfeeding Clinic at Grey Nuns, One Tiny Suitcase (includes delivery), Pharmacies (see this link for a complete list), Safeway

Places to rent pumps in Calgary: Safeway, WeeFeed,  Pharmacies (see this link for a complete list)

If you know of any other places that I can add to these lists, please let me know.

Breast pads Your body takes time to adjust to the volume of milk your baby demands.  It initially errors on the side of making too much milk.  Your body  has no idea if you have delivered a single baby, twins or triplets so it makes enough milk to feed an army.  The result is these amazing, non-surgically enhanced boobs as soon as your milk volume increases.  Some people refer to this as your “milk coming in”.   The result of this process is generally milk leakage between feeds.  Some people leak far more  than others.  You can buy disposable or reusable pads to put in your nursing bra to prevent the embarrassment of walking around with two big wet dots on your shirt.  The reusable  pads were not absorbent enough for me so I chose to use the disposable versions.

Breast cream: There is a lack of evidence that breast cream will prevent a blister from forming or even make it feel better once it has occurred.  As far as I understand, there is some support that it may help the healing process once your nipple cracks (think moist wound care).  Nipple pain or blisters occur when your babe isn’t latched on  properly… something that should be addressed ASAP.  If you are in pain (i.e. feels like such a bad sunburn you don’t want to put a bra on), get yourself to a breastfeeding clinic.

Nipples will be sore as part of the learning process. Heck, if something sucked on my finger for at least 30 minutes every 1 1/2 hours for days on end, even my finger would get sore.  Think mild sunburn discomfort.  Prevention is much easier than getting back on track after an injury occurs.   Expect learning challenges to breastfeeding.  It is not always easy and may take commitment to stay the course.

Bottling:  There is controversy regarding the ideal time to introduce a bottle to breast-fed babies, if at all. Some professionals  argue that a breast-fed baby should never get a bottle, others argue only after 8 weeks, and finally others suggest introduction is fine whenever you choose!  Talk about confusing.  After considering the literature from each perspective in combination with clinical experience, my recommendation is to introduce a bottle when breastfeeding is well-established.  Just don’t wait 4 months!  Some babies develop a firm preference for the malleable tissue and balk at a bottle nipple.  On the other hand, some babies will accept a bottle right from the get go.  web_9

What you need to know about bottle/nipple systems is that they vary tremendously from brand to brand.   One brand of slow flow nipples does not flow at the same rate as another brand.   Also, don’t believe those marketing gimics for “anti-colic”.   Evidence does not suggest that these systems actually decrease length of crying.

Approach the bottles that market themselves to mimic the breast with similar cynicism.  There are different nipple shapes that encourage different oral motor patterns. No matter what the box of a bottle system  tells you, bottle and breast feeding require different skills.  No nipple is going to be just like the breast.  The bottle aisle is confusing at the best of times, let alone when you are sleep deprived and buying one so your partner can feed the baby and let you sleep longer.  Some babies are gaggy and need a shorter nipple, other babies will take whatever you give them and some babies are extremely sensitive to how quickly the milk flows through the nipple.  Start with a slow flow nipple.  Slow flow brands that actually flow slowly are Dr. Brown’s, Gerber newborn, and Playtex Ventaire. Slow flow brands that actually flow quite fast are Evenflo, Munchkin, and Avent.  A rudimentary way to test how fast it flows is to put water in the bottle (don’t want to waste liquid gold breastmilk!) and tip it upside down.  Watch how fast the water drips out of the nipple.

Bottom line: If you can financially swing it, buy a few different brands.  See if you can borrow a few different kinds from your mama circle.    Don’t expect to buy one brand and have it accepted by babe immediately.  You will likely trial a few different brands before you find the one that works for you and baby.

*This information is not meant to be therapeutic or interventional.  If your baby is having feeding difficulties, seek assistance from you midwife, GP, Lactation Consultant or therapist. *

Pacifiers Pacifier use is controversial and an individual family choice.  At the risk of overwhelming you, the information below will provide you with a healthy understanding of the pros and cons of pacifier use.

Some groups, specifically La Leche League International,  maintain that breast fed babies should not be given a soother at all and offered the opportunity to comfort nurse instead.  Nursing for comfort is called “non-nutritive sucking”.  You can tell the difference by the sucking rate and shallower jaw movements.  When baby is drinking for nutrition, the rate will be slower and you will see his jaw open wider with a slight pause at the widest point.  People against soother use suggest it will have a negative impact on breastfeeding, specifically increasing the risk of early weaning.  There seems to be a lack of robust literature to support this claim.  A recent publication out of Oregon, published in Pediatrics March 2013, found that restricting access to pacifiers during newborn hospitalization did not decrease exclusive breastfeeding rates.  This may not be a causal relationship, but helps us to understand that it is possible for pacifiers NOT to negatively impact successful breastfeeding in mothers that are motivated to breastfeed.  Other studies suggest that pacifier use and early weaning may be associated in situations where there are breastfeeding challenges or little maternal motivation to breastfeed. In addition, for babies who struggle with suck/swallow/breath coordination, practice on a pacifier is a great way to develop skills without the risk.

Some people describe a concern that “nipple confusion” will occur.  Others maintain that nipple confusion doesn’t exist.  From an oral motor perspective, it is important to know that soothers come in different shapes.  One is called an “orthodontic” shape and has a big bulb on the end.  Babies tend to compress this shape of nipple by pushing their tongue up onto their palate.  There are also “straight” nipples (these look more like a traditional bottle nipple). Babies tend to use more of a tongue groove around a straight soother, as well as a wave pattern (more similar to breast/bottle).  Consider the nipple shape if you choose to offer your baby a pacifier.

Pacifiers have been implicated to increase the frequency of ear infections.  Evidence suggests that it is one of the factors for developing ear infections.  The risk appears to decrease when pacifier use is limited to sleeping.

Pacifier use is associated with dental issues however most studies have found that this exists with prolonged and/or inappropriate use.  Prolonged use is considered to be up until age 5 and inappropriate use would be to put a sweetener on it.  The Canadian Dental Association recommends pacifier use over thumb use because it is easier for the parent to discontinue the habit.  They also state that the sucking habit should be stopped before permanent teeth erupt.

There is growing evidence to suggest that pacifier use has a protective effect against Sudden Infant Death Syndrome (SIDS).  The American Academy of Pediatrics actually suggests pacifier use during sleep, provided that it doesn’t interfere with breastfeeding.  Remember, the effect of pacifier use on decreasing the risk of SIDS is generally weaker than other  sleep environment changes.  These include things like  putting your baby on his back to sleep, maintaining an appropriate temperature for sleeping, not using loose bedding or soft sleeping surfaces, room sharing not bed sharing (somewhat controversial), and providing a non-smoking environment.   This is not an exhaustive list.

Many young babies have a period of their day where they cry inconsolably.  Babies cry more in the first three months than the rest of their lives and it typically peaks between 4 – 6 weeks.  I never wanted to give my baby E an orthodontic pacifier due to the compression pattern it encourages, HOWEVER in the throes of her crying (and me crying as a result of my inability to soothe her),   I tried anything and everything.  Philosophy went out the window when sanity was threatened.   Consider buying a straight nipple soother AND an orthodontic soother to have on hand for those moments. Pacifiers are a known aid for self-soothing and pain management for term and pre-term babies.

It could end up that your baby just doesn’t like a soother anyways! Preferences sure show up early in life!  I have 2 babies that spit out a soother from the minute they were born.

Bottom bottom line:    A pacifier has it’s cons but contrary to my belief with my first baby, it also has some definite pros.  Consider both when making your personal decision. 

  • When baby is rooting, stirring, opening his mouth or bringing his hand to mouth, offer the breast first.  It is important to respond to feeding cues with the opportunity to feed before offering a soother.   Allow non-nutritive sucking if you enjoy it and don’t have 3 other kids vying for your attention.  A soother may be a good replacement for those times that you can’t provide the comfort nursing.
  • Pacifiers can be a great soothing tool
  • Pacifiers can reduce the feeling of pain for babies
  • Pacifier use may decrease the risk of SIDS
  • Babies with re-current ear infections should be restricted in their pacifier use

Check out Canadian Pediatric Society parent handout on safe soother use.

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