Is a pacifier a chargeable item in your facility?

Browneyedgirl · May 31, 2003

Breastfeeding mothers can offer non nutritive suckling at the breast.

I admit bias. I didn't use a pacifier with my children. I used a baby sling and lots of TLC.

dawngloves, BSN, RN · May 31, 2003

Originally posted by Browneyedgirl
Breastfeeding mothers can offer non nutritive suckling at the breast.

I admit bias. I didn't use a pacifier with my children. I used a baby sling and lots of TLC.

Brestfed both my babies and they never had a pacifier. My son does suck his thumb. I have a friend who breast fed her kids and one sucks her thumb, the other a paci.

Back to the subject, In our NICU and newborn nursery we ahve a big drawer full of pacis, no charge. But the funny thing is, in our gift shop they sell the EXACT same ones for $3!!!!!

pieWACKet · May 31, 2003

Our pacifiers are chargeable, no matter the type. We don't use the nipples sent along with the forumula as pacifiers....those are not charged but are only for forula or Expressed milk ingestion.

We have three kinds, preemie, term, and nuk....all charged.

Dayray, RN · May 31, 2003

OMG non-nutritive sucking at the breast? You must have titanium-plated nipples! OWCH =P

I work at 2 hospitals and although both are supposed to be non-profit, My favorite hospital doesn't charge for anything. The other makes us collect $3 for the vanilla flavored pacifiers; I have never had a request for the nuks so I don't know what they cost.

As far as the pacifier debate, I respect the wishes of patients who ask not to have them. I don't think it's a bad thing as long as they aren't over used. Sometimes it's a last resort comfort measure. You try everything you can to comfort the baby and then just give them a pacifier. I work in the nursery enough that crying doesn't bother me so that's not and issue for me. I just want the babies to be happy and the sucking is comforting

KRVRN, BSN, RN · May 31, 2003

We sell them in the gift shop for $3-4. They are not chargeable in the NICU and the PP floors don't stock them.

Very necessary in the NICU. Necessity is questionable in the PP area, it's a personal decision for the parents.

NICU_Nurse, BSN, RN · May 31, 2003

I hate to see this thread getting off-track, but I can't help myself here!

Some information to read about pre-termers and the benefits of NNS/pacifier use:

http://www.nichd.nih.gov/cochraneneonatal/Pinelli/Pinelli.HTM

Main results: This review consisted of 20 studies, 14 of which were randomized controlled trials. NNS was found to decrease significantly the length of hospital stay in preterm infants. The review did not reveal a consistent benefit of NNS with respect to other major clinical variables (weight gain, energy intake, heart rate, oxygen saturation, intestinal transit time, and age at full oral feeds).

The review identified other positive clinical outcomes of NNS: transition from tube to bottle feeds, better bottle feeding performance and behavior. No negative outcomes were reported in any of the studies.

Reviewers' conclusions: This review found a significant decrease in length of stay in preterm infants receiving a NNS intervention.

Addt'l info regarding ALL babies (not just preemies) and pacifier use/NNS:

http://health.discovery.com/diseasesandcond/encyclopedia/2711.html

Some babies have a constant need for sucking on their fingers, thumb, or pacifiers, while others do not show a need for extra sucking. Extra sucking is usually a self-comforting behavior. Sucking on a pacifier can offer security and comfort to many babies. The need for extra sucking is a natural habit. Many babies sucked their thumb or fingers even before being born. All babies have a need to suck, but the amount of sucking varies from baby to baby. Some want to suck all of the time, and others suck only during feeding. With some infants, the urge to suck seems to be more than what's needed for nutrition. It appears babies suck to comfort themselves when they're upset. It's also a way of exploring things. In some cases, sucking might be just a way for babies to pass the time. Babies appear more willing to take a pacifier between the ages of 2 to 4 months old. This appears to be the peak age in the need for extra sucking. After this age the sucking drive usually decreases. Many parents oppose the use of pacifiers, as they see the pacifier as an "object used to pacify a baby" rather than an object used to satisfy the sucking need. Other parents favor the use of a pacifier to meet the need for extra sucking, and as an alternative for thumb sucking.

And yet another bit of info:

http://www.lovegevity.com/parenting/expect/thumb_sucking6.html

Sucking comforts an irritable infant, creating a sense of calm and well-being. Pediatricians at Denver's Children's Hospital have monitored infants' breathing, heart rate, digestion, and frequency of crying to understand how these activities are altered by sucking. Irrespective of whether babies prefer a pacifier, finger, or thumb to suck, the action of rhythmic sucking optimizes an infant's breathing and heart rate. Because of this soothing effect, sucking helps a hungry infant wait to be fed, cuts down on fussing when infants are tired, and decreases the time infants spend crying. Thumb and finger sucking babies tend to sleep longer and more soundly than non-sucking infants, apparently because sucking eases the transition from wakefulness to sleep. Infants generally awaken often. Their normal nighttime sleep pattern involves alteration of several sleep hours and then an awake period before sleep is again resumed. Rhythmic sucking lulls them back to sleep. Psychological research with babies six months to a year old suggest that children who suck their thumbs, fingers, or pacifiers actually may develop more self-confidence than those who do not. Nine-month-olds who have sucking habits crawl further from the mother, and seem to need to spend less time in close body contact with her. Mothers of these infants stay in frequent contact with their children, but are able to do so with words and smiles rather than needing to hold them physically.

As I said, I work primarily with NICU babies, the large majority of which are pre-term, thus we use pacifiers a lot.

Furthermore, it is highly unusual in our patient population and with our babies (considering the circumstances of their diagnoses and GA and family interactions, etc.) to have a mom actually breastfeed at the breast. In most cases it is mom pumping and freezing milk to use via gavage or bottle. Though some mothers may be willing and/or able to breastfeed and/or suckle at the breast 24 hours a day on call, there are AT LEAST an equal amount (if not many, many more) who are not available nor are they willing to do such a thing. I think that the issue, then, lies primarily with the *individual* mothers who choose not to engage in these activities, rather than the nurses, who are able to spend even less time (usually) with these babies than their own mothers are. I am in absolute and total support of NNS in preemies, especially those who are not going to be latching on, and particularly with those who are being fed via gavage. I have found (and of course, this is anecdotal) that infants given preemie pacifiers during gavage feeds learn to associate feeding with sucking, and therefore demonstrate a stronger ability to suck and handle bottle feedings when the time comes (aversions notwithstanding; that's a completely seperate issue).

Usually, I try to coax their fingers into their mouths (encourages literal self-soothing, manipulation of the arms/fingers, etc.) if mom has a problem with pacifiers, but not every baby is able to sustain this position, it can create breakdown and chafing on their delicate skin and fingers, and it is easier for a parent to withdraw a pacifier later in the child's life than to convince the child to stop sucking their thumb. Pacifiers can be taken away; thumbs...well, not a whole lot one can do about that, and as many parents would be able to confirm, it can be awfully difficult to get your child to stop thumb-sucking when you feel they're old enough to wean.

Browneyedgirl, you sound like a very caring and conscientious mommy. Your children are very, very, VERY lucky to have had such a nurturing person to take care of them.

As we all know, though, this can sometimes be the exception to the rule. Sad, isn't it?

layna · May 31, 2003

"Browneyedgirl, you sound like a very caring and conscientious mommy. Your children are very, very, VERY lucky to have had such a nurturing person to take care of them."

You are absolutely right. In this materialistic culture, I know very few moms who will take the time to allow their babies to experience NNS at the breast for long periods of time. Most women won't tolerate it because they want their "freedom" and a clean house all the time. My fourth child enjoyed as much NNS as he wanted. I figured that there was plenty of time later on in life to be "free" and have a clean house when he is grown and then gone. No regrets. :-)

As far as pacis- my first three children used them. Yes- easy to take away compared to thumbs and fingers! :-)

Browneyedgirl · Jun 1, 2003

thanks Layna...

NICU babies are a completely different subject and I have been blessed to never have a seriously ill baby.

But, from my way of thinking/parenting philosophy, when a baby cries, it has a need for nurturing, and from an infant, that nurturing should preferably come from it's mommy.

All mommies are created differently as are all babies.

Only saying the pacifier should never be offered to the baby without the consent of the parent. IDEALLY....

*to read, in my view from these rose colored glasses*

I do not mean to critcize anyone else. just stating how i do/see things. .

I mean, from a medical viewpoint, with a HEALTHY baby, what does the pacifier do that some time in a loving person's arms can't do?

Teshiee · Jun 1, 2003

In our NICU unit the preemie ones are expensive and our nurse manager keeps them in her office. Personally if nurturing should come from mommies then these mommies should have their baby at home. It is so unrealistic when nurses have more than one baby to contend with. As a NICU nurse I like touch and swaddling but it doesn't work all the time. It is so easy for a parent to not want a pacifier given when the poor child is screaming constantly and the "nurturing mom" is in her room! We encourage breastfeeding and kangaroo care it is a very essential part of their progress but if they are not stable we must use alternative methods. Some cases I agree but in NICU it is a totally different ball game especially when they are acutely ill.

NICU_Nurse, BSN, RN · Jun 1, 2003

Teshiee, do you happen to know how much they cost apiece? We never get that info at work, and I've always been curious.

imenid37 · Jun 1, 2003

this is sort of away from the subject...

i just think if you want to give your child a pacifier, that as long as you are informed. (notice my you means you the parent, as i also believe that is who the decision maker should be in this and most other baby care/child-raising issues, not the nurse or the in-laws or whoever wants to stick their nose in w/ advice) then it's o.k.

so many parenting decisions are so fraught with guilt these days. should you breast feed? yes, i think so. i even more firmly believe you have the right to choose to bottlefeed (w/o being hounded w/ an extreme guilt trip) after you have weighed the info. out there and i, as a nurse serve as a source of information, not condemnation. should you go back to work after giving birth? does it mean you are not as good as the mom who makes a different decision? there are those who think so and have no qualms about telling others they are inferior if the have made a different choice.

if nns at the breast works for you fine. please don't judge the mom who it does not work for as materialistic or not involved w/ her child. i am just glad your way works for you. maybe your neighbour needs to take her other child to school or leave the home to provide financially for the family so this doesn't work for her. we need to get together as women and be a little less judgemental of others. we spend so much time and energy cutting down other women as moms and nurses when we could better spend our time enjoying our kids and one another.

SmilingBluEyes · Jun 1, 2003

very good and timely post, imenid, as I also saw a big debate heating up. (again). I refuse to argue w/parents who request a "paci". I had one for my dd. As to letting her use ME as her pacifier, no way. NO way did I want her suckling on me 24/7. It HURTS ya know. And it's kinda hard to take care of other kids when I have one attached to me 24/7. But hey, I tried. I wanted to be a good mom who practiced what I preached to others as a nurse. Just did not work for me.

But hey, She did fine. It did NOT "sabotage our breastfeeding" as LC 's would have you believe. At least I think not since she breastfed for 16 months, (exclusively for 8 months) And I am not gonna ever say it's a parent who wants to just put something in the kid's mouth to lessen the work they need to do caring. Some kids just want to suck....all the time!!!!! if not my breast (no thanks, I have a life too), then their thumb, hand, wrist, or a pacifier. She used to suck my pinky, but I decided a pacifier was a cleaner choice. She seems to have come through ok. I take good care of my kids.......

She at just turning 4 can read small words, write her name, knows left from right, all her colors and shapes, alphabet and counts to 25 without a day in preschool or school yet. She is ver self-confident, happy and has no damage to her mouth or teeth evident by the pacifier use in infancy. So, I don't buy into the theories about pacifiers being a bad thing. For some, they are needed. It's up to the parents and after being educated about them; it's a choice they have the privelege to make without a lot of misplaced value judgements on our parts as nurses. Ok whew I feel better now.