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Nipple Confusion

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by B. Far B. Far (New) New

Anyone have information on how nipple confusion relates to breast feeding? Should prems who show interest in sucking be given a bottle if Mom plans on breast feeding?

danissa, LPN, LVN

Specializes in midwifery, NICU. Has 12 years experience.

With preemies, when they start to feed, it isnt always possible for Mums to be with them each hour of every day. But they still want to suck! So give them a suck feed!

Most of our breast feeding babies do have suck feeds from a bottle, great if its MEBM, but even if not...(and I would be hung by the neck for saying this by the baby friendly people!)......Nipple teat confusion is a lie! In the NICU anyway, we have so many babies who, once they learn to suck, are happy to feed from anything that goes in their wee mouths!

danissa, LPN, LVN

Specializes in midwifery, NICU. Has 12 years experience.

AND...most of our babes have "Non-Nutrative Sucking Devices" ie Pacifiers! SO frowned upon by the breast or starve brigade.:lol2:

I don't believe in nipple confusion in premies. I just don't. It's a nice theory and all, but I've seen countless bottle fed babies be able to breastfeed successfully. I've also seen babies who were never even given a pacifier unable to do so.

Personally, I think it's barbaric to deny a premie the benefits of nns because of fears of nipple confusion.

ukstudent

Specializes in SICU.

Given than evidence based research shows that pacifiers reduce SIDS by 90%. So that by stopping infants from having pacifiers you are increasing their chance of death, nipple confusion if even real, should not have a lot of weight.

Given than evidence based research shows that pacifiers reduce SIDS by 90%. So that by stopping infants from having pacifiers you are increasing their chance of death, nipple confusion if even real, should not have a lot of weight.

The nipple nazis would just point out that breastfeeding reduces MANY infant illnesses, so by interfering with that you are harming their health as well.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

I'm all for breastfeeding, don't get me wrong....but I have never seen a baby unable to breastfeed because s/he got a bottle. It is not the end of the world, though our nipple nazis would have you think so. We actually had one LC (who no longer works there, tg) tell a mother who gave her baby some formula that she was feeding him 'poison.' :angryfire

I work well-baby but we do see many late pretermers. I just don't see that bottlefeeding contributes to breastfeeding difficulties.

ukstudent

Specializes in SICU.

We actually had one LC (who no longer works there, tg) tell a mother who gave her baby some formula that she was feeding him 'poison.' :angryfire

Several years ago one of the nicu nurses that I worked with went to a lactation conference. The whole time they would not use the word formula, it was called "the poison", your LC might have gone to the same conference.

Breastfeeding is so much harder for the little guys. Too exhausting. If they don't bf at all , chances are they aren't bottle feeding all that well either. Nipple shields (another LLC no no) have worked great for many preemies that have a poor latch.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

Several years ago one of the nicu nurses that I worked with went to a lactation conference. The whole time they would not use the word formula, it was called "the poison", your LC might have gone to the same conference.

That is absolutely ridiculous! Bleach and arsenic are poison. Not formula! :madface:

I'm not a believer in nipple confusion either. My kids had formula while in the hospital (jaundice) and I breastfed them for, in order, 6 months, 18 months, 3 years, 3 1/2 years.

The only thing that did happen with my first child was he was bottle and breast fed and at 6 months would turn away from my breast and preferred the bottle . . .I'm sure due to the ease of getting the milk from the bottle - not nipple confusion. I could have, of course, just not given in and completely stopped giving formula but back then I really wasn't very savvy about nursing at all. I think I supplemented because my doc said it was good for the baby to have formula (this was 24 years ago). After the formula in the hospital for my other 3 kids, I never gave them formula in a bottle.

I loved breastfeeding and am an advocate but I'm not a nazi - I really hate that women are made to feel bad about not breastfeeding or supplementing with "poison".

I've been to one LC class . . . . never heard it called that.

steph

LilPeanut, MSN, RN, NP

Specializes in NICU/Neonatal transport. Has 8 years experience.

Nipple confusion is a misnomer - it's not really confusion about the nipple itself, it's difficulty in switching between the two methods of feeding.

It absolutely does exist, my son was a prime example of it. All the kids who will take a bottle and then just give one or two sucks at the breast before screaming or sleeping, that's nipple confusion.

I also really dislike the vehemence against breastfeeding proponents here. While it is absolutely inappropriate to refer to formula as poison, I think many nurses feel that bmilk/formula, it doesn't make much difference.

As for the pacifier/sids study, basically the finding is that not sleeping long times, deeply, is helpful against sids. You get that anyway with bfing, as long as the parent is not forcing the child to sleep through the night.

ukstudent

Specializes in SICU.

LilPeanut, I don't believe that anyone here is against breastfeeding. I breast fed all 4 of my children well into toddlerhood. I counted one day and spent almost 10 years of my life breastfeeding, so please don't think that I am against it.

What I am VERY against is LC telling new mothers that if they child get just one bottle, they will never be able to breast fed again and it will be their fault. That a women that has had a radical breast reduction can fully breastfeed without supplimentation, so that the baby returns to the hospital 5 days later almost dead from starvation and that then needs several weeks in a nicu. I am against LC's that so brainwash new parents that when a baby is admitted to a nicu for treatment that some would rather have their babys get multiple IV's than a bottle for feeding. I am against LC that make women that either don't want to breast feed or can't breast feed for whatever reason feel like they don't deserve to be mothers, that it is akin to child abuse.

I have known some great LC's that have worked with mom's for hours to get good breast feeding established, that have been supportive of any decision made by the mother. I have also know even more that have very ridged views on breastfeeding and have seen the harm that has come to some babies because of those views.

As for the multiple SIDs studies, it has nothing to do wiith breast or bottle feeding it has only to do with a baby going to sleep with a pacifier in the mouth. Breast or bottle had roughly the same SIDs rate with everything else being equal. The 90% reduction came from pacifier use. Something else that LC's are very against.

LilPeanut, I don't believe that anyone here is against breastfeeding. I breast fed all 4 of my children well into toddlerhood. I counted one day and spent almost 10 years of my life breastfeeding

I counted up too . . .4 kids - 8.7 years.

steph

danissa, LPN, LVN

Specializes in midwifery, NICU. Has 12 years experience.

I counted up too . . .4 kids - 8.7 years.

steph

:bow::bow: To the two of you who have B/F for so many years from your lives! Now THAT is commitment...That is Motherhood!

So impressed by you two, bet you got so much from it in return! Proud Mammies all round!:flowersfo

:bow::bow: To the two of you who have B/F for so many years from your lives! Now THAT is commitment...That is Motherhood!

So impressed by you two, bet you got so much from it in return! Proud Mammies all round!:flowersfo

Well, it was just easier . . . . nothing really noble about it. No bottles to prepare and wash. And when the baby just started to wake up, you popped that nipple in their little mouth and off to sleep they would go, sucking away.

Also, the more "rest" you give your breasts from estrogen, the less likely you are to get breast cancer. Or so I've been told. More babies, more breastfeeding, later onset of menses, etc., all things that happened to me.

steph

LilPeanut, MSN, RN, NP

Specializes in NICU/Neonatal transport. Has 8 years experience.

I will reiterate that I have already said that it is inappropriate for the LCs to call formula poison, and suggest that a child should starve to death before being given formula, but in general, in this forum and in the profession in general from what I've seen, is a lot of lip service, but not a lot of dedication to BFing. And I really just have a knee-jerk reaction against people calling BF proponents in general BF nazis. Nazi is such a horrible and ugly word and concept, that I see it applied with a very wide brush and it rankles me.

I can't address the SIDS study right now - I just got home from work and just honestly don't have the energy to do a pubmed search.

I spent 5 years nursing between two children, and I see from when I was a NICU mom and other nurses in my unit where we say that BM is the best, but in the long run, it is easier for us to give a bottle/formula, so who cares. It does matter, but obviously, if BM isn't available, you have to do something else (we do also use a lot of donor milk in our unit). And if there is no breastmilk, then it's a no brainer that formula is better than starvation.

But, many women with breast reductions can nurse, it's not irresponsible for the LC to tell the mom that it is possible, but the mom needs to be responsible enough to closely monitor the child's intake and output.

LilPeanut, MSN, RN, NP

Specializes in NICU/Neonatal transport. Has 8 years experience.

I am going to defer to a couple of drs. who have already written a well-thought out reply to the studies/recommendations.

Buzzetti, R., & D'Amico, R. (2006). The pacifier debate. Pediatrics, 117(5), 1850; author reply 1850-3.

It is far from clear, however, that pacifiers play a causal role in SIDS. Each of the 9 studies in the meta-analysis conducted by Hauck et al used a case-control design to assess whether a pacifier was used during the last sleep before SIDS death, or the sleep among control infants. In such a study design, there is potential for differential recall bias between parents of infants with SIDS and those of control infants on the basis of both the timing of the questioning and the parents' perceptions of whether pacifier use is "right." If an infant usually used a pacifier, it seems unlikely that control parents could recall whether the infant did or did not accept a pacifier in an otherwise unremarkable sleep period. For a "usual-pacifier" infant, we suspect that they would be biased toward reporting that a pacifier was used.

In their discussion, Hauck et al reject the hypothesis that infant illness results in decreased pacifier use, noting that 1 of the 9 studies included in the meta-analysis controlled for symptoms of illness.2 But what if the "symptom" was merely falling asleep more easily than usual? Would parents report that as "illness?" We question whether it is possible to control for such a subtle confounder in a retrospective case-control study.

Hauck et al go on to argue that there is a dose-response relationship between pacifier use and SIDS risk, because "use for all sleep periods is necessary." This is not a dose-response effect. A dose-response effect implies that more frequent pacifier use confers greater protection, a finding which would require assessment of the duration and frequency of pacifier use among cases and noncases. Such data do not appear anywhere in the study.

In fact, it may be just as reasonable to conclude, on the basis of the finding that pacifier nonuse at last sleep increases the risk of SIDS, that no infants should be given pacifiers, because "pacifier-dependent" infants may be more likely to succumb to SIDS when the pacifier is inadvertently forgotten.

The authors also invoke biological plausibility to support a causal relationship between pacifier use and SIDS. One of their primary references, an article on arousal threshold in pacifier users versus non–pacifier users, assesses a convenience sample of 56 infants at a median age of 10 weeks.3 Infants who used pacifiers had lower arousal thresholds than infants who did not use pacifiers. Among infants who were breastfed, this difference was not significant, although the sample size was small. It is important to note that, because these infants were not randomly assigned to pacifier use, it is possible that infants who slept more deeply never "needed" a pacifier. Thus, pacifier use at 10 weeks may be a marker for a fussier, more wakeful infant, not for a protection against deep sleep.

The consistent association between pacifier use at last sleep and reduced SIDS risk is interesting. However, we disagree with the authors' assertion that there is adequate evidence to recommend universal pacifier use in the absence of prospective cohort studies or randomized clinical trials showing an inverse association between pacifier use and SIDS.

Given the tenuous relationship between pacifiers and SIDS protection, we are concerned that the American Academy of Pediatrics chose to include a recommendation supporting pacifier use in their revised SIDS guidelines.4 The medical literature is littered with well-intentioned interventions born of case-control data and plausible explanations. National organizations need to proceed cautiously before making recommendations that can have a major public health impact.

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