Nipple Confusion

Specialties NICU

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ukstudent

805 Posts

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.

allnurses Guide

Spidey's mom, ADN, BSN, RN

11,304 Posts

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

Specializes in midwifery, NICU.
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

allnurses Guide

Spidey's mom, ADN, BSN, RN

11,304 Posts

: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

Specializes in NICU/Neonatal transport.

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.

Specializes in NICU/Neonatal transport.

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.

fergus51

6,620 Posts

You can be an advocate of breastfeeding without believing every word out of the LCs' mouths. I have helped countless women breastfeed and will go to great lengths to do so when they want it. I've finger fed and cup fed and syringe fed and used lactation aides at the breast all to avoid the dreaded bottle. I've even denied babies the comfort of a pacifier when they were in the NICU because the mom read something about nipple confusion or heard it from the LC and was convinced one suck on a paci would make her baby unable to breastfeed.

I still don't believe in nipple confusion. Your personal experience makes you believe it. That's fine. Mine doesn't. I've seen some kids prefer the bottle to the breast, I've seen others prefer the breast to the bottle. I've seen countless kids bottle feed and then go on to breast feed without problems. It's just a different skill they have to learn.

Elvish, BSN, DNP, RN, NP

4 Articles; 5,259 Posts

Specializes in Community, OB, Nursery.

Let me reiterate...I am NOT against breastfeeding. I breastfed my son for 15 months (almost 6mo exclusively) and would happily have gone on for as long as he wanted. He decided at 15 months that he had had enough and there was a big wide world to explore that had nothing to do with Mom's boobs.

I too have cup, syringe, SNSed, and nipple shielded and Lansinohed and just about everything else with moms who truly did not want to give a bottle. I will gladly do that. What I do not appreciate is when I have a mother who is at her wit's end -- her milk is not in and her 7lb baby is down to 6+2 and is glowing like a nuclear power plant -- and she has been made to feel inadequate for giving her baby formula, whether by bottle, cup, or whatever else.

Or the mom who has BFed 3 previous children for 2 years apiece while also giving them formula, and is told by a LC that she must take all the bottles out of her crib. (Uh, folks, I think she's got it figured out.) And not nicely -- more along the lines of "Get those bottles out of your baby's crib!"

I am not saying that every LC out there is like the one who described formula as poison. I am blessed to have met some wonderful LCs who met their pt's needs with compassion and realism. It's about half and half at my hospital. The bad half give the great half a very bad rep.

My experience is that babies are smart, not confused. Once mom's milk comes in and baby doesn't have to wait for milk, problem is gone and mom goes to exclusive BFing. I have seen it over and over.

Specializes in NICU/Neonatal transport.

Like I said - Nipple "confusion" is a misnomer. It's not really confusion, it's preference. We call it confusion when a child prefers something that is not natural or as healthy; they have to work harder to BF, that's one of the reasons why it's better for them.

And I've never said you have to believe everything out of a LC mouth, but preference for a bottle is nipple confusion. They are supposed to be nursing and they are "confused" about their correct way to feed.

I'm not saying anyone is against BFing, but it seems people typically only say negative things about LCs and horror stories of BFing and how "milk nazis" would rather a child die than drink formula, when such people a) should be reported to management because it is beyond their scope of duties to tell a mom to kill her child if she can't BF b) is completely out of line of the teaching they've received and are supposed to be using.

It's like if a nurse were to say that she likes to spit on her IV ports prior to accessing them because she thinks it's cleaner that way. She should not be trotted out in every nursing discussion as an example of nursing, and whoever works with her should be reporting her to hospital management because she is endangering pts.

MA Nurse

676 Posts

Specializes in NICU, Telephone Triage.
You can be an advocate of breastfeeding without believing every word out of the LCs' mouths. I have helped countless women breastfeed and will go to great lengths to do so when they want it. I've finger fed and cup fed and syringe fed and used lactation aides at the breast all to avoid the dreaded bottle. I've even denied babies the comfort of a pacifier when they were in the NICU because the mom read something about nipple confusion or heard it from the LC and was convinced one suck on a paci would make her baby unable to breastfeed.

I still don't believe in nipple confusion. Your personal experience makes you believe it. That's fine. Mine doesn't. I've seen some kids prefer the bottle to the breast, I've seen others prefer the breast to the bottle. I've seen countless kids bottle feed and then go on to breast feed without problems. It's just a different skill they have to learn.

I agree that it's terrible to deny a baby in the NICU a pacifier. They are in the NICU because they are sick! They are not at home, healthy and ready to breastfeed! If mom is not at the bedside 24/7, the baby should be allowed to use a pacifier to get comfortable from gas, etc.

We actually have a LC that is ok with pacifiers in the NICU! Woohoo!

i am all for breastfeeding, too...when the baby is able to do it...if tehy can't, then i would rather feed a baby a bottle than stick an IV in him or shove an NG tube down him because the mom thinks bottles are so wrong. All 3 of my kids took a bottle and the breast fine, no problem.

i think the confusion is more that they want the faster flow of the bottle, not that they' re confused and don't know what to do! If a baby is hungry enough, they'll figure it out one way or another.

fergus51

6,620 Posts

Like I said - Nipple "confusion" is a misnomer. It's not really confusion, it's preference. We call it confusion when a child prefers something that is not natural or as healthy; they have to work harder to BF, that's one of the reasons why it's better for them.

And I've never said you have to believe everything out of a LC mouth, but preference for a bottle is nipple confusion. They are supposed to be nursing and they are "confused" about their correct way to feed.

I'm not saying anyone is against BFing, but it seems people typically only say negative things about LCs and horror stories of BFing and how "milk nazis" would rather a child die than drink formula, when such people a) should be reported to management because it is beyond their scope of duties to tell a mom to kill her child if she can't BF b) is completely out of line of the teaching they've received and are supposed to be using.

It's like if a nurse were to say that she likes to spit on her IV ports prior to accessing them because she thinks it's cleaner that way. She should not be trotted out in every nursing discussion as an example of nursing, and whoever works with her should be reporting her to hospital management because she is endangering pts.

A preference isn't a disease. It can be overcome. That's my point. That's why this "diagnosis" doesn't mean anything to me. A baby can prefer the breast to the bottle. I still wouldn't call that nipple confusion when dad has trouble getting baby to take the bottle. You teach the baby to bottle feed. Along the same lines, you teach a baby to breastfeed. People who believe in nipple confusion often have a fit if a baby has a nipple. I don't. Heck, some kids prefer the right breast to the left. I don't say that they have nipple confusion because they have trouble nursing on one side.

I know from your posts here that you felt some nurses were judgemental when they cared for your baby. You talking about your personal experience doesn't make me defensive and accuse you of calling all nurses judgemental. Along the same lines, if I talk about a nipple nazi I think it can be assumed that I wasn't talking about ALL LCs.

Specializes in NICU/Neonatal transport.

I totally agree, it can be overcome and is not a disease per se, but it can make it more difficult for mom and baby to successfully nurse eventually, to the point where it never gets established. I'm all for binkies, and bottles when they are needed, I just think people need to be aware it can cause problems with nursing and be prepared to work on those.

I would argue, by and large, most of my posts about nursing though are not about judgmental nurses, in fact, I only had 1 particular nurse that was unpleasant, the rest were wonderful. And even when the conversation comes up, I wouldn't call them names like nazi.

I do think that LCs that are advocating killing babies and lying to parents should be reported.

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