Bulletin - The measure of excellence : Canadian early childhood ...

SPECIAL FEATURE ON RESEARCH: NEWBORN BABIESNO NEED FOR A BAN: STUDY FINDS PACIFIERSNOT LINKED TO EARLY WEANINGWhether it is called a pacifier, asoother or, as the British do, adummy, this little rubber object hascreated controversy. Studies havesuggested a link between pacifieruse and early weaning from breastfeeding,possibly by creating nippleconfusion in the baby.Both the World Heath Organizationand the United NationsChildren's Fund strongly discourageits use, and observational (nonexperimental)studies have consistentlyshown that babies who use pacifierson a daily basis are weaned earlierthan those who do not. Yet studiesalso show that pacifiers reduce ababy's crying in the short term, abenefit for both parents and child.Then a team of Canadian researchersset out to explore what rolethe pacifier might play in weaningand soothing babies. They carriedout a randomized, double-blind,controlled study at Montreal's RoyalVictoria Hospital with 281 mothers(258 completed the study). All thewomen received information andhelp with breastfeeding. However,one group was asked to avoid usinga pacifier when the baby cried orfussed. Instead, mothers were askedto offer the breast or to try carryingor rocking the infant. A secondgroup received information on alloptions available for soothing thebaby from breastfeeding to using apacifier. The mothers kept a log oftheir infant's behaviour at four, sixand nine weeks of age. The motherswere also interviewed at threemonths to assess breastfeeding andpacifier use rates.The researchers discovered thatpacifier use, when analyzed accordingto the randomized allocation, had noeffect on the risk of weaning bythree months. When randomized allocationwas ignored, however, thosebabies who used pacifiers on a dailybasis were more likely to be weanedby three months. These resultsstrongly suggest that pacifier use is amarker (indicator) of breastfeedingdifficulties or a mother's decliningcommitment to breastfeeding, ratherthan a true cause of early weaning.The study also found that thepacifier was no more successful inpacifying the baby than othersoothing methods, such as breastfeeding,carrying and rocking. Thismuch-debated object may provide awarning to health professionals ofTiny, fragile and vulnerable, babiesborn weighing less than one kilogramneed all the help advancedtechnology can provide. Simply survivingis a struggle, and those wholive often face a host of health anddevelopmental problems. Now, arecent study suggests that theseextremely low-birthweight (ELBW)babies may need monitoring, particularlyfor behavioural problems,well into their school years.Published in The Lancet, the studyexamined 408 ELBW children fromheight to ten years of age in theNetherlands, Germany, Canada andthe United States. Researchers askedparents to answer questions abouttheir children using a tool called theChild Behavior Checklist. This list helpsidentify behaviours that are aggressive,delinquent,anxious,somatic(suchas dizziness and headaches) or withdrawn,as well as social, thought andpotential breastfeeding difficultiesthat could derail the mother-infantnursing relationship."Understanding that pacifier useis a marker and not a cause ofbreastfeeding difficulties may helphealth professionals find newapproaches to helping breastfeedingmothers who are reachingfor the pacifier, and pacifier; when abreastfeeding mother is using asoother, she may need more helpand support," said Dawn Walker,Executive Director of the CanadianInstitute of Child Health. WalkerTINY BABIES,LONG-TERM PROBLEMSattention problems.The scores for the ELBW childrenwere compared to scores for full-termchildren. In all four countries, the ELBWchildren exhibited greater social,thought and attention difficulties.The researchers concluded thatELBW children, regardless of the culturethey are born into, are at risk for thoughtproblems, attention difficulties andproblems integrating into social groups.They hold that ELBW children should bemonitored on an ongoing basis andprovided with preventive interventionfor learning and social problems.Chad O'Brien, a regional coordinatorof Early Childhood for First Nationsof Quebec and Labrador Health andSocial Services Commission, said thestudy came to some very valid conclusions."Extremelylow-birthweight childrenare definitely at a disadvantage,"he said. However, O'Brien added thatmore research should be done to lookadded that women today feel greatpressure to breastfeed but mayunderestimate the time and effortinvolved. Using a pacifier may beone way to shift a breastfeedingbaby's schedule (normally everyhour and half to two hours) moretowards the three-to-four hourintervals of a formula-fed infant.Ref.: M. S. Kramer et al., "PacifierUse, Early Weaning, and Cry/FussBehavior. A Randomized ControlledTrial,” Journal of the AmericanMedical Association, vol. 286, July2001.at how socio-economic issues impactthe behavioural problems of ELBWchildren. He also noted that the studylooked exclusively at Western andEuropean cultures and suggested itwould be worthwhile to look at othercultures such as First Nations.While the study confirms whatmany practitioners have long suspected,namely that extremely lowbirthweightchildren need long-termcare and follow-up, O'Brien addedthat resources are still few and farbetween. "There is so little out therefor these kids. We need educationand awareness programs. Preventingpreterm birth would also be key. Butwe need to increase the funding forservices to children."Ref.: É. T. M. Hille et al. "BehavioralProblems in Children Who Weigh1000g or Less at Birth in FourCountries." The Lancet. Vol. 357. May2001.VOLUME 1, N O 3 - DECEMBER 2002 BULLETIN OF THE CENTRE OF EXCELLENCE FOR EARLY CHILDHOOD DEVELOPMENT - PAGE 9