Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trialBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38131.675914.55 (Published 22 July 2004) Cite this as: BMJ 2004;329:193
All rapid responses
I am pleased that the authors have added some support to the theory
that avoiding bottles increases the success of breastfeeding.
As a NICU practitioner of nineteen years, midwife and Lactation
Consultant, I am certainly not suggesting that babies should be given
bottles and/or pacifiers without consideration but I wonder if it could be
the 'way that you do it' that is as significant as 'what you do'. I find
that if you encourage babies to open their mouths wide for a pacifier then
they are more likely to do this for a breast. The baby needs to be
encouraged towards a wide 'gape' and a 'rooting' response so that this is
'programmed' feeding behaviour. When a baby gets accustomed to only
opening the mouth a little for a pacifier to 'enter', it makes latching at
the breast a more frustrating exercise. I have not conducted a study but
would be interested to hear thoughts from the authors and others about
Perhaps NICU researchers could continue work in the area of 'non-
nutritive suckling' on a recently expressed breast for preterm babies not
yet ready for full breastfeeds? Narayanan et al (1991) found that this
'non-nutritive suckling' on the breast appeared to promote lactation and
supported a longer duration of breastfeeding.
In the end I suggest that it is the contact between mother and baby
that fosters the breastfeeding relationship and anything you can do to
facilitate this contact will be beneficial. Thomas (1996) poses a question
about NICUs and Kangaroo Mother Care and wonders if pacifiers would be as
necessary in NICUs if we practised more KMC. I would add that the KMC
probably needs to be practiced in a less restricted manner than in most
NICUs. There seems to be a tendency to practice KMC in a 'token' way and
in the level 3 area only in many units.
Narayanan I.,Mehta R., Choudhury D.K.,& Jain B.K. (1991) Sucking
on the 'emptied' breast: non-nutritive sucking with a difference. Archives
of Disease in Childhood, 66,241-244.
Thomas S. (1996) Contemplating Baby-Friendly in the NICU? Neonatal
Competing interests: No competing interests