Lubbe Welma, Ten Ham-Baloyi Wilma
North-West University, School of Nursing Science, Private Bag X6001, Potchefstroom, 2520, South Africa.
Nelson Mandela Metropolitan University, Faculty of Health Sciences, Private Bag 77000, Port Elizabeth, 6031, South Africa.
BMC Pregnancy Childbirth. 2017 Apr 27;17(1):130. doi: 10.1186/s12884-017-1306-8.
The use of pacifiers is an ancient practice, but often becomes a point of debate when parents and professionals aim to protect and promote breastfeeding as most appropriately for nurturing infants. We discuss the current literature available on pacifier use to enable critical decision-making regarding justifiable use of pacifiers, especially in the Baby-Friendly Hospital Initiative context, and we provide practical guidelines for clinicians.
Suck-swallow-breathe coordination is an important skill that every newborn must acquire for feeding success. In most cases the development and maintenance of the sucking reflex is not a problem, but sometimes the skill may be compromised due to factors such as mother-infant separation or medical conditions. In such situations the use of pacifiers can be considered therapeutic and even provide medical benefits to infants, including reducing the risk of sudden infant death syndrome. The argument opposing pacifier use, however, is based on potential risks such as nipple confusion and early cessation of breastfeeding. The Ten Steps to Successful Breastfeeding as embedded in the Baby-Friendly Hospital Initiative initially prohibited the use of pacifiers in a breastfeeding friendly environment to prevent potential associated risks. This article provides a summary of the evidence on the benefits of non-nutritive sucking, risks associated with pacifier use, an identification of the implications regarded as 'justifiable' in the clinical use of pacifiers and a comprehensive discussion to support the recommendations for safe pacifier use in healthy, full-term, and ill and preterm infants. The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere with it. Justifiable conditions have been identified as: low-birth weight and premature infants; infants at risk for hypoglyceamia; infants in need of oral stimulation to develop, maintain and mature the sucking reflex in preterm infants; and the achievement of neurobehavioural organisation. Medical benefits associated with the use of pacifiers include providing comfort, contributing towards neurobehavioural organisation, and reducing the risk of sudden infant death syndrome. Guidelines are presented for assessing and guiding safe pacifier use, for specific design to ensure safety, and for cessation of use to ensure normal childhood development.
使用安抚奶嘴是一种古老的做法，但当家长和专业人士旨在保护和促进最适合养育婴儿的母乳喂养时，它往往会成为一个争论点。我们讨论了当前关于安抚奶嘴使用的文献，以便就合理使用安抚奶嘴做出关键决策，特别是在爱婴医院倡议的背景下，并为临床医生提供实用指南。
吸吮 - 吞咽 - 呼吸协调是每个新生儿为成功喂养必须掌握的一项重要技能。在大多数情况下，吸吮反射的发展和维持不是问题，但有时该技能可能会因母婴分离或医疗状况等因素而受到影响。在这种情况下，可以考虑使用安抚奶嘴进行治疗，甚至为婴儿带来医疗益处，包括降低婴儿猝死综合征的风险。然而，反对使用安抚奶嘴的观点基于潜在风险，如乳头混淆和母乳喂养过早停止。爱婴医院倡议中包含的成功母乳喂养十步骤最初禁止在母乳喂养友好环境中使用安抚奶嘴，以防止潜在的相关风险。本文总结了非营养性吸吮的益处、与使用安抚奶嘴相关的风险、确定在临床使用安抚奶嘴中被视为“合理”的影响因素，并进行了全面讨论，以支持在健康足月儿、患病和早产婴儿中安全使用安抚奶嘴的建议。在某些情况下使用安抚奶嘴是合理的，并且会支持母乳喂养而不是干扰它。已确定的合理情况包括：低体重和早产儿；有低血糖风险的婴儿；需要口腔刺激以促进、维持和成熟早产儿吸吮反射的婴儿；以及实现神经行为组织。与使用安抚奶嘴相关的医疗益处包括提供舒适感、有助于神经行为组织以及降低婴儿猝死综合征的风险。本文还给出了评估和指导安全使用安抚奶嘴的指南、确保安全的特定设计指南以及停止使用以确保儿童正常发育的指南。
