Sleepy babies who feed infrequently and don’t gain weight – the risks of pacifier use in the early weeks
An LLLSA Leader was approached by a mother with concerns that:
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Her 3-week-old baby struggles to wake up to breastfeed.
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He easily goes 3-5 hours between feeds.
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This was causing her to become painfully engorged.
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She had tried waking him up, tried skin-to-skin contact as well.
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She had even tried expressing some milk onto his lips before latching to entice him.
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When she does put him to the breast, he cries and fusses or doesn't seem interested in feeding at all.
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The crying was causing her a lot of distress.
The Leader gently asked the mom how she soothed her baby when he cries and is upset.
The mother shared that she panics completely as she isn't sure how to soothe a baby, so she desperately pops a pacifier in his mouth and that he then sucks himself to sleep and stops crying.
The LLLLeader explained some practical and physical ways to soothe a baby, including breastfeeding. Over the conversation the mother wondered if the pacifier was likely hiding hunger cues and making baby sleep through breastfeeding sessions. She decided to try to stop using the pacifier and resolved to attempt to soothe the baby with her breasts and with gentle rocking, swaying and singing.
Three days later she reported back that her baby’s schedule had changed entirely. He was now breastfeeding every hour and a half to two hours, not sleeping extra-long stretches, spending more time awake than he used to and her mothering felt more natural and intuitive. Her breasts were also no longer painfully engorged. The baby’s nappy output and poops had increased.
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The Womanly Art of Breastfeeding (WAB) offers an explanation for this very common newborn behaviour:
Sucking on a pacifier releases a hormone called CCK. A baby can fall asleep with a pacifier, thinking she’s been fed. But really, she’s been fooled out of a meal, and your breasts have lost a feeding’s worth of milk removal. Result: slower weight gain and lower supply.
Excerpt from WAB about CCK, 8th edition, pg. 107:
If she (the baby) has fallen asleep nursing (breastfeeding), it’s partly because her level of cholecystokinin (CCK) has risen. In a newborn, a high level of this hormone makes a baby sleepy and tells her that she’s full; a low level can wake her and tell her she’s hungry. After maybe twenty minutes of sucking (not necessarily eating) your baby’s CCK has risen enough to put her to sleep and give her a rest from all her hard work. About twenty minutes after she’s stopped sucking, her CCK level has fallen again. Your baby may wake up (HELP! STARVING BABY!), convinced she’s never eaten before in her life, giving her a chance to “top off her tank” with renewed energy. Another sucking bout, another CCK rise, and she’s likely to zonk out completely.
CCK is a marvellous arrangement that keeps your baby from working too hard for too long but also acts as an alarm clock to give her a second or third (or fourth) chance if she needs a little more. And it allows a new and inefficient baby to come back for seconds and encourage your new milk supply—part of a system that helps ensure enough food for the baby, enough production from Mama.
Sucking on a pacifier releases CCK, too. A baby can fall asleep with a pacifier, thinking she’s been fed. But really, she’s been fooled out of a meal, and your breasts have lost a feeding’s worth of milk removal. Result: slower weight gain and lower supply.
CCK is Nature’s way of helping to make sleep happen and keeping your supply strong. Why mess with such a well-designed system? Save yourself a lot of effort, nurse (breastfeed) the baby one last time, and odds are she’ll start to snooze.