| Summary: | The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative
(BFHI) in an attempt to increase breastfeeding rates amongst infants. This initiative
is focussed on eliminating hospital practices that could influence breastfeeding
success. One such practice is the provision of pacifiers to breastfeeding infants
which is highlighted in step 9 of BFHI’s 10 steps to successful breastfeeding.
Pacifiers are known to potentially cause nipple confusion and a decrease in milk
supply. In this report I argue that the use of pacifiers for preterm infants in the
Neonatal Intensive Care Units (NICUs) is ethically justified, since the benefits of
pacifier use for preterm infants in the NICU outweigh the potential influence on
breastfeeding success. The benefits of pacifier use for NNS for preterm infants
include self-regulation, pain management and a faster maturation of the suckswallow-
breathe (SSB) coordination. An established SSB coordination is needed for
successful oral feeding.
In the NICU, preterm infants face unique challenges. These challenges include
separation of the mother-infant dyad, frequent painful stimuli and breastfeeding
difficulties that can be attributed to a poor SSB coordination. This paper suggests
that pacifiers can be used to mitigate and improve the effects of these challenges.
In this paper I used the principlism framework, consisting of the four bioethical
principles namely autonomy, beneficence, non-maleficence and justice to highlight
the constitutional conflicts and ethical dilemmas when considering the benefits of
pacifier use and its potential influence on breastfeeding. I argue that hospitals with a
baby friendly accreditation have ethically justified reasons to provide pacifiers for
preterm infants in their NICUs
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