Soothing an infant: Mothers, pacifiers and others

Pacifiers versus pacifying

Several years ago, I was walking down a main street in Frankfurt on a sunny afternoon. The brilliant sunshine filtered through thick branches onto the streets onto scores of families that were out to catch the precious warmth before the evening chill set in. Children were all over, in strollers and outside them. Infants, toddlers and older children, running around, walking with their families, and almost all of them had a small object in their mouths: a pacifier! I do believe that this was the first time I realized how popular pacifiers were, and how much adults depend on them to handle the task of soothing babies. That was the beginning of a sustained interest in pacifiers, their origin and use by adults in handling babies. The task of pacifying a crying baby is universal, societies all over the world have worked out ways to make children comfortable, it is how they do it that differs. I was familiar with the Indian way, where one would expect to find babies being carried around, rocked, fed, talked to or distracted to soothe them. It is when we encounter something so starkly different from what we are used to, that cultural difference becomes even more pronounced. Pacifiers were just not a popular option in India, and I decided to investigate why.

Pacifier, a brief history and overview

The pacifier is known by different names in different countries: Soother in Brazil, Pacifier in the US, Dummy in England, New Zealand and Australia. The first known introduction of a pacifier was recorded in the 17^th century although the use of honey to pacify a child is mentioned as early as the 2^nd century. This was an object made from a corn cob and was recommended to be used as a replacement for a mother’s sore breast. Pacifiers made of substances like coral, ivory, cloth and silver have also been recorded. Also, little objects in the shapes of animals were also found on gravestones in Italy. Apparently, these were hollow and filled with honey and hung around children’s necks for them to suck on[1]. In 19^th century Europe and US, soft muslin cloth containing bread, sugar and (maybe) poppy seeds were also seen. The first evidence of a rubber teat was seen around 1900 in the US, this was called the ‘comforter’. Initially, it was believed to be a feature of child upbringing among ‘poor classes’; associated with poor hygiene and inappropriate care of the child. An article in the New York Times by an ‘Aunty Pacifier’ strongly condemned the use of this practice by the poor because of the assumed consequences for hygiene and health. Similarly, in the year 1914, a paediatrician in London also launched a campaign against this “unhygienic” practice. The dramatic dismissal of the use of pacifiers can be seen reflected in an article around 1879 in a German Medical Journal in which the activity of non-nutritive sucking was seen as harmful which contained a disturbing illustration of a “6 year old thumb pleasure-sucker with active assistance” The illustration left no doubt what was meant by “active assistance.” The journal article — “The sucking of the fingers, lips, etc. by children (pleasure-sucking),” by S. Lindner, a German pediatrician — concluded without reservation that infantile sucking was an unpleasant act. Pacifiers were as problematic as fingers. “Remember that a baby that has a dummy is like a tiger that has tasted blood,” an English health pamphlet warned, using the British term for pacifier. A popular childcare book of the time described a typical pacifier user as “rickety, pale, pasty, soft, wanting in bone and muscle, feeble, nervous, timid.” Taking away the pacifier was not enough. To prevent infants from sucking, parents were instructed to tie their children’s hands to their cribs, and if that didn’t work, to stuff them inside aluminium mittens, writes Nicholas Day![2]

However, the Binky was here to stay and the convenience of the object in soothing babies resulted in the first mass produced ‘Binky’ by Playtex in 1935. They still carry the patent for the soother. Despite the negative publicity, the pacifier was here to stay and has now become a fixture in the basic kit for newborn babies in many countries.

Possible consequences

Some of the suspected consequences of the use of the pacifier relate to beliefs about its interference with breast-feeding by interfering with nutritive sucking time for the baby, but this has never been confirmed. Also, there is some evidence of higher proneness to ear-infections, again, this remains unsubstantiated. The impact on dental structure has been frequently written about and there is some evidence of long-term changes to the dental cavity, but mostly if used beyond the age of three years. The use of pacifiers has also been linked to a reduction in the incidence of SIDS, but this too remains unconfirmed and one source puts it thus: “It seems appropriate to stop discouraging the use of pacifiers on account of reduced evidence of Sudden Infant Death Syndrome (SIDS)”

Adult pacifiers!

During my search about information related to pacifiers, I came across the ‘NUK 5’, or the adult pacifier, that has been recommended in the treatment of Bruxism (excessive teeth grinding and jaw clenching) snoring and smoking! Strangely, it is also a known item in rave parties where it is used for the dispensation of oral drugs!

Pacifier comments from other countries:

Here are some of the responses related to pacifier use from different parts of the world that highlight its use with children.

• UK, an Editor for a publishing house: “I did not know that the pacifier was not used in other cultures. When I was young, I was obsessed with my ‘binky’, my grandmother said. My daughter did not take to it, and was an avid thumb-sucker. I think they serve the same purpose. I’ve always thought much of what we consider necessary equipment for caring for babies is a result of successful marketing”. Some concerns about dental health and language, but children as old as 5 and 6 are seen using it.
• US: A Psychology Professor: “Never wanted to use the pacifier, wanting to be ‘pro-natural’ parents. When the baby needed soothing, we would pick them up!”
• Australia: “Accepted by parents and teachers, as a matter of fact they have a big, big approval as a soothing resort.”
• Germany, a researcher (baby due): “My sister and brother did not use it, I really don’t know what I would do, my husband and I don’t agree on several things. He says it’s better than sucking the thumb. In my mother’s village in Hungary, they used to put crushed poppy seeds (alcohol also) and sugar into cloth pacifiers to make the baby sleep!”
  • In Germany, 70% babies are given pacifiers as per one report
• Brazil: Common practice to give the soother, the “non-nutritive sucking is believed to create stability and relaxation”
  • Recent concerns from dentistry and some psychoanalytic practice have led to some skepticism
  • One mother: “I gave the pacifier, but was afraid my child would be fixed on ‘orality’. My granddaughter was given the soother after the mother stopped breast-feeding, and for brief moments, when she is falling asleep. When she feels like sleeping she says ‘I want bubu and little blanket’”
  • One expert: “Despite the ‘scientific understanding’ that it may do harm from overuse, mothers persist because it soothes the child”
• Denmark: Commonly used. “There are specific ‘Pacifier trees’ where children’s pacifiers are hung when it is time to give it up” and children pay regular visits to these trees as they grow to revisit their past.

India and the pacifier

There was no available evidence of the use of the pacifier as a device to soothe the baby in Indian homes, although a couple of mothers have informed us that they used it with their babies when they were young. What was the reason for this failure for pacifiers to enter the Indian market? For one, it is true that it is not recommended by the medical fraternity, it is not part of the recommended kit for a newborn. Furthermore, the older generations characterizes the use of objects like the pacifier with suspicion, as a possible attempt by the younger generation to release themselves from the tasks of child care by replacing themselves with objects. Car seats, high chairs, milk bottles, diapers and pacifiers are all part of that list, although when something is convenient, it is mildly tolerated. The story of diaper use is a case in point. One of our advisors remembers that when she went for shopping for her baby, the high chair, pacifier and car-seat were frowned upon by the child’s grandmother as an excuse not to pick up the baby! 

Perhaps because they are never with soothers, it is possible that Indian children are “seen as” more noisy and disruptive in public spaces. My impression is that Indians living abroad seem to adopt local practices of host culture related to the use of pacifiers, but there is not much evidence beyond personal accounts. In India, the use of pacifiers continues to be resisted, even though the convenience and safety of other objects like car-seats and high chairs, diapers and bouncers have all been easily accepted by young parents. Pacifiers are still frowned upon. Why? Here are some of the reasons that we were able to gather.

1. The belief is that it makes children habitual of sucking on to something, and habits are not good. As one of our respondents said: ‘Aadat ke gulam nahi banena chahiye’ (We should not be slaves to habit). Adding that “Habits are pleasure-seeking behaviours and pleasures should be given up (tyaag) as they interfere with attainment of self-regulation”.
2. Discouraging use of pacifiers can also be related to the Indian climate and proneness to infections. This is also an argument used against bottle-feeding as opposed to breast-feeding. Infections breed easily here, it is believed and “a rubber pacifier, wet from constant sucking, covered with milk mixed saliva can be a fertile ground for germs and bacteria. Therefore, it has to be avoided”, was one of the responses.
3. Mother is the best pacifier! One common opinion is that people are the best pacifiers for a baby, and objects will just not serve the same function. “If the child needs to be soothed, the best thing for that is the mother, or other person. Why a plastic object? Breast is the best for soothing a baby and it is nourishing also.”
4. Placing the pacifiers has another consequence and that is preventing the child from vocalizing. This was not seen as favourable by some respondents. “Why would you want to suppress a child from speaking by shoving something in the mouth? It sounds cruel to me.”
5. “I think a pacifier would weaken the child internally. And, also weaken the palate which is supposed to be strong. It seems like a way to get the mother off her responsibility of caring for the baby. One of those “modern” solutions. Well, I would say: don’t have children, then, that is the best solution!”
6. Other opinions: “I think it completely messes with the shape of the teeth and modifies a child’s lips and I have heard doctors also disapprove of the same.”
7. No one mentioned anything positive about the pacifier with the exception of one of our experts who found it very useful for the first year of caring for her baby and in her case, it was not difficult to give it up after about a year of using it to soothe the child to sleep.

Commentary:

The sound of a baby crying is not a likely subject of a cute video, but crying is the main way for a baby to communicate messages to those around her. For their part, caregivers are likely to make a reasonably accurate assessment of why a baby is crying depending upon time and type of crying. In fact, caregivers soon learn that the undifferentiated crying of a newborn becomes distinguished into a range of different sounds that a mother becomes capable of reading. The cry of a fussy, sleepy child can be accompanied by signals such as rubbing of the eyes, whereas a sudden, sharp onset of a wail can indicate pain. There are, however, instances in which adults are at a loss and nothing seems to work.

Between the baby and the caregiver/s, managing a child’s crying is a matter of major concern and it is hard not to be impacted by the sound of a crying baby. In such situations, how one chooses to soothe the baby is something that is guided by local cultural beliefs. How one deals with the fussing depends on how the adult-child relationship is understood in society which parents use to guide them through the different choices they make to handle the baby. A community’s beliefs about a baby’s relationship with its caregivers are actively structured around the prevailing folk models about children’s development. The choices available for us to manage our babies relates to the ways in which society around us interprets infant signals and advises adults to work towards managing them. In this essay, we look primarily at the task of soothing a crying baby and keeping a baby calm and the dynamics around this domain of activity between adults and children with specific focus on the use of pacifiers.

All adults who deal with children will agree to the fact that crying is common for children, and soothing a crying baby is an important objective of an adult’s care strategies. But how one should, in fact, soothe a crying baby is not! Should it be a person, a position, or an object? Babies are also known to form habits and providing them with a repetitive condition (object, place or person) is likely to become habit forming, and adults can be acutely aware of this. Let us take this piece by a young mother as an example.

Megan Margulies[1] writes, “One of the first pieces of advice I received as a new mother was to never let my baby use me as a pacifier. I took this advice to heart, resolving to keep my daughter on an ironclad feeding schedule: once every two hours, 20 minutes on each side, so regular that I may as well have asked her to punch in and out at each shift.” Nevertheless, Megan argues that breast-feeding turned out to be a challenge and when she looked more carefully at other resources about feeding, she read that in fact, scheduling feeds is something that has little to do with the baby’s needs and everything to do with the positioning about adult schedules as an expert the author quotes argues: “It’s a common idea in Western parenting that parents should restrict their infants’ feeding behaviors. This idea has little to do with babies’ biological well-being……and has developed as a safeguard against raising spoiled children whose parents schedule around their whims.”, and idea that emerges from a specific trend in the history of child care very specific to American society in the early 20^th century, when the new science of behavior was born. Among some of the advice that Watson had about child rearing was related to the fact that parenting was supposed to be grounded in knowledge and not “natural”, old-fashioned techniques since children were believed to be made and not born. Raising well-adjusted, happy children was a responsibility of the parents. This is the foundation of modern parenting in the West.

Cultures vary in the way that infancy is understood

Our culture provides meanings to guide us towards specific ways of handling babies. In the way the West predominantly defines the baby, we see an image of a “mute and uncomprehending newborn arriving for the first time in the world of humans” argues Alma Gottlieb[2]. Contrasting it with the ways in which a Beng baby is visualized, Gottlieb goes on to say that “A Beng baby is considered to be a reincarnation of someone who has died” and this has significant consequences on how babies are handled. Let me add that this is by no means exclusive to Beng society. Among Hindu Indian families, the physiological manifestations of expressions in babies is assumed to relate to their past lives and experiences therein. These memories are believed to linger for a while before the experiences of this life-span take over the conscious mind. Thus, emotional reactions of babies are considered to have a meaning that weaves through the different lives that a soul may travel through. There is something beyond the physiological, and behaviours like crying are not simply matters of present state. Unexplained and intense crying can be related to ‘past fears’, but these fears can be soothed away by a caring touch.

Because our care for children is guided so closely by our belief systems, it is no surprise that pacifiers continue to face a deep resistance in the Indian home. Despite the acceptance of many other objects for infant care that have added to the convenience of parenting, soothers still remain highly suspect for various reasons: susceptibility to infection, dependence and habit formation as well as forceful silence that is imposed on the child as a consequence. It is seen as a symbol of a sort of parenting where the mother desires to “free herself from the child” something that continues to be evaluated unfavourably in the local understanding of infant-adult relationships. As we move ahead in the care of children, and as families grow smaller in size, it is essential for us to understand that convenience in handling children through the use of props like soothers should not be equated automatically with ‘bad parenting’. There is no evidence of harmful outcomes, and if this is what works, what is so bad about releasing a parent from some of the pressures of constant supervision. Perhaps we need to accept that every parent-child interface needs to find its own balance based on a child’s needs and a family’s situation. With the absence of a large network of support for the care of a child, it is reasonable and even beneficial to look at tried and tested options, even if they may not be something we grew up with. As in the case of those who accept pacifiers, the practices have little to do with ‘evidence-based’ research and much more to do with the folk understanding of child care and the infant-adult relationship. Balance is thus the key to parenting, with or without pacifiers!

 

[1] https://www.theatlantic.com/health/archive/2016/03/breastfeeding-pacifier-comfort-feeding/475836/

 

[2] Do infants have religion? American Anthropoogist 100(1): 122-135. Copyrightt3 1998, American Anthropological Association.

[1] http://www.bubbawest.com/the-dummy-dilemma-a-fascinating-history-of-the-pacifier/

[2] https://www.salon.com/2010/04/27/pacifier_anxiety/