Now, a review article in the AMA’s pediatrics journal (April 2009) reassures us that pacifiers may be okay for breastfed babies, after all. 4 randomized trials were reviewed; babies were assigned to the “pacifier” or “no pacifier” groups. All four studies showed no effect of pacifier use on breastfeeding outcomes. In fact, more than half of babies in the “no pacifier” groups actually were given pacifiers by their parents, but these babies breast-fed just as well.

In several observational studies, babies not using pacifiers did breastfeed somewhat more, but the authors speculate that this might be due to family attitudes towards breastfeeding, rather than an effect on breastfeeding by pacifiers. That effect would be difficult to distinguish with this type of study, which is why the randomized trials carry more weight.

Why does it matter? The American Academy of Pediatrics recommends that babies should be offered a pacifier for naps and sleep after 1 month of age (after nursing is established), for the first year or so of life. (Some studies suggest that pacifiers during sleep might reduce the chances of SIDS, although this is not definite.)

So now I feel comfortable reassuring parents that it’s ok to use pacifiers when their infant sleeps. I still recommend that an alert but fussy infant should be offered a feeding before giving a pacifier, to encourage on-demand feeding. And in any event, the use of pacifiers (and bottles) should be ended by 15 months.

(Archives of Pediatric and Adolescent Medicine 2009; 163(4): 378-382)

– David M. Epstein, MD

This is not surprising, because the skills required are different.  Daytime bladder control is under voluntary control, and can be taught.  (This is why it’s best to wait for potty training until your child is interested in staying dry.)  At night, though, the child is (hopefully) asleep, and has no voluntary bladder control.

Nighttime dryness is an unconscious act; it happens when the child’s brain becomes sufficiently mature.  Everyone achieves this state eventually, except in the rare event of a medical problem.  We label bedwetting as a problem only when it becomes a social issue, usually after age 6 or so when many children start to receive invitations for sleepovers at friends’ homes.  The medical term for this is “primary eneuresis,” indicating that the eneuresis or bedwetting does not have another medical cause.

Bedwetting often runs in the family.  Many children with prolonged bedwetting will have relatives who have also suffered with it (though some family members may be reluctant to discuss it).  These children generally are dry during the day, but they wet the bed several times per month, in some cases nightly, throughout childhood until they grow out of their bedwetting.  Limiting fluids in the hours before bedtime, and planned night awakenings for bathroom trips, can help.  Electronic beeper-style alarms, available for under $100, can teach kids to wake themselves over time.  If these measures are ineffective, there are safe and effective prescriptions available.

If a child begins bedwetting repeatedly after a dry period of months or years, it may be a sign of a different medical disorder requiring treatment.  This is called “secondary eneuresis,” and is less common than the inherited primary eneuresis.  A urine infection would be the most frequent culprit.

–  David Epstein, MD

You can run a quiet fan, or buy “noise machines” from a baby store.  Or, for a buck or two, you can download an hour-long “white noise” track, burn it to a CD or mp3 player, and play on “repeat” to help soothe your baby (or yourself for that matter!) to sleep.  Click on the links below:

Try this one for simple, monotonous white noise.
Or check out one of these for something slightly less monotonous.
Finally, here is a website with several free white-noise downloads.

–  David Epstein, MD