sucking Archives • Nourish: Birth + Postpartum

A hypothesis for colic is presented by Pediatrician Dr. Harvey Karp with a term defined as “The Missing Fourth Trimester”. This refers to the timeframe of a newborn baby’s first three months, and Dr. Karp’s discovery of the neonatal response, also known as the calming reflex or “off switch” for crying in infants younger than 3 months, which is activated by his solution called “The 5 S’s” technique.

According to most doctors, there are four main theories of the cause of colic:

gastrointestinal disorders
difficult temperament
brain immaturity
maternal anxiety

However, Dr. Karp lists several rebuttals to these four theories in detail:

Colic starts at 2 weeks of age; gas starts shortly after birth
Colic ends at 3 months of age; gas lasts a lifetime. Dr. Karp argues symptoms like gas that are suggestive of intestinal pain are probably an overreaction of an immature neurological system to normal intestinal sensations (e.g., the gastrocolic reflex).
Colic peaks in the evening; gas occurs all day. Dr. Karp claims evening predominance of crying may be caused by a gradual accumulation of stress throughout the day in the absence of calming rhythmic stimulation which newborns are used to experiencing in the womb.
Colic is absent from some cultures around the world; gas is not. Dr. Karp explains that the parents in these cultures imitate the womb for the baby all day long with constant holding and rocking and frequent nursing.
Overfeeding is ruled out, as one of these cultures known as the !Kung San, nurse their children 50 to 100 times a day, but their babies never experience colic.
The swallowed air theory also doesn’t seem to apply, due to radiographs of fussy babies demonstrating they have more air in the GI tract when they finished crying than when they began to cry.
The theory of brain immaturity does not match either. Newborns do have immature brains that are incompletely myelinated. They display slow transmission of impulses from the retina to the occipital cortex during the first three months of life, have frequent tremors, irregular breathing, crossing of their eyes, and poor state control. However preemies have very immature state control, and they do not experience colic until after their due date.
The theory of difficult infant temperament was rebuked by researchers as well through numerous studies which have found the association with temperament to be small.
In addition, the theory that maternal anxiety is a cause of colic was rebutted by studies with mothers of colicky babies proving they are no more inherently anxious than other mothers, and colic is as common in a couple’s fifth baby as in their first baby. Dr. Karp explains this argues against anxiety playing a role in colic because parents tend to be more anxious with their first baby than subsequent ones.
Lastly, the cessation of colic after approximately 3 months fits perfectly with Dr. Karp’s theory of the missing fourth trimester.

Dr. Karp notes that while these four theories are aspects of colic, they don’t detail its root cause; which is what he calls the missing fourth trimester. He even states babies are born three months too soon. Whether this is the case or not, we need to consider that upon birth, babies are suddenly extracted from a rhythmic, snug and entrancing environment (the womb) to an environment of sporadic noises, new reflexes and sensations. Therefore it is understandable this may overwhelm infants who have poor state control and thus provoke persistent crying.

The exciting part is the solution Dr. Karp has found to be a calming reflex which takes place involuntarily during the last months of pregnancy. The response puts fetuses in a trance, keeping them head down and motionless. Dr. Karp’s clinical experience has found that the calming reflex can be activated after a baby is born as well, by what he calls “The 5 S’s” – maneuvers that mimic uterine sensations. These techniques include:

Swaddling, which keeps the baby snug and mimicking the womb’s motionless hold during the last few months during pregnancy
Side or stomach positioning which halts the Moro reflex as babies aren’t in the supine position
Shushing to audibly reenact the sound of blood flow fetus’ have heard for their entire life before birth
Swinging copies the movements the baby experienced inside of the mother
Sucking, which relocated babies sucking their fingers in utero

I believe every pediatrician, caregiver, and parent should be informed of Dr. Karp’s theory of the missing fourth trimester. In my experience, performing the 5 S’s solution has soothed many babies I’ve cared for and proves to be an important gift every baby deserves in their first few months of their beautiful new life.

Pacifiers can be both a godsend AND a nightmare. I have cared for and supported hundreds of families and babies, from singletons to preemies with special needs and multiples. A lot has changed according to the AAP and guidelines from orthodontists and lactation consultants since I became a Certified Advanced Newborn Care Specialist, Doula, and Certified Lactation Educator Counselor.

Over my course I went from not recommending pacifiers to understanding the physiology of a human newborn and their sucking reflex in conjunction with their speech, oral, and facial development and how that actually connects with and benefits the breastfeeding relationship.

Let’s get down to it. As a new parent, you do not want your baby to become dependent upon pacifiers. This can result in sleepless nights for parents and disruption of your baby’s precious time to sleep and grow, as some argue that pacifying can lead to baby’s feeding signals being interrupted and disrupting breastfeeding. But if your baby is truly hungry, they’re going to spit it out and will not settle with a pacifier if they want to eat.

I have consulted with many families and as a Postpartum Doula, I’m going with the new parents (usually assisting the new mother while her partner is at work) to their pediatrician appointments. I have spoken to many pediatricians and all their views vary. Some pediatricians are very strict and don’t recommend a pacifier until 6 weeks and some are more casual, recommending to wait until the newborn is 2 weeks young.

In my experience as a Birth Doula, I have encountered hospitals using them often for NICU babies to encourage facial and oral development and promote sucking, but I’ve also seen hospitals lock up pacifiers!

Some healthcare professionals argue that pacifiers cause nipple confusion. There is no such thing as nipple confusion. It’s flow-preferencing that takes place, caused by hunger satiation from using any type of “flow” nipples (including preemie and slow-flow nipples), not using no-flow bottle nipples, the improper use of nipple shields, and from not practicing evidence-based paced bottle-feeding. Pacifiers don’t cause this.

As a trained lactation consultant, I do advise to use pacifiers sparingly. This could mean using it in the first week only a few times or using it in the baby’s third week as needed when Baby is quivering and not hungry – they have a sucking reflex and need to suck, so it’s okay. Not everything is black and white in postpartum, because every baby is so unique and different.

For example, if a baby was whisked away due to a lower APGAR score at birth, and then poked and prodded with needles and tests, they may have birth trauma and anxiety and that pacifier may help them. Birth trauma exists for newborns, too – they just went through a LOT! Even if they weren’t taken to the NICU, they can have trauma from coming down the birth canal, regardless if delivery was fast or slow, and regardless if a vacuum was used.

Babies receive a lot of pressure coming out, and they are resilient, but I have seen many babies with alignment issues who, when receiving proper care, are easily corrected by a pediatric chiropractor. Sometimes these issues aren’t addressed until the baby is 3-4 weeks old, for example, until the new parents are suggested to see a craniosacral therapist or pediatric chiropractor by the Postpartum Doula.

A fussy baby is an indication that something is wrong. Don’t panic. It doesn’t mean something is devastatingly bad or seriously wrong or hurting the baby. It means there could be one tiny variable that something is off. So let’s narrow it down, go down the list, and figure it out together.

There are different levels of fussiness; and it can be super overwhelming for new parents! The role of the Postpartum Doula alone is not trained in, or to offer, newborn care. It’s in my scope as a Certified Advanced Newborn Care Specialist to help you through issues you’re having if you’re my client, and this is why I do emergency, remote Newborn Consultations.

Determining what is and what is not colic, the definition of Purple Crying, determining the baby as being hungry, if they’re clusterfeeding, variables from Baby being too warm and a frantic parent actually thinking Baby is cold, to a hair strung around Baby’s finger, to a tiny gas bubble, to a wet diaper that is irritating Baby and not turning the diaper indicator line blue – all these variables and more can justifiably confuse a parent and cause so… much… frustration!

If a pacifier is going to save you sanity, then by all means, use it. How many pediatricians have admitted to me they used it on the first night with their newborn… I don’t have enough fingers to count.

Also, if the new mother has cracked and bleeding nipples, there’s an issue with improper latch and possibly not a deep enough latch, and other variables I’m not going to go into at this moment, and then a pacifier may provide relief to that baby while she gets help from an IBCLC (International Board Certified Lactation Consultant) or from a Lactation Counseling Consultation on what to do get baby fed, help heal her nipples, proper nipple care, guidance for preventing further similar issues, and a plan to protect her milk supply.

Don’t judge yourself. We aren’t going to judge new parents, that’s ridiculous, and you’re not welcome here if you’re judging a new parent. So let’s establish that as rule number 1: we aren’t going to judge ourselves because, let’s face it, there’s just not a great foundation of proper prenatal or postpartum care in America, which is one of the main reasons the American Doula profession has grown so much, because in Europe and other countries it’s just standard decency that the government both allows and provides multiple, and I repeat, several, postpartum nurses to visit and care for the newly postpartum mother in the first week and first few weeks (if not more) after childbirth. You’re off the hook here, it’s not your fault you’re here now, so let’s get to the point and get you some quick tips!

The room should be darkened already (with the correct lighting that doesn’t inhibit melataonin), your white noise sound machine should be on, and the room should be comfortable with the correct humidity and temperature for your baby’s age.
Ideally, your baby has been fully fed and burped and held upright for 15 minutes after each feed (so they aren’t having issues with tiny gas bubbles and reflex) then laid down for sleep on their back.
When laying them down, place your hand on your baby without changing the amount of pressure of moving your hand at all, and without moving your hand around as that stimulates nerve endings. No petting, no rubbing, just a steady, slightly firm amount of pressure to let your baby feel your warmth and that you’re still there. This gives them a sense of security and comfort. Keep your hand there for about a minute.
Sleep is a learned behavior which is directly associated with a caregiver-child relationship; the way your baby learns to sleep now will directly impact how they face stressful issues. They need to learn it from you. Your gift of sleep conditioning is an empowering investment in their future which will carry on into the future as it will give them the ability to calm themselves when they face a stressful situation as a child and even as an adult. Through these tips of sleep conditioning, your baby will eventually learn to self-soothe (when your baby is an infant, not a newborn) and you may be able to avoid sleep training.
If your baby is agitated and moving around even after holding your hand steadily on their tummy for over a minute, you can take both your hands and gently, ever so gently, I said super gently, squeeze their sides and hold. Newborns were inside the womb, which was a very snug environment, and some newborns need to feel a tighter boundary and like to be able to feel they’re safe and secure. You can release a little pressure little by little over a bit of time and then lift your hands.
If they become too agitated, you may need to keep your hands on their side and slowly jiggle them to settle them a little. This can be for about 15 seconds, while you quietly “shh, shh, shh” in a staccato fashion. Then when you see them start to settle, slow down your little jiggle and hold your hands at their sides steadily for about thirty seconds, and then gently release pressure and lift your hands slowly.
You may need to do this a few times. Some babies are out right away with just this technique.
Other babies need more. You may even need to pat their tummy/side softly while shushing. Some newborns love this and they’re settled immediately, while other babies are too stimulated by this. Every baby is unique. Do not try this until you have tried the above steps more than once.
If after trying a few times, they may be need to feed a little more, they may have a gas bubble and need to be burped, or they may have a wet diaper. If you already did these things, the chances are not high, but sometimes Baby is still hungry. Do you ever want a little more, an extra serving, a snack, or something sweet after a meal? Babies do, too.
If you are certain they’re totally full, and nothing has worked, their diaper is dry, they could be overtired (did you have them up for more than the golden hour? Try not to exceed more than an hour to 90 minutes wake time for a newborn.) You may calm them by mimicking your womb, and “SHHHHH” near their ear.
Time to pick up Baby now. You may swing and sway Baby ever so softly but swiftly in your arms, while Baby is in cradle position, to wear their head is softly jiggly ever so slightly. Do not have them upright on your chest or over your shoulder and then start to bounce. Also do not bounce while sitting on your birth ball. Would you want to be bounced after you’ve drank something, like a milkshake? Think about it… You will cause your baby to spit up. Swaying from side to side for a few minutes usually does the trick and Baby will be fast asleep. You can then set Baby down on their back and place your hand with slightly firm, steady pressure (don’t move your hand around) on their chest for about thirty seconds, or at their sides with both hands. This usually settles them to sleep.
Still not sleeping? This is usually when a pacifier is introduced. If you touch Baby’s lips with the pacifier and Baby starts rooting, they’re hungry! Feed them. If they’re not, insert it gently and slowly to where they won’t be startled and until they grasp on and start sucking. Usually after a short time, that pacifier will be dropped out of your baby’s mouth. Through sucking, serotonin is released by your baby’s brain, allowing for a faster transition to sleep.
Do not go in and continually put the pacifier in your baby’s mouth. You do not want a ticket to the musical pacifier ride at this theme park. Avoid this at all costs… usually this can easily be avoided by a few sucks on the pacifier and then they drop it and they’re off in la la land.
When you leave the pacifier in, now that’s when the problem starts. Don’t allow them to sleep with it. Remove it after a couple minutes. This way you allowed them to self-soothe with the pacifier, and removed it when it wasn’t needed anymore, and no addiction is formed.

If you do the above for a couple of fussy moments, it will cease and your baby can learn to self-soothe and go back to sleep on their own.

Are Pacifiers Good For For Baby?

Babies are born wanting to suck. Some even suck their thumbs or fingers before they’re born in Mommy’s womb. Sucking is often an important method of self-soothing as it is comforting, familiar and a calming mechanism in their new world outside of the womb. The American Academy of Pediatrics gives pacifiers the green light throughout baby’s first year for the following reasons:

The Pros

Researchers have found an association between pacifier use during sleep and a reduced risk of SIDS/SUIDS.
Pacifiers do not decrease breastfeeding rates in full term infants.
Also, studies show pacifiers actually help with breastfeeding.
Some babies are happiest when they’re sucking on something. They are born with over 70 reflexes that they grow out of overtime, and one of them is a sucking reflex! This is a non-nutritive sucking reflex, and often confuses parents to thinking their baby is hungry when their baby just wants to suck!
There is a physiological process where an infant moves from a “suckling” pattern to a “sucking” pattern to a more mobile “collection and swallowing” pattern. Pacifiers can help infants with oral muscle flaccidity, difficulties with latch during breastfeeding, or encourage sucking in pre-term newborns.
A pacifier may help your baby go to sleep if your baby is fussy.
A pacifier may buy you a few minutes when your baby is hungry to empty your bladder, find a comfortable spot to nurse or to prepare a bottle, or be helpful during shots or blood tests. It is super imperative to curb maternal or paternal anxiety from seeing your baby cry from medical procedures. Come on, say it. You matter, too. Give yourself a break here.
Pacifiers are inexpensive and recyclable.
Most pacifiers designed now are orthodontically-approved.
The binky is easily disposable. Toss when its time to stop. You can’t do that with fingers if baby prefers to suck their thumb.

The Cons

Your baby may become dependent on the pacifier and wake up frequently if you choose to replace it every time it falls out of their mouth.
Pacifier use may increase the risk of middle ear infections. However, rates of middle ear infections are generally lowest from birth to age 6 months – when the risk of SIDS is the highest and during this time period is when your baby may be most interested in a pacifier. Usually the babies who are not allowed to keep their pacifier in too long don’t get addicted to pacifiers, and around 6 months of age, they are generally not interested in it anyways.
Typically, the reflexive need to suck (non-nutrative sucking reflex) slows by approximately 5 months of age. This is also when we begin to hear our children coo and babble quite a bit. That is generally the appropriate time to stop offering the pacifier. Again, studies show that 90% of SIDS deaths occur before the age of 6 months of age. According to Speech Pathologists and Certified Oralfacial Myologists, using a pacifier after that time is simply not necessary and instead becomes a “nurturing” pattern the parent offers to the child.
Prolonged pacifier use may lead to dental problems. Normal pacifier use during the first few years of life doesn’t cause long-term dental problems. If your child continues to use a pacifier persistently, however, their top front teeth may slant out or the upper and lower jaws may be misaligned. This can be avoided by not allowing the pacifier to be left in your baby’s mouth when sleeping, not allowing it during awake time, moved out of sight by the parent and/or caregiver when the baby is awake, by providing appropriate teething toys instead, and by choosing an orthodontically-safe pacifier in the first place. Breastfeeding instead of bottle-feeding also helps with preventing dental problems.

Pacifier Tips

Let your baby set the pace. If they aren’t interested, skip the binky entirely!
If the pacifier falls out while they’re sleeping, don’t pop it back in!
Try other ways to calm your baby first. Change their position, sway for a few minutes, check if they’re hungry or if their diaper is soiled.
Before using a new pacifier, wash it with soap and water, and sterilize by boiling it! Avoid fungus by soaking it in equal parts white vinegar and water for a few minutes a day and air dry thoroughly before returning it to your baby. Thrush can be transferred to and from Baby, Mom, and pacifiers so be sure to sterilize any pacifiers you have, and often. You may also pop it in the dishwasher to clean it depending on the brand.
Watch for signs of deterioration. Replace pacifiers before they deteriorate; cracked nipples can tear off and pose a choking hazard.
Use caution with pacifier clips; use a short strap to prevent it from wrapping around your baby’s neck. Better yet, don’t use one.
Once a favorite paci is established, buy a few identical binkies to have on-hand.
Choose the one-piece, dishwasher-safe variety. Pacifiers made of two pieces pose a choking hazard.
Pull the plug before the bad habit forms. If you are jumping to put the pacifier into the baby’s mouth because the baby cannot stay asleep without it, it is a bad habit, your baby is clearly restless because they’re hungry, wet, have an air bubble/gas trapped, are teething, or have another issue. A pacifier addition can happen the first week of life. Remember 3 times starts a habit.

Recommended Pacifiers

Clockwise from top left to right:

Eco-friendly, hypoallergenic, 100% pure natural rubber pacifier with orthodontic nipple: Sweetie Pacifier
100% medical grade silicone & dishwasher-safe: Ryan and Rose Cutie PAT Pacifier
Eco-friendly, hypoallergenic, 100% pure natural rubber pacifier with orthodontic nipple: Natursutten Butterfly Orthodontic Rubber Pacifier
Best classic paci and great for cleft palette: BIBS Pacifier
Most popular pacifier for newborns up to 3 months (most American hospitals send these home with new parents after childbirth): Philips Avent Green Soothie
Best pacifier for preemies up to 30 weeks gestation (not 30 weeks postpartum): Philips Wee Thumbie
Best orthodontic pacifier for infants up to 2 months old and best pacifier for breastfed babies: MAM Newborn Start Pacifiers
Best pacifier for breastfed babies: The First Years GumDrop
Best classic paci and great for cleft palette: BIBS Pacifier
Best glow-in-the-dark binky and for bottle-fed babies: Tommee Tippee Pacifier
Another best orthodontic paci for up to 3 months: NUK Newborn Pacifier
Best pacifier for cleft palette and tongue-tie: WubbaNub (see various styles)
Best clinical and silicone binkie: Chicco PhysioForma Pacifier
Best anti-colic and ergonomic paci for breastfed babies: Nanobébé’s Flexy Pacifier

Tag: sucking

The Calming Reflex And Colic

The Secret 4th Trimester

The 5 S’s

What is Colic?

Sleeping with a Pacifier