Analgesic effects of sweet solutions and pacifiers in term neonates

# Suckling at the breast is better than sweet solutions and pacifiers {#article-title-2} EDITOR—A breastfeeding mother spontaneously comforts her distressed infant by putting him or her to the breast. It is a pity that Carbajal et al, when assessing the analgesic effects of orally administered glucose and sucrose in healthy term neonates, did not include a comparison group of infants given breast milk, which is rich in lactose and naturally sweet.1 It would also have been appropriate to compare the analgesic effect of using a pacifier with that of suckling at the breast before and immediately after the painful procedure. Pacifiers and sugar solutions given unnecessarily to healthy neonates are not proved to be “simple and safe interventions,” as Carbajal et al state. Exclusive breast feeding (for about the first six months) is the World Health Organization's recommendation.2 Two of the evidence based “ten steps to successful breastfeeding,” developed by the WHO/Unicef Baby Friendly Hospital Initiative, are step 6 (“Give newborn infants no food or drink other than breast milk, unless medically indicated”) and step 9 (“Give no artificial teats or pacifiers, also called dummies or soothers, to breastfeeding infants”).3 Anything that may interfere with the establishment of lactation or undermine the mother's confidence in breast feeding is to be avoided. I hope that this flawed piece of research will not result in either pacifiers or sugar solutions being “widely used for minor procedures in neonates.”1 1. 1.↵1. Carbajal R, 2. Chauvet X, 3. Couderc S, 4. Olivier-Martin M . Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. BMJ 1999; 319: 1393–1397. (27 November.) [OpenUrl][1][Abstract/FREE Full Text][2] 2. 2.↵1. World Health Organization . The World Health Organization's infant-feeding recommendation. WHO Wkly Epidemiol Rec 1995; 17: 117–220. [OpenUrl][3] 3. 3.↵1. Vallenas C, 2. Savage F . Evidence for the ten steps to successful breastfeeding. Geneva: World Health Organization, 1998. # Use of pacifier may modify responses measured on rating scale {#article-title-5} EDITOR—Carbajal et al conclude that the analgesic effects of both pacifiers and sweet solutions are clinically apparent and that pacifiers are more effective than sweet solutions alone.1 As a measure of pain they used a rating scale, douleur aiguë du nouveau-né (DAN), which has been described previously.2 This scale uses facial expression, limb movements, and vocal expression to give a score between 0 and 10. Low scores mean no or little … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DCarbajal%26rft.auinit1%253DR%26rft.volume%253D319%26rft.issue%253D7222%26rft.spage%253D1393%26rft.epage%253D1397%26rft.atitle%253DRandomised%2Btrial%2Bof%2Banalgesic%2Beffects%2Bof%2Bsucrose%252C%2Bglucose%252C%2Band%2Bpacifiers%2Bin%2Bterm%2Bneonates%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.319.7222.1393%26rft_id%253Dinfo%253Apmid%252F10574854%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=319/7222/1393&atom=%2Fbmj%2F320%2F7240%2F1002.atom [3]: {openurl}?query=rft.jtitle%253DWHO%2BWkly%2BEpidemiol%2BRec%26rft.volume%253D17%26rft.spage%253D117%26rft.atitle%253DTHE%2BWORLD%2BHEALTH%2BORGANIZATION%2527S%2BINFANT-FEEDING%2BRECOMMENDATION%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx