War of the Passy

Most Breastfeeding activists or "lactivists" will tell you that you should not use pacifiers or bottles to avoid nipple confusion. With some babies that is a problem, others... not so much.
The NICU is where you have to throw such "rules" out the window.
In the NICU babies, especially the long-term members, run the risk of developing oral aversion. Oral aversion comes from long term NICU stay and tube/IV feeds. The babies get so used to anything in their mouths being a negative sensation. They get new feeding tubes, breathing tubes, suction tubes, bad tasting meds, etc. And they don't like it. When they develop oral aversion they refuse anything going near their mouth and will fight it, which only intensifies the OA. These babies end up requiring stomach tubes, that are surgically implanted in their stomach. It becomes a very very long road to get them to accept anything orally.
Some will accept pacifiers though. Pacifiers may be the only positive experience they get. Between needles, tubes, sensitive skin, bright lights, loud noises, cold hands and other daily experiences passes are their one joy.
We had a speech therapist from our church warn us about this in the early NICU days. She convinced us to push for a speech therapy consult. Both therapists gave us suggestions to avoid oral aversion.
•PASSIEES!- for all the above reasons
• varied positive sensation- allow baby to suck on clean finger tips, q-tips, lemon swabs (sparingly, can cause diarrhea), his own hands when possible, etc.
•positive tastes- tiny drops of sweet ease (sugar water) and breast milk (NEVER formula!) will help comfort and get them used to things in their mouths
•passy + feeds- We made his nurses make sure he had a passy in whenever he got a feeding so that he would associate a filling tummy with sucking
Baby C had a preference for his suction tube and would also suck on his breathing tube.
It seems like there are so many different types of passies in stores and there are so many more that most never know about. What kind of passy you use will depend on your situation. Our NICU kept preemie and newborn soothiees in stock, but they didn't help him as a micropreemie. My sister managed to order some micropreemie passies for him. He loved them! Micropreemie passie
The tip of that passie is about the size of a Q-tip. It is designed to fit around the breathing tube.
He eventually outgrew that passy and went through the preemie and newborn sizes. Which is when we created "Snack Passy"


  1. Interesting that preemies can have total oral aversion. That makes sense. It just goes to show how we must use more than just one piece of parental advice (don't use pacifers or it will create nipple confusion) and we need to understand the context of the situation and understand that this baby needs a pacifer so it will learn to be comforted by mama in due time and just simply eat!!

  2. Such a great explanation of a case where pacifiers are a very GOOD thing! My oldest and youngest (<-- both full-term) never had one bit of interest in a paci. But we were sure to use one with our micropreemie middle child during her tube feeds. Associating sucking with feeding was essential when she was eventually given the go-ahead to drink thickened breastmilk from a bottle. Great post!


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