It is recommended that pacifiers and other types of artificial nipples be avoided for at least the first 3-4 weeks. I’d personally suggest that most breastfed babies – if they get a pacifier at all – would be better off without a pacifier until mom’s milk supply is well established (6-8 weeks, usually) and the 6 week growth spurt is over. That way you’ve established a good milk supply and don’t lose any much-needed breast stimulation to a pacifier.
After the early weeks, pacifier use is less likely to cause problems as long as you are aware of the following:
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- Never substitute a pacifier for a feeding at the breast or try to hold the baby off longer between feedings with one. (See Should baby be on a schedule?)
- There are studies that indicate that babies who take a pacifier tend to wean earlier than those who do not. This is most likely because as a baby gets older – once he’s established on solid food – it is often his desire to suck that ensures he continues to seek out the breast often. Babies who use pacifiers are getting that need to suck met with something other than the breast, and therefore may decide to give up breastfeeding sooner than if they did not take a pacifier.
- Some babies who take pacifiers are more prone to oral yeast (thrush) which can be transferred to mom’s nipples.
- A number of studies have shown a link between pacifier use and an increased incidence of ear infections.
- Pacifiers can result in choking or strangulation if the pacifier breaks or if it is tied around the neck (which it never should be). Follow all safety guidelines and keep an eye out for the many pacifier safety recalls. Also, keep in mind that latex allergy is becoming an increasing problem – consider using a silicone pacifier rather than latex.
- Prolonged pacifier use can result in teeth misalignment, and can also occasionally lead to shaping of the soft palate or speech problems.
- Giving baby a pacifier will increase mom’s chances of ovulating and getting pregnant. Exclusive breastfeeding, depending upon your breastfeeding frequency and other factors, is a method of birth control that can be more than 98% effective during the first 6 months and 94% effective during the second six months. Ensuring that all of baby’s sucking needs are met at the breast increases the effectiveness of this method of contraception.
If you observe any of the following problems, it would be a good idea to discontinue pacifier use, at least until the problem is resolved:
- Pacifier use reduces your baby’s frequency or duration of feeds (newborns should be nursing at least 8 to 12 times a day).
- Baby is having difficulties nursing well (this may be due to nipple confusion).
- Baby is having problems with weight gain (in which case baby needs to nurse as often as possible).
- Mom is having problems with sore nipples (baby may be causing this due to nipple confusion)
- Mom is having milk supply problems (in which case she needs to put baby to breast, not pacifier, at every opportunity in order to increase milk supply).
- Mom and/or baby have thrush, particularly if it’s hard to get rid of or repeated.
- Baby is having repeated ear infections (an increased incidence of ear infections has been linked to pacifier use).
Have you heard that pacifier use might help to prevent SIDS? Here’s what the American Academy of Pediatrics Section on Breastfeeding says about this in their February 2012 Policy Statement:
Given the documentation that early use of pacifiers may be associated with less successful breastfeeding, pacifier use in the neonatal period should be limited to specific medical situations. These include uses for pain relief, as a calming agent, or as part of structured program for enhancing oral motor function. Because pacifier use has been associated with a reduction in SIDS incidence, mothers of healthy term infants should be instructed to use pacifiers at infant nap or sleep time after breastfeeding is well established, at approximately 3 to 4 weeks of age.
As long as you keep the above in mind and only use a pacifier sparingly, it is up to you whether and when you wish to comfort baby yourself or with a pacifier. However, keep in mind that there is no scientific evidence that suggests that babies have a need to suck independant of the need for food. When a baby is indicating a sucking need, it’s generally best that baby be encouraged to breastfeed, especially if there is a weight gain concern. The breast was the first pacifier and in most cases remains the best.
Pacifiers by Diane Wiessinger, MS, IBCLC
Pacifiers: Yes or No? by Gwen Gotsch. From NEW BEGINNINGS, Vol. 12 No. 6, November-December 1995, pp. 172-3.
When is it okay to introduce a pacifier? by Debbi Donovan, IBCLC
Do Pacifiers Cause Early Weaning? by Yvonne E. Vaucher, MD, MPH
Top Ten Reasons for NOT Using a Pacifier by Linda J. Smith, IBCLC
Perils of the Pacifier by Bruce A. Epstein, MD
To Plug or Not To Plug: The Pacifier Debate by Roxanne Willems Snopek
AAP Guide to Thumb Sucking and Pacifiers (including safety guidelines)
Avoiding Nipple Confusion by Becky Flora, IBCLC
Nipple Confusion from AskDrSears.com
The Truth About “Nipple Confusion” by Paula Yount
Dealing with Nipple Confusion from Breastfeeding and the Working Mother by Cecilia Mitchell Miller
The Pitfalls of Supplementing a Breastfed Baby by Cheryl Taylor White
Late Nipple Confusion by Carrie Ganz, from NEW BEGINNINGS, Vol. 16 No. 2, March-April 1999, p. 43.
Nursing Through Confusion by Olga April (a mom’s story)
Howard CR, Howard FM, Lanphear B, Eberly S, deBlieck EA, Oakes D, Lawrence RA. Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics. 2003 Mar;111(3):511-8.
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Cynthia R. Howard, Fred M. Howard, Bruce Lanphear, Elisabeth A. deBlieck, Shirley Eberly, and Ruth A. Lawrence. The Effects of Early Pacifier Use on Breastfeeding Duration. Pediatrics 1999;103: e33.
Riva E, Banderali G, Agostoni C, Silano M, Radaelli G, Giovannini M. Factors associated with initiation and duration of breastfeeding in Italy. Acta Paediatr. 1999 Apr;88(4):411-5.
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Righard L. Are breastfeeding problems related to incorrect breastfeeding technique and the use of pacifiers and bottles? Birth 1998 Mar;25(1):40-4.
Righard L, Alade MO. Breastfeeding and the use of pacifiers. Birth 1997 Jun;24(2):116-20.
Cesar Gomes Victora, Dominique Pareja Behague, Fernando Celso Barros, Maria Teresa Anselmo Olinto, and Elizabeth Weiderpass. Pacifier Use and Short Breastfeeding Duration: Cause, Consequence, or Coincidence? Pediatrics 1997;99: 445-453.
FC Barros, CG Victora, TC Semer, S Tonioli Filho, E Tomasi, and E Weiderpass.
Use of pacifiers is associated with decreased breast-feeding duration. Pediatrics 1995;95: 497-499.
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Marjo Niemelä, Outi Pihakari, Tytti Pokka, Marja Uhari, and Matti Uhari. Pacifier as a Risk Factor for Acute Otitis Media: A Randomized, Controlled Trial of Parental Counseling. Pediatrics 2000;106: 483-488. A Finnish study on pacifiers has found that reduced pacifier use in children can decrease the incidence of acute otitis media, or ear infections. The study, published in the September issue of Pediatrics, the journal of the American Academy of Pediatrics, followed two groups of children under 18 months. In one group, pacifier use was decreased by 21 percent, while children in the second group used pacifiers continuously. The first group had a 29 percent lower incidence of acute otitis media than the second. Researchers concluded that restricting pacifier use to when a child is falling asleep could prevent such infections.
Fleming, P. J, Blair, P. S, Pollard, K., Platt, M. W., Leach, C., Smith, I., Berry, P J, Golding, J., the CESDI SUDI Research Team. Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study. Arch. Dis. Child. 1999;81: 112-116.
Kate North, Peter Fleming, Jean Golding, and the ALSPAC Study Team. Pacifier Use and Morbidity in the First Six Months of Life. Pediatrics 1999;103: e34.
Ollila P, Niemela M, Uhari M, Larmas M. Prolonged pacifier-sucking and use of a nursing bottle at night: possible risk factors for dental caries in children. Acta Odontol Scand 1998 Aug;56(4):233-7.
Jackson JM, Mourino AP. Pacifier use and otitis media in infants twelve months of age or younger. Pediatr Dent. 1999 Jul-Aug;21(4):255-60.
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Darwazeh AM, al-Bashir A. Oral candidal flora in healthy infants. J Oral Pathol Med 1995 Sep;24(8):361-4.