What should I know about giving my breastfed baby a pacifier?

July 31, 2011. Posted in: Common Newborn Concerns

By Kelly Bonyata, BS, IBCLC

When can I begin using a pacifier?

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.

What should I consider before using a pacifier?

After the early weeks, pacifier use is less likely to cause problems as long as you are aware of the following:

  • 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.

 When to avoid the pacifier

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).

 Can pacifiers help prevent SIDS?

Have you heard in the news that pacifier use might help to prevent SIDS? Here’s what the American Academy of Pediatrics says about this in their March 2000 Policy Statement Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position:

Four recent studies have reported a substantially lower SIDS incidence among infants who used pacifiers than among infants who do not. Although this association has been strong and consistent, it does not prove that pacifier use prevents SIDS. Mechanisms by which pacifiers might protect against SIDS have been proposed, such as stinting of the upper airway, but data are lacking to demonstrate that any of them are relevant to SIDS. Conversely, other studies have demonstrated that pacifier use can be linked to a shortened duration of breastfeeding, increased susceptibility to otitis media, and increased dental malocclusion. The Task Force believes that additional outcome studies are required before a specific recommendation about pacifiers can be made.

 In conclusion…

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 nurse, especially if there is a weight gain concern. The breast was the first pacifier and in most cases remains the best.

 

 More information

Is your baby nursing all the time? @

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

Pacifiers: In or Out? and Giving a pacifier to a breastfed baby by Dr. William and Martha Sears

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

Nipple Confusion by Teresa Pitman

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)

 Some Journal Articles on Pacifier Use and Breastfeeding

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.

AM Vogel, BL Hutchison and EA Mitchell. The impact of pacifier use on breastfeeding: A prospective cohort study. J Paediatr Child Health 2001;Feb;37(1):58-63.

Wojdan-Godek E, Mikiel-Kostyra K, Mazur J. Factors associated with exclusive breastfeeding of infants in Poland. Med Wieku Rozwoj 2000;4(3 Suppl 1):15-24.

Aarts, C., Hörnell, A., Kylberg, E., Hofvander, Y., Gebre-Medhin, M. Breastfeeding Patterns in Relation to Thumb Sucking and Pacifier Use. Pediatrics 1999;104: 50e.

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.

Hornell A, Aarts C, Kylberg E, Hofvander Y, Gebre-Medhin M. Breastfeeding patterns in exclusively breastfed infants: a longitudinal prospective study in Uppsala, Sweden. Acta Paediatr 1999 Feb;88(2):203-11.

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.

 Some Journal Articles on Pacifier Use in General

Warren JJ, Levy SM, Kirchner HL, Nowak AJ, Bergus GR. Pacifier use and the occurrence of otitis media in the first year of life. Pediatr Dent. 2001 Mar-Apr;23(2):103-7.

Larsson E. Sucking, chewing, and feeding habits and the development of crossbite: a longitudinal study of girls from birth to 3 years of age. Angle Orthod. 2001 Apr;71(2):116-9.

Martinez Sanchez L, Diaz Gonzalez E, GarciaTornel Florensa S, Gaspa Marti J. Pacifier use. risks and benefits. An Esp Pediatr. 2000;53(6):580-5.

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.

Uhari M, Mantysaari K, Niemela M. A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis 1996 Jun;22(6):1079-83.

M Niemela, M Uhari, and M Mottonen. A pacifier increases the risk of recurrent acute otitis media in children in day care centers. Pediatrics 1995;96: 884-888.

Darwazeh AM, al-Bashir A. Oral candidal flora in healthy infants. J Oral Pathol Med 1995 Sep;24(8):361-4.