Pacifiers

By Krista Gray, IBCLC. Last updated August 2, 2017.

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PacifierIn the West, mothers are often told not to let their babies use their breasts as a pacifier.  “It will spoil them,” moms are told along with a myriad of other reasons.  Instead, mothers are encouraged to replace the original pacifier – their breasts – with something artificial.  Assuming this cultural norm must be correct, and wanting a break from the almost constant nursing in the early days, many mothers introduce a pacifier to their baby.  However, from a breastfeeding perspective, there are many negative impacts a pacifier can have.  Let’s look at the benefits and repercussions of this common practice.

Pros

  • Allows baby to self-soothe
  • Perception parenting can be easier
  • Can improve digestion when a preterm baby sucks on a pacifier during gavage feeds 1
  • Possible reduction in SIDS

Cons

  • Associated with a decrease in exclusive breastfeeding
  • Associated with earlier weaning
  • Increased incidence of ear infections
  • Increased incidence of thrush/candida
  • Increased risk of dental caries
  • Increased risk of mouth malformation
  • Cannot rely on LAM as reliable method of birth control in first six months

Pacifier’s impact on milk supply

During the first six weeks following birth, a breastfeeding mother’s body is adjusting to the right amount of milk production for her baby(ies).  Giving a pacifier during these early days can alter breastfeeding rhythms and decrease the number of breastfeeds in a day.  Decreased breastfeeds – along with other associated factors of pacifiers such as decreased time in skin-to-skin contact and being held – can reduce a mother’s milk supply.  Therefore, even if you do decide to give a pacifier later, it is best to never give a pacifier until breastfeeding is well established.

One study looked at a pacifier’s use in relation to breastfeeding duration and weaning.  These researchers found that daily pacifier use had a deleterious effect on breastfeeding duration. 2

Decreased milk supply and/or early weaning also impact a mother’s fertility returning earlier.

Pacifier’s impact on infant health

Numerous studies have shown that pacifier use is positively related to ear infections.  In fact, there is a 1.2 – 2-fold increase in ear infection rates with pacifier use. 3

In addition to ear infections, pacifier use is also associated with an increased incidence of candida.  Whether the pacifier is accidently shared, touches a surface contaminating it, or is not cleaned thoroughly allowing for reinfection, if the fungus is on the pacifier and then put in the baby’s mouth his chances of getting an overgrowth greatly increase.  Not only this, but researchers postulate that sucking on a pacifier can also allow for the build up of sugars in a baby’s mouth. 4

The position of the tongue when sucking on a bottle or pacifier is completely different than suckling at the breast.  Breastfeeding helps to develop a normal palate and jaw formation, as well as protect against malocclusion.  Conversely, sucking on an artificial teat increases malformations of the mouth as well as cavities.

Benefits of pacifier use

Why is it, with so many known detriments, that pacifiers are still as common as candy?  Well, many mothers are tired and exhausted in the early days and need a break.  Mothers are not informed of any detrimental effects and think if a pacifier can just give them a few minutes to rest, shower, or grab a bite to eat it will have been worth it.  It’s true; many times babies will self sooth with a pacifier and allow a mother a break.  Additionally, western culture puts a top priority on scheduling babies, putting them on routines, and not wanting mothers to meet their babies every desire immediately.  A “good” baby is considered one that sleeps often and/or doesn’t cry much.

Another perspective, though, is that babies really may not be manipulative and if they are crying they actually have a need.  They’ve just entered a scary new world, coming from a place that was warm, where they were gently rocked to sleep, soothed by quiet sounds, and ate on demand.  Seen from this light, leaving a baby to “self soothe” may not be ideal.  See the page about fussy evenings for more information and tips on dealing with a needy baby and exhaustion.

Do pacifiers decrease SIDS rates?

Research has shown a 71% decreased risk of SIDS when pacifiers were given to babies to sleep. 5  So compelling was this information that the American Academy of Pediatrics’ Task Force recommended all babies be given a pacifier for sleeping (with the exception of breastfed babies whom they caution mothers to wait until baby is one month old first).

However, we also know that breastfeeding is protective against SIDS.  It is not the fact that baby is sucking on a pacifier that protects him against SIDS but that he is sucking.  Therefore, safely co-sleeping with your baby to allow easy nighttime nursing could offer the same protection.  In fact, simply sharing the same bedroom (not necessarily bed) with your child is protective against SIDS.  And though the AAP may recommend pacifier use when sleeping, the World Health Organization in their Baby Friendly Hospital Initiative clearly state that no pacifiers or artificial nipples should be given to breastfeeding infants.

Show 5 footnotes

  1. McCain GC. (2003) An evidence-based guideline for introducing oral feeding to healthy preterm infants. Neonatal Network – Journal of Neonatal Nursing. 22(5):45-50.
  2. Vogel A.M., et al. (2001) The impact of pacifier use on breastfeeding: a prospective cohort study. Journal of Paediatrics & Child Health 37(1): 58-63.
  3. AAP (2005) The changing concept of Sudden Infant Death Syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 116(5): 1245-1255.
  4. Sio, J.O., et al (1987) Oral candida: is dummy carriage the culprit? Archives of Disease in Childhood 62(4): 406-408.
  5. Chapman, D.J. (2006) Is pacifier use protective against Sudden Infant Death Syndrome. Journal of Human Lactation 22(1):129-130.
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