Pros and Cons of Pacifier Use in Breastfed Babies

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Parents of breastfed babies often wonder if it’s OK for their baby to use a pacifier. With all the opinions and conflicting information about pacifier use, their concerns are understandable. 

Fortunately, there is not sufficient evidence to suggest that pacifier use is bad for breastfeeding babies. In fact, using a pacifier may even be beneficial. Ultimately, whether or not you offer your baby a pacifier is a personal decision, but there are some pros and cons that may help you decide if it’s right for you and your family.

Why Parents Worry

Every child is different, with unique needs and abilities. Some babies can go back and forth between breastfeeding and a pacifier without any problems, while pacifiers may pose some challenges for others. Some of the concerns about pacifier use—like the risk of nipple confusion, breast refusal, and low milk supply—are only relevant for breastfed babies.

At the heart of these concerns is often the fact that the sucking technique used during breastfeeding is different from that used with artificial nipples on bottles and pacifiers. While sucking is undoubtedly an instinct in newborns, it's also a skill that develops with time and practice.

For babies who are new to breastfeeding, the differences between the breast and a pacifier can lead to frustration when nursing and even breast refusal (not to mention that a poor latch and less than ideal sucking technique at the breast can also be painful for the breastfeeding parent).

If a baby's learned sucking technique or frustration leads to inefficient and ineffective breastfeeding, it can result in weight loss and a low milk supply. The same goes for when a baby is regularly offered a pacifier in place of a feeding.

Introducing pacifiers at the right time may be key to avoiding these breastfeeding complications. Just like it may take a little while to learn to ride a bike without falling, it can take a parent and baby a few dedicated weeks to get the hang of nursing.

To reduce the likelihood of experiencing challenges, the American Academy of Pediatrics (AAP) recommends that parents begin introducing pacifiers after breastfeeding is well established, generally around 3 to 4 weeks of age.

Since babies use the same sucking technique when using a pacifier and a bottle, you don’t need to worry about nipple confusion if your baby is exclusively bottle-fed. They can use a pacifier right from the start.

You and your partner will know your child best. Together, you can determine if using a pacifier is right for you and your baby. You can also consult your baby's doctor to help you make that decision.

Pros 

There is good reason that pacifiers are considered a "must-have" for many parents—they can offer a number of benefits, some of which include:

  • The AAP recommends giving a pacifier at naptime and bedtime because some studies have shown that they may help protect babies from sudden infant death syndrome (SIDS).
  • Many babies have a need to suck even when they are not hungry; a pacifier can satisfy this desire for non-nutritive sucking.
  • Non-nutritive sucking has been shown to provide pain relief. Babies with colic, who are receiving vaccines, or who are injured, sick, or undergoing a medical procedure may be soothed by the use of a pacifier.
  • Premature babies may particularly benefit from pacifier use; one study showed that giving preemies pacifiers resulted in a quicker sucking success and transition to oral feeding.
  • A pacifier is a soothing tool that a non-breastfeeding caregiver can provide, offering the breastfeeding parent a break.
  • Pacifiers are helpful during travel on an airplane as sucking can relieve painful pressure in the middle ear.

Cons

Pacifiers can also present some downsides. Some of these drawbacks, like concerns about nipple confusion and milk supply, apply only to breastfed babies. Most often, however, the cons of pacifier use can be mitigated by following recommended guidelines.

Here are some things to watch out for:

  • Introducing a pacifier too early could get in the way of your baby's ability to latch on and breastfeed. This could lead to breastfeeding problems such as sore nipples, engorgement, plugged milk ducts, and mastitis. To limit those risks, the AAP advises waiting until around 3 to 4 weeks to introduce a pacifier.
  • If a pacifier is used to replace feedings, your milk supply may be impacted or lead to weight loss in your baby.
  • Pacifiers have been linked with ear infections, which is why the AAP recommends limiting or eliminating the pacifier after 6 months of age.
  • Pacifiers often fall out of babies’ mouths, which means they can become conduits for germs, especially if they are not frequently cleaned and sanitized.
  • Some argue that pacifiers are unnecessary since babies who do not use pacifiers often find other ways to soothe themselves by sucking on their hands, fists, or fingers.
  • The overuse of a pacifier during the day could prevent your baby from getting enough milk at daytime feedings, which can cause them to wake more often during the night to eat.
  • A systematic literature review found moderate evidence that pacifier use was associated with poor dental development, specifically anterior open bite and posterior crossbite.
  • Children can become very attached to their pacifiers; it may be difficult for your child to give up using the pacifier when the time comes.

Are Pacifiers Bad?

It used to be thought that pacifier use in breastfed infants could lead to early weaning. More recent research, however, points to the opposite. 

In one study, pacifier use did not impact the duration of breastfeeding up to 4 months of age. Another study found that restricting access to pacifiers in the hospital during the newborn period actually decreased exclusive breastfeeding rates.

Pacifier use is no longer discouraged for breastfed infants, though it is recommended to wait to introduce a pacifier to a healthy, full-term infant until breastfeeding is going well and your milk supply has been established.

Safety Tips

If you decide to use a pacifier, be sure to use it safely. Pacifiers can pose certain hazards like choking and exposure to allergens and germs, so it's important to keep the following safety guidelines in mind:

  • Avoid pacifiers that are not one continuous piece. Two-piece pacifiers can become a choking hazard if they separate.
  • Clean your child's pacifiers every day to prevent thrush and bacterial infections. Follow the manufacturer's instructions for proper care. Some pacifiers can be cleaned in the dishwasher others should only be washed with warm, soapy water and rinsed well.
  • Never hang a pacifier around your baby's neck or use any kind of string or ribbon to tie the pacifier to the crib, car seat, stroller, or infant seat. Your baby could become strangled in any type of cord that is within their reach.
  • Do not use the nipple from a bottle as a pacifier. It is not safe and may cause your baby to choke.
  • Many brands of pacifiers specify the size of the pacifier for the age of the baby. Use the proper size for your baby. An older child could choke on a newborn pacifier since the entire pacifier may fit into an older child's mouth.
  • Avoid latex pacifiers if you are concerned about the possibility of latex allergies.

Check pacifiers for signs of wear and breakdown regularly. Replace them when they become discolored, broken, or damaged.

A Word From Verywell

Whether or not to use a pacifier is a decision only you can make. Remember, you know your child best, and you will be the best judge to determine whether you and your baby would benefit from the use of a pacifier. 

Many breastfed babies use pacifiers. If you decide to try a pacifier, you may want to consider waiting until breastfeeding is well established, which often happens when babies are just shy of 1 month old. If you're unsure, talk to your child's pediatrician or a certified lactation consultant for guidance.

When your child begins to get teeth, take them to the dentist for regular exams. Talk to the dentist about your child's pacifier use and discuss the age at which they recommend pacifier use to end.

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Article Sources
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