When is it safe to give your breastfed baby a pacifier?

That really is the million-dollar question, isn’t it!

While finishing up a course on Research in Maternal-Child Health, I’ve spent hours and hours pouring over studies, trials, and systematic reviews on research about the relationship between pacifiers and breastfeeding. I was hoping to answer the question, “When is the best (if any) time to introduce a pacifier to your breastfeeding baby?

Guess what, I still don’t know. And researchers don’t really know either. 

So, for you to make your own decision on whether a pacifier is right for your baby, when to give the first one, and which ones to give, here are a few things to consider. 

Baby-Friendly Hospital Initiative 

Have you heard of a Baby-Friendly Certified Hospital? Did you know that a hospital with that designation isn’t allowed to give pacifiers to infants born there? 

Actually, after a recent revision in 2018, the policy currently reads, “Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.” (World Health Organization, 2018) It used to be much more strict, but it’s generally considered best to avoid pacifiers until breastfeeding is off to a good start.

Reducing the Risk of SIDS

There are several studies related to Sudden Infant Death Syndrome (SIDS) that say babies have a LOWER risk of SIDS when using a pacifier! 

Now, that may seem like a great argument in favor or pacifier use! But if you dive into the studies, few included those babies who were breastfeeding. There is some research to support pacifier use in bottle-fed babies in reducing their risk of SIDS (Moon, Tanabe, Yang, Young, & Hauck, 2012)… 

but for breastfed babies… the data isn’t available. This may be due to the fact there are fewer breastfed babies to study regarding SIDS because so few breastfed babies die from SIDS. (Bernshaw, 1991)

 What are Dentists Saying? 

Great question! And good news! Most studies agree on this topic. The longer a baby uses a pacifier, the more likely they are to have oral problems. 

One study states, “the prevalence of malocclusion was roughly 71 percent in children who used a pacifier or sucked a digit for more than 48 months, compared with 32 percent in those who ceased sucking between 36 and 48 months, and 14 percent in those who ceased sucking before 24 months.” (Warren, Bishara, Steinbock, Yonezu, Nowak, 2001).

 Benefits in Preterm Infants

There are some potential benefits of pacifiers in preterm infants, which I think is one of the reasons the BFHI adapted their policy a few years ago to be less strict on pacifier use. 

Using pacifiers along with tube feedings in premature infants has some positive effects, especially when it is not feasible to have the baby sucking at the mother’s breast. If you want to read some more about that application, here are some studies for you:

  Learning a New Skill

So, if we think about this practically, let’s look at some other examples of learning new skills. I’ll give a few examples and hopefully one resonates best with you. 

  • If we are learning to play the guitar, should we also practice using a cello? 
  • How difficult would it be to learn French AND German at the same time? 
  • At baseball practice every day, what would happen when half the time you used a baseball and the other half a football?

It makes sense that when learning a new skill, you should practice just one skill at a time AND use the correct equipment! This translates easily into breastfeeding, which IS a natural desire for all infants, does require a bit of learning and coordination between the mother and child. Introducing a pacifier too soon (or ever) MAY interfere with or change the breastfeeding relationship. 

Unfortunately, most studies on this topic are inclusive or lump pacifiers along with bottles. There is clear evidence that adding bottles while you’re trying to breastfeed can make things more challenging, but few studies have looked at the use of pacifiers ONLY in otherwise exclusively breastfed babies.  

The Convenience Factor

I’m a mom too, I can totally understand the convenience factor of a pacifier! Here is some interesting data from a 2012 study on WHY mothers introduce a pacifier:

  • Pacifiers were introduced by 79% of mothers
  • 28.7% were advised to use a pacifier by their mother/mother-in-law 
  • 22.7% were advised by a midwife. 
  • mothers used a pacifier in order to soothe their infant (78.3%), 
  • to help put them to sleep (57.4%) 
  • and to keep them comforted and quiet (40.4%)

And in this study, it also stated: “Pacifiers given to infants before four weeks and used most days were significantly associated with shorter duration of breastfeeding.” (Mauch, Scott, Magarey, Daniels, 2012) 

We can’t ignore these reasons from moms, and most seem reasonable! But breastfed babies would be just happier (and likely better off) being at the breast, even if the breast was “empty” (which it’s not :)). 


So… the million-dollar question. When is it safe to give your breastfeeding baby a pacifier

Really, it’s up to you. There are many risks of pacifier use, and few benefits. Ideally, a breastfed baby would be put to the breast when they want to suck which provides nutrition for the infant, stimulation of continued milk flow for the mother, bonding for both, appropriate oral development, and an array of other benefits. 

To be realistic, the biggest reason mothers give a pacifier is for convenience. Sometimes it’s not always easy to breastfeed on demand, all day and night, every day. I’m a mom too, I get it! But to give you and your baby the best shot of appropriate physical development, adequate nutrition, and easiest breastfeeding, it may be best to forget the pacifier altogether.

I wish there was a clearer answer for you, but in the end, use your mother’s intuition. Every baby is different, and every situation is unique. 

If you have more questions, please leave a comment below! Check back later to more articles on pacifiers and breastfeeding, how to survive without them, “I’m a human pacifier”, and other breastfeeding tips and tricks. 


References

Bernshaw, N. J. (1991, June). Does breastfeeding protect against sudden infant death syndrome? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2036158.

Fleming, P. J., et al. (1999). “Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case-control study.” Arch Dis Child 81(2): 112-116.

Mauch, C. E., Scott, J. A., Magarey, A. M., & Daniels, L. A. (2012, January 19). Predictors of and reasons for pacifier use in first-time mothers: an observational study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3323436/.

Moon, R. Y., Tanabe, K. O., Yang, D. C., Young, H. A., & Hauck, F. R. (2012, April). Pacifier use and SIDS: evidence for a consistently reduced risk. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21505778.

World Health Organization. (2018, August 17). Ten steps to successful breastfeeding (revised 2018). Retrieved from https://www.who.int/nutrition/bfhi/ten-steps/en/.

~ New Little Life ~

When is it safe to give your breastfed baby a pacifier?

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