Breastfeeding & Pacifiers

by evian granitz

Let’s talk pacifiers.

Pacifiers, dummies, binkies, pacis, soothies. Perhaps one of the most common baby items in our society. What’s the deal with pacifiers and do they have any impact on breastfeeding success?

 
 Photo credit:  Madeline's Box

Photo credit: Madeline's Box

 

THE ROLE OF PACIFIERS + NON-NUTRITIVE SUCKING

Pacifiers are meant to do exactly as their name suggests - pacify, or calm your baby. They satisfy the need to suck and try to mimic the soothing babies can get from “non-nutritive” sucking at the breast (or sucking not for the purpose of eating).

Babies need the ability to non-nutritive suck before they can effectively suck at the breast to eat (1,2). Around 24 to 28 weeks in utero, babies begin visibly sucking via ultrasound and this process is fine tuned throughout pregnancy (3). While many babies master the suck-swallow-breathe pattern before they are born, some infants only get it down once they’re born and because sucking is so important, we want our baby to have plenty of practice; usually this is done at the breast (4). Once baby is born and latches on typically within the first hour of life, they begin to suck - this is not for food as babies are not born hungry, this is to practice their suck and swallow coordination, help clear out the meconium through movement of the intestines as a result of sucking (known as peristalsis) and coat their insides with colostrum (the first milk you produce and have been making in your breast since about 4 months pregnant). Non-nutritive sucking is also important for other things such as infant bonding, communication from baby to your body, minimizing pain, reducing stress and digestion (2).

While pacifiers can serve a useful purpose in limited situations, non-nutritive sucking can be fulfilled by sucking at the breast whether or not they’re actively feeding - and yes, non-nutritive sucking is backed by science to minimize unnecessary pacifier use (5). 

ARE THERE NEGATIVES TO PACIFIERS?

Here’s what the research says about pacifiers.

Early weaning / shortened duration of breastfeeding has been associated with the frequent use of pacifiers in infants under six months (6, 7). This may be for a variety of reasons such as delaying/skipping feeds, not responding to hunger cues which are subdued due to the pacifier, and a reduction in milk supply (as a result of skipped/delayed feeds) though researchers are not quite sure what is the root cause behind this relationship. Pacifiers use may also be a sign that there are subtle underlying breastfeeding issues that should be addressed early on which may be the cause of the early weaning and not the pacifier itself (15). We do know however, that pacifier use and successful breastfeeding to four months seems to be less important if the baby is healthy and full term and if the mother is motivated to breastfeed (11).

Frequent use of pacifiers can lead to an increased risk in ear infections and dental issues such as misaligned teeth and dental caries (cavities) (6, 8). As such, babies should be weaned off pacifiers at six months to reduce these risks.

There is no evidence to show pacifiers cause nipple confusion (9). Let’s clarify - babies are pretty smart. They can tell the difference between a dummy nipple and the real deal which is why your baby will reject the pacifier if they’re in the late hunger stage and their hunger is overpowering the satisfaction of non-nutritive sucking. Same goes for the bottle, there is no confusion but they can develop a preference. That topic will be explored soon, stay tuned!

ARE THERE TIMES WHERE A PACIFIER IS RECOMMENDED?

Yes! There are certain times when pacifiers may be beneficial.

  • Early mom and baby separation. If mom and baby are apart for prolonged periods of time, especially early on from cesarean recovery or mom/baby complications, baby should have a pacifier to practice sucking coordination and to keep the intestines moving (a process known as peristalsis which helps flush out meconium and reduce jaundice) (10)

  • Premature/NICU babies who may need help with their suck coordination and can use the pacifier to help soothe and reduce pain while separated from mom (10)

WHAT ABOUT DURING SLEEP?

The American Academy of Pediatrics recommend pacifier use during periods of sleep once baby is around 3 to 4 weeks old and after breastfeeding is established (12, 13). There is a possible benefit between pacifier use and a decrease in SIDS, though the evidence is lacking. Additionally, since the increase in pacifier usage over the past several decades, there has not been a decrease in SIDS cases (14). Pacifier use is recommended for sleep in bottle-fed babies who do not get the same sucking at the breast as a breastfed baby (14).

Keeping baby close, responding to their cues and feeding through the night is backed by research to be protective against SIDS, maintain milk supply, protect baby weight gain and is recommended over pacifiers (14).

LET’S RECAP.

  • Research shows pacifiers can impact breastfeeding early on for some and their use should be limited
  • Pacifiers are recommended in situations where mom and baby are separated and with premature / NICU babies

  • As for sleep, it is best to keep your baby close and respond to their cues at night to protect against SIDS however, pacifiers may reduce this risk as well. [Keeping baby close can mean in your room on a separate sleep space, it does not have to be in your bed though this can be done safely - for safe co-sleeping guidelines check out the criteria from the University of Notre Dame.]

  • An occasional pacifier is likely to be fine as long as you are limiting use, not replacing feedings, and baby is not showing signs of decreased/slow weight gain or struggling to go between breast/dummy nipple

 

References

(1) Popescu EA, Popescu M, Wang J, Barlow SM, Gustafson KM. Nonnutritive sucking recorded in utero via fetal magnetography’. Physiol Meas. 2008;29:127–39.

(2) Bertoncelli N, Cuomo G, Cattani S, Mazzi C, Pugliese M, Coccolini E et al. Oral Feeding Competences of Healthy Preterm Infants: A Review. Int J Pediatrics. 2012. doi.org/10.1155/2012/896257.

(3) Riordan J, Wambach K. Breastfeeding and Human Lactation. 3rd ed. Sudbury: Jones and Bartlett Publishers; 2005

(4) Lubbe W., Ham-Baloyi, W. When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician’s guide. BMC Pregnancy and Childbirth, 2017;17:1-10.

(5) Narayanan I, Mehta R, Choudhury DK, Jain BK. Sucking on the ‘emptied’ breast: non-nutritive sucking with a difference. Arch Dis Child. 1991;66:241–4.

(6) Sexton S, Natale R. Risks and benefits of pacifiers. Am Fam Physician. 2009;79:681–5

(7) 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;111(3):511–8

(8) Castilho SD, Rocha MAM. Pacifier habit: history and multidisciplinary view. J Pediatr. 2009;85:480–9

(9) Kramer MS, Barr RG, Dagenais S, Yang H, Jones P, Ciofani L, Jané F. Pacifier use, early weaning, and cry/fuss behavior: a randomized controlled trial. JAMA. 2001;286:322–6

(10) UNICEF. Baby friendly hospital initiative: revised, updated and expanded for integrated care. In: Section 2, strengthening and sustaining the baby friendly hospital initiative: a course for decisionmakers. 2009. https://www. unicef.org/nutrition/files/BFHI_section_2_2009_eng.pdf. Accessed 7 Sept 2015.

(11) Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database Syst Rev. 2011;16

(12) Kair LR, Kenron D, Etheredge K, Jaffe AC, Phillipi CA. Pacifier restriction and exclusive breastfeeding. Pediatrics. 2013; 131:e1101-e1107

(13) American Academy of Pediatrics. Breastfeeding and the use of human milk.Pediatrics. 2012;129(3).

(14) Lawrence R, Lawrence R. Breastfeeding: A guide for the medical professional. NY: Elsevier Health Sciences; 2015.

(15) Zimmerman E. Pacifier and bottle nipples: the targets for poor breastfeeding outcomes.  J Pediatri (Rio J); 2018.