Pacifiers: Good, bad or indifferent?

Why are there differing views on using a pacifier? Is it true that breastfed babies should NOT use a pacifier?

The American Academy of Pediatrics (AAP) states, “Pacifiers do not cause any medical or psychological problems. If your baby wants to suck beyond what nursing or bottle feeding provides, a pacifier will satisfy that need. However, a pacifier should not be used to replace or delay meals.” The AAP feels that pacifier use may protect against Sudden Infant Death Syndrome (SIDS), however, they suggest that pacifier use be delayed until one month of age so that breastfeeding is well established.

Young babies like to suck. Sucking can calm and soothe a baby, and sucking also helps babies to organize their breathing. Babies suckle when they breastfeed; they can also suckle on a finger, their fist or a pacifier.

Some research has shown that pacifier use in the first month of life is associated with babies not breastfeeding as long. No one knows if pacifiers “cause” breastfeeding problems. Other research has shown that when pacifiers are withheld from babies, parents are more likely to supplement with formula in order to satisfy their baby. A mother may feel she does not have enough milk if her breastfeeding baby wants to suck more after breastfeeding.

Does this mean that a newborn should never be given a pacifier?

It is important to feed a hungry baby. Pacifiers should not be used to replace or delay a breast feeding. If a baby is feeding well and gaining weight well, a pacifier may help some babies to soothe themselves. Pacifiers are often most helpful in the early weeks or months when babies are very focused on sucking. However, not all babies want, or need, a pacifier.

If you do choose to use a pacifier with your baby, what type is best?

There is no research to guide us. When asked, our lactation consultants tend to suggest a round, long pacifier (like a standard bottle nipple) versus a short, flat one. This shape seems to promote a groove down the center of a baby’s tongue and may help with a shallow gag reflex. If breastfeeding is going well, it may not matter what specific kind of pacifier you use with your baby except that it should be one piece and have a shield that is wider than your baby’s mouth (at least 1 ½ inches in diameter).

Other considerations when using a pacifier include:

  • Do not coat a pacifier with any type of a sweet solution.
  • Clean your baby’s pacifier regularly and replace a pacifier if worn in any way.
  • Pacifiers should never be tied by a string to a baby’s crib, or around a child’s neck or hand.