Getting a baby to suck on a pacifier (or dummy) is a common method used by parents to help settle their baby.
For some parents, pacifiers are a godsend and they couldn’t imagine life without one.
However, other parents worry that use of a pacifier might negatively interfere with breastfeeding.
The World Health Organization (WHO) recommends against early pacifier use “to enable mothers to establish and sustain exclusive breastfeeding for 6 months”.
Although it’s difficult to predict how pacifier use might affect individual babies (and doing what works best for your family is important), knowing what the research says about breastfeeding outcomes and pacifier use can help you make informed decisions.
So, can pacifiers help with breastfeeding?
Pacifier Use May Not Negatively Impact Breastfeeding When Mothers Are Motivated To Breastfeed
Cochrane reviews are internationally recognised as providing the highest quality evidence for health related topics. They do this by collating together all the existing quality primary research on a topic, assessing it using strict guidelines and then forming conclusions.
A 2016 Cochrane review of 3 randomised controlled trials (RCTs) on this topic found pacifiers didn’t affect how long women exclusively or partially breastfed up to four months of age.
The RCTs included in this review randomised mothers to pacifier use or non-use. This could make the studies less representative of the choices mothers would normally make, as they would decide whether or not to use a pacifier on their own. The review also can’t tell us whether less motivated mothers might be disadvantaged by pacifier use.
In addition, there was no information in this review about the potential impact of pacifiers on short-term breastfeeding difficulties (e.g. mastitis, cracked nipples, breast engorgement) or about the potential long-term effect of pacifiers on babies’ health (e.g. dental malocclusion, ear infections).
So, is there any research to suggest pacifiers might have any negative effects on breastfeeding?
Pacifier Use May Lead Premature Interruption To Exclusive Breastfeeding
Despite the Cochrane review’s findings, several observational studies have suggested a link between frequent and continuous pacifier use and earlier interruption to exclusive breastfeeding.
It’s unclear if this link is causal or a marker for reduced motivation to breastfeed.
A 2016 systematic review of 40 studies (2 RCTs and 38 observational) looked at the link between pacifiers and breastfeeding.
None of the RCTs in this review found an association between pacifier use and exclusive breastfeeding interruption but the observational studies did. This review concluded: “Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use.”
A 2016 Brazilian study (which was not included in this systematic review as it was published after the studies for the review were obtained) supports the conclusions of this systematic review.
So, despite the lack of a link found in the RCTs, observational studies strongly suggest that pacifier use may be a risk factor to cessation of exclusive breastfeeding.
If you use a pacifier, here are two tips that may help minimise its potential impact on breastfeeding:
Wait Until Breastfeeding Is Well-Established: The way a baby sucks at the breast as compared to a pacifier is very different. To help get your baby used to sucking well at the breast and avoid the possibility of your baby getting confused about different ways of sucking, it may help to wait until breastfeeding is well-established around 6 weeks before introducing a pacifier.
Use Pacifiers Only For Comfort: Using pacifiers only for comfort, and not trying to space out feeds with them, can help minimise the risk of them interfering with the supply equals need basis of breastfeeding.
Breastfeeding aside, here are three additional factors to consider when it comes to pacifier use.
#1: Pacifier Use Is Linked To Higher Infection Risk
Pacifier use has been linked with higher risk of infections such as ear infection, wheezing and gastroenteritis.
The American Academy of Pediatrics recommends weaning babies from pacifiers in the second six months of life to help reduce the risk of ear infections.
Longer duration of pacifier use (especially more than 48 months) has also been associated with an increased risk of dental malocclusion.
On the flip side, pacifier use has also been linked to some benefits.
#2: Pacifier Use May Reduce The Risk Of Sudden Infant Death Syndrome (SIDS) Risk And Reduce A Baby’s Pain Response
Sucking (e.g. breastfeeding, finger-sucking or pacifier use) tends to have a calming effect on babies, including reducing a baby’s response to pain.
Also, research has suggested that pacifier use might reduce the risk of SIDS, but the mechanism behind this isn’t clear and more evidence is needed.
Some studies suggest that babies who never have a pacifier didn’t have an increased SIDS risk but babies who didn’t have a pacifier (but usually used one) were at increased risk of SIDS. Hence, these studies suggest that if babies have a pacifier for sleep that they should always have it.
So, it seems the jury is still out with regards to pacifier use and breastfeeding. Hopefully this article will help you make your own informed decisions about pacifier use.