There is much debate over whether babies, particularly breastfeeding babies, should use pacifiers. There are valid arguments to be made on both sides of this discussion – valid reasons for concern as well as unnecessary hysteria over this issue. So what are the facts?

For mothers who want to breastfeed, it is best to avoid pacifiers in the first 2-3 months as breastfeeding is becoming established, and especially in the first hours and days after birth. When babies are first born, they have an instinctive need to suckle. Their suck need is the highest in about the three days after birth. The biological intention of this is to provide significant stimulation to the breast in order to signal the body to create prolactin receptors and produce breast milk.

The early milk, or yellowish colostrum, that is in the breast at the time of birth provides significant nutrition until the body begins to produce the thinner, more mature whitish milk meant to provide sole nutrition to the baby in the first 6 months to a year, and nutrition supplemented by foods after that point. Pacifier use in these first days may satisfy the baby's high suck need without supplying the breast with the appropriate stimulation needed to establish milk supply.

Pacifier use in these early days may interfere with signaling the need to breastfeed, reduce the frequency and duration of feedings and lead to reduced milk supply and even low infant weight gain as a result. This is much more significant than any fear of "nipple confusion" which tends to be indicated as a common concern. In fact, babies may transfer seamlessly between breast and pacifier, but still endanger breastfeeding through reduced feedings.

So babies who nurse shouldn't use pacifiers, right? Well, no...it's not that simple.

After the milk supply and nursing patterns are well established, between 8-16 weeks, pacifiers can be a useful substitute for the breast to satisfy the urge to suck when adequate nutrition is given at the breast, using expressed milk, or if absolutely necessary using formula, and the baby still desires to suckle. There is absolutely nothing wrong with allowing a breastfeeding baby to "pacify" at the breast – nursing is sometimes as much about closeness and comfort as it is about nutrition (see my article on Comfort Nursing in related links below). But sometimes this is not possible or practical. If the baby will accept a pacifier, this is a reasonable substitution.

Preemies or sick babies may need pacifiers to satisfy their sucking needs, especially if unable to nurse or receiving nutrition not by mouth. This is not only appropriate, but important. As soon as it is possible to nurse, it is of course ideal to supply the "real thing." In this instance, mothers wanting to maintain milk supply must pump to establish and maintain supply, generally with a hospital-grade breast pump. The pacifier is the least of the concerns in this scenario.

Essentially, if milk supply is established, breastfeeding is pain-free and baby is gaining weight appropriately, there is room to experiment with a pacifier if it seems like the baby's sucking needs are not satisfied at the breast. It is important to note that studies have shown that regular pacifier use is correlated with early weaning, according to the Breastfeeding Answer Book, 3rd Edition. The more times a day the pacifier is used, the higher the correlation. This does not necessarily mean though that pacifier use causes babies to wean. Instead pacifier use may be one expression of another problem or choice – decreased milk supply or the mother's desire to nurse less often, for example. That said, some babies may love the pacifier, nurse frequently and voraciously and grow by leaps and bounds.

It is also important to know that babies have normal growth spurts, usually around 3-4 weeks, six weeks and three months old, so offering the breast more often should be expected during this time. Pacifiers are not an appropriate substitute during growth spurts because babies need the additional milk and the breasts need the increased stimulation in order to increase supply to satisfy that need.

Note that pacifier use is also associated with increased fertility, because it may reduce stimulation time at the breast. Those with babies who use pacifiers regularly should take greater care with contraception. (See my article on Fertility and Breastfeeding, in related links below).

If you are nursing your baby and he or she is growing well, and the milk is flowing and the baby loves that pacifier, you are doing nothing categorically wrong!. Just take care to observe that the baby's growth and the milk supply continue to thrive. If the hospital gave the baby a pacifier after a cesarean birth, in the baby warmer or during an exam, while it would be best if they did not do that, your chances at nursing are not destroyed. However, being aware of the true potential effects of a pacifier on milk supply and infant growth can help parents make informed choices about pacifier use for their individual situation.

While I take issue with the naming of these pacifiers as "newborn" sized, as true newborns really should not be offered pacifiers as discussed above, many nursing mothers tend to like the "Soothie" brand of pacifiers below. Due to their lack of ring attachment they are also available with specially designed holders/clips.




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