Pacifiers for breastfed babies: pros and cons

If you’re a new mom who’s also a breastfeeding mother, you may be wondering whether you should be giving your baby a pacifier, which pacifiers are best for a breastfed baby and whether it can affect their milk supply.

This is a really difficult question to answer, because this goes back all the way to evidence-based information and informed choice. Only you, the parent can make that decision on whether you feel the need to give your baby a pacifier. But it’s best to make that an educated one.

What is a pacifier?

A pacifier is a rubber, plastic, or silicone nipple substitute given to an infant to suckle upon when they’re unable to suckle at the breast.

It’s important to remember that pacifiers are not the biological norm for babies, it was made so that bottle feeding babies can also have an opportunity to comfort suck like breastfed babies do at the breast.

Recommendations regarding pacifier use in breastfed babies

Both UNICEF’S baby friendly hospital initiative and the American Academy Of Pediatrics (AAP) recommend only introducing pacifiers after the 6–8-week mark, after breastfeeding has been established.

The World Health Organization (WHO) doesn’t recommend the use of pacifiers for breastfed babies at all.

Most lactation consultants will usually encourage you to not use a pacifier at all when possible, and for good reason. It can come with many issues including sore nipples for mom, milk production issues, weight gain issues and early weaning. It can hinder a successful breastfeeding journey.

Do breastfed babies need pacifiers?

The simple answer is no. Pacifiers are meant to offer comfort sucking opportunities for babies who can’t do so at the breast.

The breast is the original pacifier. Babies suckle and breastfeed for more than just a feeding, they’re also meant to comfort suck at the breast.

There’s no need for pacifiers or bottles in normal circumstances. Your breasts will satisfy almost all of your baby’s needs, including for feeding (hunger and thirst), comfort, immunity, bonding with mom, pain relief and going to sleep.

The pros of using a pacifier for your breastfed baby

Reduced risk of SIDS

There are some studies that have found pacifier use at sleep time decreases the risk of sudden infant death syndrome (SIDS). But it is still unclear as to why.

In one study, pacifier use decreased the risk of SIDS more when the mothers were ≥ 20 years of age, married, nonsmokers, had adequate prenatal care, and if the infant was ever breastfed. So, it’s quite clear that there is an entire criterion that has to be met for it to be truly effective.

Studies are yet to show the difference between the sucking of a pacifier and the sucking of the breast. Sucking on a pacifier and sucking at the breast does the exact same thing for infants, although the breast is the optimal choice for oral development.

Hopefully future studies will focus on this topic more so breastfeeding moms don’t feel like a pacifier will do a better job at reducing the risk of SIDS than her breasts, which are the biologically normal way of suckling and feeding for babies.

Benefits to NICU babies

One study has found that giving pacifiers to premature infants and making them listen to lullabies has a positive effect on their transition period to oral feeding, their sucking success and their vital signs (peak heart rate and oxygen saturation).

The suck-swallow-breathe coordination is an important skill that every newborn must acquire for feeding success. In most cases the development and maintenance of the sucking reflex is not a problem, but sometimes the skill may be compromised due to factors such as long-term mother–infant separation or medical conditions. In such situations the use of pacifiers can be considered therapeutic and even provide medical benefits to infants.

Sucking on their hands and at the breast is an innate behavior seen in all babies. Non-nutritive sucking provides comfort, state regulation and an opportunity to organize oromotor development.

More rapid weight gain, lower incidence of necrotizing enterocolitis and earlier hospital discharge have also been attributed to non-nutritive sucking during nasogastric tube feedings.

It’s important to note that the above research has found non-nutritive sucking beneficial, and not the use of a pacifier itself. Non-nutritive sucking is best done at the breast, when possible.

A substitute when the breast is unavailable

The sucking reflex is a very innate behavior in babies, and they use sucking for many reasons including comfort, sleep and pain relief. When a baby has high sucking needs and is separated from the mother for extended periods of time, a pacifier may be able to meet their sucking needs.

The cons of using a pacifier for your breastfed baby

Weight gain and milk supply issues

When sucking on a pacifier, some babies may not cue for hunger early on, and this can cause them to stretch feedings for longer than it should have.

When a baby suckles, the hormone cholecystokinin is released into the intestine. Cholecystokinin is responsible for satiety and sleepiness, helping to soothe an infant. This hormone is released when a baby suckles on a pacifier or the breast. So, it’s easy to see how this may trick a baby into thinking they just had a feed from the breast.

This may stretch feedings out even longer and may result in weight gain issues and even supply issues for the mother.

It can cause a shallow latch at the breast

Nipple confusion although not proved by research, is an infant’s difficulty with or preference for one feeding mechanism over another after exposure to artificial nipples. There is literal confusion between the different teats. This is more common in a newborn baby than in slightly older babies.

Some believe that babies are much too smart for confusion between a real breast and a pacifier. I agree, but pacifiers can encourage a shallow latch at the breast.

When this occurs, a baby may start to latch shallow on the breast like they do on a pacifier which can cause damage to the mother’s nipples, and it can also cause insufficient weight gain in the baby.

In severe cases it may result in complete breast refusal which may sometimes be irreversible.

Increased risk of Thrush

One study cultured and followed 95 healthy babies and toddlers aged 12 to 24 months for yeast. None developed oral candidiasis, but those who used a pacifier were almost twice as likely to be colonized with any candida species.

The pacifiers also cultured positive for Candida albicans in 22% of silicone pacifiers and 75% of latex pacifiers.

Increased risk of otitis media (ear infections)

One survey of parents of children aged 12 months or younger also found the risk of developing otitis media to be twice as high in pacifier users.

Another study has found pacifier use appears to be a risk factor for recurrent acute otitis media.

Risk of becoming overweight

Pacifier use beyond early infancy is associated with accelerated infant growth and toddler overweight, although the reasons for this relationship are still unclear.

Increased risk of malocclusions

Dental caries, malocclusion and gingival recession are commonly cited problems associated with long term use of pacifiers. Most studies have found that these problems exist with prolonged or inappropriate use.

One study showed significant differences in dental arch and occlusion characteristics in users at 24 months and 36 months of age compared with those that had stopped sucking by 12 months of age.

Another study looked at children aged two to five years and also found significant increases in overjet (greater than 4 mm), open bite and posterior crossbite in pacifier users. The longer the use was, in months, the stronger the association with open bite and crossbite.

Premature weaning from the breast

Several studies’ results show that pacifier use may be a marker of breastfeeding difficulties or decreased maternal motivation to breastfeed, as opposed to being the causal agent in early weaning.

In one study, daily pacifier use was associated with early cessation of breastfeeding and a reduced duration of full breastfeeding. Finger sucking was not associated with a reduced duration of breastfeeding.

The verdict on pacifier use for breastfed babies

No one can make the decision for you, but it’s important that you make an informed choice about pacifiers. Knowing both the pros and the cons to using a pacifier while breastfeeding is incredibly important.

Pacifiers do hold great value such as being used in the NICU when babies can’t breastfeed, but overall, breastfed babies don’t need pacifiers as they can suckle at the breast whenever they need to.

Suckling at the breast whenever possible, is best as breastfeeding promotes optimal oral function, which in turn supports optimal oral development.

The best pacifiers for breastfed babies

The breast

I have to mention this it’s very important to realize that a baby doesn’t need a pacifier, they only need the breast to meet all of their needs. Breastfed babies do not need pacifiers as the breast can meet all of their sucking needs.

Phillips Avent Soothie (0-3 months)

This is the most commonly used pacifier in hospitals all over the world. It is inexpensive, made from medical-grade silicone and it has a straight nipple with a wide base which is best for breastfed babies, making it a very good choice.

Dr Browns happy paci

While Dr. Browns are best known for their bottles, they also have a specific pacifier that is growing in popularity. It is the same shape as their bottle nipples (the narrow neck version), so if you are already using these bottles your baby may accept these pacifiers well.

Ninni Co pacifier

This pacifier has a straight nipple with a very wide, soft base to help baby get a deeper latch to help reduce issues with breastfeeding.

This pacifier is often used by infant oral physical therapists, speech and language therapists/pathologists and International (Board Certified Lactation Consultants IBCLC’S) to help babies with suck training.

Do stay away from any orthodontic pacifiers. The orthodontic shape is flat and therefore promote a flat tongue posture. While the term “orthodontic” may sound appealing, don’t be fooled by this lingo, it’s just another marketing tactic. These pacifiers reduce the ability of the sides of the tongue to elevate and cup the nipple.

Important notes on pacifiers and breastfeeding

New parents nowadays are often questioning everything they do regarding their babies and that’s such a good thing. Empowered parents make better choices for their babies. So continue asking those questions, just make sure you ask the questions to trusted and reliable sources.

The good news is that in normal circumstances, breastfed babies don’t need pacifiers as they can suckle at the breast for both nutritive and non-nutritive sucking needs.

Natural rubber latex pacifiers are not recommended due to possible allergies. It’s best to stick to a silicone pacifier if you do choose to use a pacifier.

If you do decide to offer your breastfeeding baby a pacifier, it would be a good idea to hold off on doing that in the early weeks until you’ve established a good milk supply.

If you ever need evidence-based information or support related to anything about breastfeeding, contact an International Board certified Lactation Consultant (IBCLC).