Pacifiers, also known as dummies or soothers, are often used to calm, pacify or soothe a fussy baby. Babies love to suck for comfort and security, as well as nutrition and a pacifier provides a bottle fed baby with a substitute to frequent comfort sucking at the mother’s breast. But what about a breastfed baby? Does a breastfed baby need a dummy? Is it OK to use a dummy or pacifier when you’re breastfeeding? This article looks at the pros and cons of using a pacifier or dummy with a breastfed baby and answers frequently asked questions.
What is a pacifier?
A pacifier, dummy or soother comprises a teat shaped piece of soft silicone or latex attached to a flat piece of plastic. The baby holds the silicone teat between their lips and it rests on the front part of their tongue giving them something to suck.
Can a pacifier affect breastfeeding?
A pacifier may not affect breastfeeding, particularly if breastfeeding is well established before it is introduced. But sometimes using a pacifier can affect the way a baby attaches to the breast (latches) or how often they breastfeed which can affect a mother’s milk supply and baby’s weight gain. Ten things to consider:
#1 Missed hunger cues
Sucking fingers or fists, searching for the breast with a wide open mouth, starting to fuss and crying are how a baby signals they want food. These signals are known as hunger cues. Using a pacifier can cause a baby’s hunger cues to be missed because any kind of sucking, including non-nutritive sucking, can pacify or quieten a baby. If a mother uses a dummy to comfort her baby between feeds because she thinks he can’t possibly be hungry yet, this will prevent her baby feeding on demand and regulating their intake of milk.
Breast milk can be digested within an hour
Babies can be hungry very quickly again after a breastfeed, they only have small tummies and breast milk can be digested within an hour. We also don’t know how much milk any individual breast might store and this dictates how often baby may need to feed. Babies are trying to double their weight in a few months and their rapidly developing brains need energy (i.e. lots of breast milk) to grow. Missing cues or pacifying hunger cues with a dummy—because a parent thinks an arbitrary time should pass between feeds—can affect weight gain and milk supply.
#2 Baby’s latch could be affected
A baby’s mouth position and tongue action when sucking on the small firm teat of a dummy is quite different to the wide open mouth position desired on a soft breast. When a baby breastfeeds, or even when a baby takes the right shaped bottle teat, the nipple or teat lands deep in the baby’s mouth and their mouth is propped wide open. With a dummy, the mouth is relatively closed and the teat is further forward in the mouth.
This difference in sucking action can cause some babies to take the breast with a shallow latch (sucking mostly on the nipple). This is sometimes called nipple confusion—confusion between the different feel, shape and sucking action of the breast and artificial teat. If a baby is latched to the nipple without a big mouthful of breast this will be painful, and baby will struggle to get a good flow of milk. A baby may begin to fuss at the breast, refuse to breastfeed or pull at the nipple in frustration.
#3 Low milk supply
By virtue of #1 (delaying feeds) and #2 (affecting the latch) another possible drawback with using a pacifier is that a mother’s milk supply might drop. Being in a shallow latch or having infrequent feeds mean the breasts are emptied less well and less often. When breasts are not emptied often enough, milk production slows down.
Exceptions to the rule
If a mother only uses a dummy occasionally or when her baby falls asleep without missing feeding cues it may not affect milk supply. And for mothers who have a true oversupply, careful use of a dummy may settle a baby who wants to fall asleep sucking but doesn’t want another helping of milk straight away. Alternative options in this situation are to put baby back to the least full breast, or let baby suck on a clean finger 1.
#4 Breastfeeding may end earlier
Pacifiers and problems, which came first?
Whether pacifiers cause breastfeeding problems or whether pacifiers are used because of breastfeeding difficulties isn’t always clear 5. One review suggested using a pacifier did not seem to shorten breastfeeding duration very much for mothers who were very motivated to breastfeed 6.
#5 Emotional attachment to the dummy
As with any comfort object such as a cuddly toy or favourite blanket, a baby may become overly attached to a pacifier as their main comforter when used long term. The long term health implications of turning to a dummy or other inanimate object instead of a mother’s arms and breast are unclear. AskDrSears explains:
…there’s nothing wrong with being a human pacifier. You want your baby to learn to seek comfort from people, not plastic. Your baby’s need to suck for comfort will diminish with time. Meanwhile, enjoy cuddling with your baby at your breast.
#6 Increased risk of infections
#7 Tooth alignment and mouth development
Pacifiers can affect the way baby teeth grow and influence the shape and development of the mouth, teeth and jaws 11. Excessive use of bottle teats and pacifiers could affect airway development and be associated with snoring and sleep apnoea12.
#8 Higher risk of tooth decay
Pacifiers and bottle-fed sweet milk drinks are associated with tooth decay and higher levels of Strep mutans and other decay-related micro-organisms in the mouths of children13. Parents sucking the baby’s dummy to “clean it” can contribute to sharing undesirable bacteria14.
#9 Language development may be delayed
As baby grows, a dummy constantly held in his mouth could interrupt opportunities to start babbling and articulating words leading to delays in language development.
#10 Early return of fertility
If breastfeeds are being delayed, this can affect the contraceptive effect of breastfeeding and a mother’s fertility may return sooner. See Can You Get Pregnant While Breastfeeding?
Frequently asked questions
Do breastfed babies need a pacifier?
A dummy is a substitute for the breast so most breastfed babies fed on demand are unlikely to need a dummy. Canadian paediatrician, Jack Newman explains:
…if the baby is breastfeeding well, there is no need for pacifiers; having the baby satisfy his sucking needs at the breast helps to establish a good milk supply. If the baby is not satisfied at the breast, the mother needs help to make the breastfeeding work better; the baby does not need a pacifier. And if the baby is breastfeeding poorly, pacifiers often make the problem worse.
What if I have a fussy baby?
If a baby seems fussy and unsettled, parents may be tempted to introduce a pacifier to settle them. It’s important to try and establish the reason for the fussing first, and rule out hunger as a cause. See The Fussy Breastfed Baby and check in with a breastfeeding specialist.
Are there times when a pacifier is helpful?
Although pacifiers may cause breastfeeding difficulties for some babies, a pacifier might be useful in the following situations:
Sucking can be a form of pain relief and if a breast isn’t available a pacifier can help provide pain relief through procedures such as blood tests1516 or comfort babies who are upset or have tummy ache. The American Academy of Pediatrics states:
Given the documentation that early use of pacifiers may be associated with less successful breastfeeding, pacifier use in the neonatal period should be limited to specific medical situations. These include uses for pain relief, as a calming agent, or as part of structured program for enhancing oral motor function.
For those premature or poorly babies who are temporarily unable to breastfeed, sucking on a pacifier can help them to digest their food until breastfeeding can be established. La Leche League GB (LLLGB) explains:
In some hospitals premature babies may be given a dummy during tube feeding to stimulate their sucking reflex, help digestion and help them associate the action of sucking with receiving food. It’s best if this is just a temporary substitute and efforts are made to establish breastfeeding as soon as possible.
Do dummies protect against Sudden Infant Death Syndrome (SIDS)?
The World Health Organisation promotes exclusive breastfeeding without bottles, teats or pacifiers17 but some studies have found that giving a baby a pacifier to fall asleep seems to be protective against the risk of sudden infant death syndrome (SIDS). Such studies need to be weighed against the fact that pacifiers can undermine breastfeeding which is itself protective against SIDS. A breastfed baby may not want or need a pacifier because sucking a dummy to fall asleep mimics breastfeeding to sleep 18. BASIS—Baby Sleep Information Source provides comprehensive discussions on this topic for health professionals 19 or parents20.
Who says what?
The UK’s National Health Service (NHS) says the evidence for dummies protecting against SIDS is not strong:
Breastfeeding your baby reduces the risk of SIDS.
It’s possible using a dummy at the start of a sleep also reduces the risk of SIDS. But the evidence isn’t strong and not all experts agree that dummies should be promoted. If you do use a dummy, don’t start until breastfeeding is well established. This is usually when they’re around 1 month old. Stop giving them the dummy when they’re between 6 and 12 months old.
The Lullaby Trust recommends:
- If you choose to use a dummy, wait until breastfeeding is well established, which can take a few weeks.
- Stop giving a dummy to your baby between 6 and 12 months
- If you use a dummy, make sure to offer it to your baby for every day and night-time sleep
- Don’t force your baby to take a dummy or put it back in if your baby spits it out.
The American Academy of Pediatrics21 currently recommends using a pacifier at nap or sleep time after breastfeeding is well established. However the authors of Sweet Sleep feel such a general recommendation for all babies is not backed up by research:
Here’s what the studies actually found: some babies who routinely use dummies and sleep separately seem to be at greater risk of dying on a night when there’s no dummy available and they’re sleeping separately.
For a vulnerable baby who is used to soothing and stimulating himself by sucking, being without a dummy might be stressful and even interfere with arousal. But it doesn’t make sense to apply the results of these dummy studies to babies who don’t use them, or who breastfeed off and on throughout the night while bedsharing.
no research has shown that offering a dummy to all babies is safe and effective just because some babies who sleep alone may be helped by them.
Tips for using a pacifier
If you decide to use a pacifier, recommendations include:
- Wait until breastfeeding is well established and use only for falling asleep22. It is not recommended to use a dummy before four to six weeks of age.
- Always offer a breastfeed before offering a dummy to avoid missing feeding cues
- Don’t force a baby to take a dummy if he doesn’t want one
- Wash and sterilise dummies regularly to prevent infections
- Phase out using a dummy towards the end of the first year (Hauck, et al).
- Never tie anything on to the dummy.
- If you notice sore nipples or a shallow latch after introducing a pacifier, try returning to exclusive breastfeeding for a while paying careful attention to latch and position.
- If you encounter low milk supply, cut back or stop using a pacifier and see our tips for increasing milk supply. Using both breasts per feed, breast compressions and frequent feeds can all increase milk supply.
- If your baby starts refusing to breastfeed see our tips to get baby back to breast and the value of skin-to-skin contact.
- If your baby has constant ear infections or thrush, bear in mind the pacifier may be a cause.
How can I phase out a pacifier?
If you do use a pacifier for your baby to fall asleep, the recommendations are to phase this out after 6-12 months. Offering more breastfeeds, giving lots of extra attention and letting your baby breastfeed to sleep can help. And see Baby Waking Up at Night for ideas for baby to learn new sleep associations.
What is the best pacifier for a breastfed baby?
The breast is the best pacifier. A dummy is a replacement for a breast. All manufactured pacifiers are variations of the same theme and I don’t currently have any information on designs that might be “better” for a breastfed baby.
Some experienced breastfed babies will manage to switch between sucking a pacifier (dummy or soother) and a breast without any problems but breastfeeding may be affected for some babies. Sucking a pacifier requires a different tongue and jaw action to breastfeeding and it can affect the way some babies latch—making breastfeeding painful and ultimately lowering milk supply. Mothers may miss feeding cues if they use a dummy. Studies link pacifiers with a shorter overall duration of breastfeeding, tooth decay, poor teeth alignment and increased risk of infections. Some studies have found that having a pacifier to fall asleep can be protective against SIDS for some babies. A pacifier is a replacement for a breast and a breastfed baby may not want or need one.
* Excerpt reproduced with permission from Pinter & Martin