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Mothers of La Leche League, UK & USA
Photos: Suzie Blake
The connection between babies and pacifiers
Pacifiers (also known as “dummies” or “soothers”) are widely assumed to be an essential piece of baby equipment. There’s a strong cultural association between babies and pacifiers. Consider how frequently pacifiers appear in illustrations on new baby greetings cards. Along with depictions of the ubiquitous bottle with a teat, pacifiers have come almost to represent babyhood.
Should we be concerned about such an association? Is the use of pacifiers benign, just cute and jokey? While pacifiers can no doubt be helpful, there are good reasons why UNICEF and the World Health Organization have taken a firm stand against their use (1).
Brits call the pacifier a “dummy.” The Oxford English Dictionary definition of “dummy” reads:
“an object designed to resemble and serve as a substitute for the real or usual one.”
The dummy then is no more than a substitute for the breast, an object to silence or pacify a baby when the real thing (the mother) is not available.
The real thing
Babies are born with the instinct to suck for both food and comfort.
The enjoyment of breastfeeding is part of our biological design. Babies are comforted by their mother’s warmth, familiar smell, and heartbeat. After growing inside his mother’s body, a newborn baby still regards her body as home for many months to come and breastfeeding nourishes, comforts, reassures, and relaxes your baby (and you!).
Dummies can be such a convenient way to soothe a crying baby and many mothers rely on one to quiet fussing on car journeys or shopping trips. Leaving enough time to stop to breastfeed, expecting journeys to take that bit longer, and carrying your baby in a sling, rather than pushing him in a stroller, can be easy and pleasant ways to make the dummy unnecessary.
Impact on milk supply
Whenever a substitute for sucking at the breast is used, a pacifier or other artificial teat, there is a risk of affecting the breastfeeding relationship. If you choose to offer your baby a pacifier, the recommendation is to wait until breastfeeding is well established and your baby is gaining weight appropriately (AAP 2005). Follow the manufacturer’s guidelines on cleaning and replacement.
“If you offer your breast only as food and not as a pacifier, you’ll cut out all the calories he gets along with those other reasons, you’re more likely to end up with supply problems, and you’ll lose the pleasure of—literally—going with the flow. The phrase ‘he’s just using you as a pacifier’ works against confident, smooth-running breastfeeding. Nursing is how a baby grows; why hold back?” The Womanly Art of Breastfeeding, 8th edition, 2010, page 136.
The hormone cholecystokinin (CCK) is released by a baby when he sucks. In a newborn, a high level of CCK makes him feel full and sleepy, while a low level can cause him to wake up feeling hungry. This ensures frequent feeding in the early days, when the baby’s tummy is tiny and his mother’s breasts need frequent stimulation to establish and maintain a good supply of milk.
Sucking on a pacifier also releases CCK, so that a baby may fall asleep without actually having a feed. If this happens, the mother’s breasts will not receive the expected stimulation to make more milk and consequently her supply can dwindle.
“A pacifier is like sugarless gum for someone who’s trying to double his weight in a matter of months. It can reduce intake when a baby is meant to grow quickly.” The Womanly Art of Breastfeeding, page 128.
Studies are not clear whether pacifiers always contribute to weaning (2) and more research is needed before drawing any conclusions.
Struggling to breastfeed
Mechanical differences between sucking at the breast and sucking on the dummy can make it harder for a baby to breastfeed comfortably and effectively. Some babies come to prefer the stronger sucking trigger of a harder pacifier, leading to “confusion” about how to nurse at the softer, more pliable, breast. The baby may become frustrated and start to fuss, cry, or refuse to breastfeed altogether. The result can be sore breasts for the mother and not enough milk for her baby.
If a baby is struggling to breastfeed, rather than offering a dummy to soothe him, offer to breastfeed while your baby is still calm, paying extra attention to how he is positioned and attached at the breast. Allowing your baby frequent access to the breast so that he can nurse for comfort may well encourage him to breastfeed more effectively. Before offering your breast, you can hand express a little so that the milk is ﬂowing to encourage your baby to latch well and drink. Spending extra time cuddling, carrying, and holding your baby, including skin-to-skin contact, are ways you can help a baby relax and encourage his interest in breastfeeding.
Sometimes premature babies may be given a pacifier if they are being tube fed to stimulate their sucking reﬂex, aid digestion, and help them associate sucking with receiving food.
Sometimes mothers with an oversupply of milk or an overactive let-down may find a pacifier helps. When a baby is struggling to cope because his mother’s milk is coming so fast that he is choking, then he may be soothed by sucking on a pacifier instead. If this is a problem for you, you may find it helpful to seek strategies for managing the oversupply.
Seek skilled help if you are having any difficulties with breastfeeding.
The endocrine disruptor bisphenol (BPA) is no longer used in the teat of pacifiers but is still present in the hard outer shield of many. Pacifiers don’t last long and are not recycled adding to the world’s unnecessary waste mountains.
Babies who have a dummy regularly have an increased risk of ear infection (3). Thrush (an infection caused by the fungus candida albicans) can be a problem with using dummies, as the fungus thrives on moist surfaces at room temperature. Careful sterilizing of dummies is necessary (4).
Breastfeeding exercises a developing baby’s mouth, tongue, and jaws and many orthodontists say they see fewer dental problems in breastfed babies. Regular dummy use can affect the positioning of teeth and the shape of babies’ mouths (5), (6).
Dummy use increases the risk of sleep apnea (irregular breathing). It can also increase the levels of decay-causing bacteria in babies’ mouths (7).
A lactating mother risks engorgement and mastitis when she introduces a pacifier—a particularly painful problem if she has an oversupply of milk. Her menses and fertility may also return earlier with the introduction of a pacifier as her hormone levels are affected when her baby nurses less (8).
The American Academy of Pediatrics (AAP) suggests that all parents consider the use of a pacifier at sleep times because several studies found a protective effect of pacifiers on the incidence of SIDS (9),(10). What the studies actually found was that some babies who sucked a pacifier routinely and also slept separately from their mother appeared to be at a heightened risk of death on a night when they did not have a pacifier and were sleeping separately.
To date there is no research to show that giving a pacifier to a baby who falls asleep breastfeeding while sharing a bed with his mother reduces his risk of SIDS. More importantly, is a baby who breastfeeds to sleep likely to want or need a dummy?
“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.
“And here’s the surprising result: one study found that the average time a dummy stays in a baby’s mouth at night is only half an hour. (11) Another found it to be a mere 11 minutes, with three-quarters of the dummy episodes lasting less than 15 minutes and only 3 per cent lasting for more than an hour. Yet the AAP doesn’t suggest putting the dummy back in the baby’s mouth when it falls out. Why would a baby’s last bedtime feed need immediate follow-up sucking? How would having a dummy for a brief time at bedtime protect against SIDS at four in the morning?
“Babies who use dummies are less likely to use their own fingers for comfort, (12) so the baby who needs sucking but loses the dummy is left with nothing at all. It’s been proposed that sucking helps regulate breathing or arousal. (13) Could it be that those few babies who keep a dummy in their mouth throughout the night are the only ones who are at risk without it?… 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.” Sweet Sleep, pages 369–370.
Whether or not breastfeeding is affected by pacifier use, “sticking the plug in” can reduce the opportunities a child has to babble when he is learning how to talk and be sociable. You cannot easily interpret a child’s expression if his mouth is obscured by a pacifier.
The recommendation is for parents to stop giving a pacifier after their baby is six months old, but older babies and toddlers still need to suck. If you are to wean a child from his customary dummy, offering extra attention, cuddling, or breastfeeding will help you do this gently.
As with the vast majority of baby equipment, those benefitting most from pacifiers aren’t the babies or their parents, but the companies making the sales.
- World Health Organization, & United Nations Children’s Fund. (2009). Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care. Geneva: World Health Organization.
- Jaafar S. et al. Effect of pacifier use on duration of breastfeeding in full-term infants (Review) 2012; The Cochrane Collaboration. Nelson, E. et al. International Child Care Practices study: breastfeeding and pacifier use. Journal of Human Lactation 2005; 21(3), 289–295. Ullah, S., & Griffiths, P. Does the use of pacifiers shorten breastfeeding duration in infants? British Journal of Community Nursing, 2003; 8(10): 458–63. Howard, C. et al. Randomized clinical trial of pacifier use and bottle-feeding or cup feeding and their effect on breastfeeding. Pediatrics 2003; 111(3): 511-518. DiGirolamo, A. et al. Effect of maternity-care practices on breastfeeding. Pediatrics 2008; 122 Suppl 2, S43-49. Righard, L. & Alade, M. Breastfeeding and the use of paciﬁers. Birth 1997; 24(2): 116–20. Victoria, C. et al. Paciﬁer use and short breastfeeding duration. Cause, consequence or coincidence. Pediatrics 1997; 99(3): 445–453. Righard, L. Are breastfeeding problems related to incorrect breastfeeding technique and the use of pacifiers and bottles? Birth 1998; 25(1) 40–44.
- Lubianca Neto J, et al. Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood. J. Pediatr. (Rio J) 2006;82:87–96. Warren, J. et al. Paciﬁer use and the occurrence of otitis media in the ﬁrst year of life. Pediatric Dentistry 2001; 23(2): 103–07.
- Ollila, P. et al. Risk factors for colonization of salivary lactobacilli and candida in children. Acta Odontologica Scandinavica 1997; 55(1): 9–13.
- Romero, C. et al. Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition. J. Appl. Oral Sci. April 1, 2011; 19(2): 161–8. Chen, X. et al. Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition. BMC Pediatr. 2015; 15:46.
- Viggiano, D. et al. Breastfeeding, bottle-feeding, and non-nutritive sucking: Effects on occlusion in deciduous dentition. Arch Dis Child 2005; 89: 1121–23.
- Palmer, B. Breastfeeding: reducing the risk for obstructive sleep apnea. Breastfeeding Abstracts 1999; 18(3): 19–20.
- Ingram, J. The association of progesterone, infant formula use and pacifier use with the return of menstruation in breastfeeding women. EJOGRB 2004; 114, 197–202.
- Hauck, F. et al. Do paciﬁers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics 2005; 116(5): e716-23. Li, D. et al. Use of a dummy (paciﬁer) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study. BMJ 2006 Jan 7; 332(7532): 18–22.
- Moon, R. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 128( 5) e-341-e1367. Blair, P. & Fleming, P. Dummies and SIDS: causality has not been established. BMJ 2006; 332: 178. Fleming, P. et al. Paciﬁer use and sudden infant death syndrome: results from the CESDI/SUDI case control study. CESDI SUDI research team. Arch Dis Child 1999; 81: 112–6.
- Franco, P. et al.Pacifier use modifies infant’s cardiac autonomic controls during sleep. Early Human Development 77, no.1 (2004);99–108.
- Weiss, P., & Kerbl, R. The relatively short duration that a child retains a pacifier in the mouth during sleep: implications for sudden infant death syndrome. Eur J Pediatr 2001; 160(1):60.
- Franco, P. et al.Pacifier use modifies infant’s cardiac autonomic controls during sleep. Early Human Development 77, no.1 (2004);99-108. Moon, R. Sudden Infant Death Syndrome: an update. Pediatrics in Review 33, no.7 (2012): 314–320.
Editor’s note. Do you give your baby a pacifier? Has dummy use had any negative or positive impact on your breastfeeding relationship? Please comment in the box below.