Pacifiers: Yes or No?
By Gwen Gotsch
Oak Park, Illinois, USA
From: NEW BEGINNINGS, Vol. 12 No. 6, November-December 1995, pp. 172-3
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
Pro: Babies need to suck. Sucking calms and quiets them. Mother's breast is not always available. Pacifiers are a convenient substitute.
Con: Pacifiers are artificial nipples and may confuse a baby, leading to ineffective sucking at the breast. Pacifiers decrease the amount of time a baby spends at the breast, and this may affect the mother's milk supply.
Is it appropriate for a breastfeeding mother to offer her baby a pacifier? The answer is—sometimes.
In many parts of the English-speaking world, pacifiers are called dummies. They stand in for mother's breast, like a dummy stands in for a human being in a department store window or in an automobile crash test. There are times when dummies serve good and useful purposes; there are also times when a dummy just can't do the job.
Babies are driven to suck. Without this drive they might not get the nourishment they need to grow and thrive. Sucking also soothes babies. The steady rhythm, the concentration on one task, and the pleasurable stimulation of nerve endings help babies pull themselves together and overcome the many distractions of a big and confusing world.
There was a time when "experts" frowned on the use of pacifiers. These same advisors also discouraged parents from picking up babies who cried. Fortunately, the world has grown a little more tolerant of babies' needs, including the need to suck. The contented newborns lined up at the window of the hospital nursery may very well have pacifiers in their mouths.
But wait! What's wrong with this picture?
Those pacifiers are artificial nipples. And artificial nipples, attached to bottles or not, can interfere with breastfeeding. This is one of the problems with offering a pacifier to a breastfed baby, especially one who has not yet mastered nursing at the breast.
Sucking on an artificial nipple is different from sucking at the breast. The artificial nipple is already formed and fairly rigid. The breast is soft and flexible. The baby must open his mouth wide to latch on to the breast, and the nipple goes to the back of the mouth, away from the movement of the gums and tongue. A caregiver can coax a pacifier into a baby's closed mouth. The muscles of the mouth and face and the tongue move differently when sucking on an artificial nipple; the action used to drink from a bottle or to calm down with a pacifier won't get milk out of a breast.
Switching back and forth from breast to artificial nipple is a lot to ask of a baby in the early days of learning to breastfeed. A baby who tries to suck at the breast the way she sucks on a bottle nipple or a pacifier will quickly become frustrated and may cry, fuss, or refuse to nurse. She won't get much milk, and she may have a difficult time learning to breastfeed effectively.
Sucking on a pacifier can also interfere with a mother's milk supply and eventually with infant growth. Babies who satisfy some of their sucking needs with an artificial nipple will spend less time stimulating the breast, possibly interfering with milk production. Cutting feedings short and offering babies pacifiers may deprive them of the high-calorie, high-fat hindmilk, which is produced at the end of feedings and is important for growth. A recent study in Brazil found that babies given pacifiers by one month of age were at a higher risk for weaning over the next 24 months (Victora 1993).
Pacifiers can be risky for breastfed babies. When it comes to comforting newborns, they are not right for the job, and mothers should avoid them until breastfeeding is well established, at least for the first three or four weeks. Pacifiers should not be offered to babies who are having trouble learning to latch on or to suck correctly, or to babies whose mothers are concerned about their milk supply or about their baby fussing at the breast.
Instead, newborns who need to suck should be offered mother's breast. Some babies will nurse almost continuously, or for long periods of time in their first few days. This is good for them. They're rewarded with colostrum and a bountiful milk supply within a few days. They avoid the physical and emotional agonies of crying. They learn to be calm.
Of course, babies have to be with their mothers if they are to depend on nursing for comfort. The kind of postpartum mother-baby separation that makes pacifiers helpful should not be allowed to occur in the first place. And with careful attention to positioning, latch-on, and how well the baby is sucking, nipple soreness can be kept to a minimum, or even avoided completely.
As they get older, babies may still need to continue sucking even after their tummies are full—perhaps they need to go to sleep, or to wake up, or just to relax. This comfort sucking is different from the active, vigorous suck a baby uses to bring down the milk that will satisfy hunger. At this point, some mothers may choose to use a pacifier. However, breastfed babies can do their comfort sucking right at the breast, because the mother's milk flow slows to a trickle as the baby's sucking becomes less intense. Babies can continue sucking without stuffing themselves and without swallowing a lot of air.
Bottles and artificial nipples don't have this infant-controlled regulatory system. The milk flows at a steady rate, and a baby with a full tummy who wants to suck for another ten minutes may end up overfed, with gas bubbles and spitting up soon to follow. Here's where a pacifier can fill an important need.
Pacifiers sometimes serve useful purposes in breastfed babies, too. They can calm a baby whose mother is unable to nurse at the moment, because she's driving, paying for groceries, or caring for an older child. They may soothe a colicky baby whose mother's arms, breasts, and patience are severely overtaxed. They can comfort a baby who for one reason or another is too distracted or too frantic to nurse at the breast. Mothers of twins find pacifiers helpful when one baby just has to wait while mother takes care of the other. Hospitals use pacifiers for premature infants, to stimulate their sucking reflex and to help them associate sucking with the delivery of food, even while they are still being tube-fed.
Frequent use of pacifiers can create little "addicts" who are rarely seen without a "plug" in their mouth. Overuse of pacifiers will also create breastfeeding problems, and a mother with concerns about her milk supply or a baby who is reluctant to take the breast should reevaluate the choices she's made about pacifiers and bottles. However, mothers know their babies best. A well-informed approach to the decision about using a pacifier will help them make good decisions about what's best for their families.
Pacifiers and comfort sucking at the breast both have their place. There are times when a dummy can stand in for a mother's breast, ease a baby's distress, and restore peace to everyone. Nursing for comfort helps ensure a plentiful milk supply and brings warm feelings to mother and baby. When pacifiers are used judiciously, a mother can have it both ways.
Anderson, G. C. Pacifiers: the positive side. MCN 1986; 11:122-24.
Newman, J. Breastfeeding problems associated with the early introduction of bottles and pacifiers. J Hum Lact 1990; 6:59-63.
Victora, C. G. et al. Use of pacifiers and breastfeeding duration. Lancet 1993; 341:404-6.
Editor's Note: Many thanks to Anne Grider of Woodstock, Georgia, for the ideas she contributed to this article.