The Correct Way to Introduce a Pacifier to a Breastfed Baby, According to the American Academy of Pediatrics 

The Correct Way to Introduce a Pacifier to a Breastfed Baby, According to the American Academy of Pediatrics 

Pacifiers are a tool that can calm a crying baby, soothe their sucking impulse, and grant a new mother’s body some much-needed rest. But pacifiers have been shown to hinder breastfeeding relationships and limit a baby’s ability to communicate hunger effectively if used too early.

What constitutes “too early?” Research indicates that pacifiers should be avoided within the first four weeks of life if mother and baby want to establish a long-term breastfeeding relationship. Once a baby has cleared specific feeding milestones a pacifier can be used effectively in the correct circumstances.

What Does a Pediatrician Say About Pacifiers?   

Dr. Meg, a pediatrician in Winston-Salem, explains her stance on using pacifiers when breastfeeding:

“Ideally babies should not use a pacifier until breastfeeding is established. The AAP advises waiting 3-4 weeks. When a breastfeeding mom is choosing a pacifier, IBCLCs recommend choosing one that looks like the maternal nipple to reduce the risk of nipple confusion.

Pacifier use should never interfere with feedings. Baby should be going to breast 8-12 times a day, in the beginning, to help stimulate milk production and to provide adequate nutrition. Pacifiers shouldn’t be given in place of a feeding if a baby is showing hunger cues.

If a mom is having breastfeeding issues or the baby isn’t gaining weight, I wouldn’t recommend a pacifier during that time. Parents should also watch for signs of wear and tear on the pacifier and never use a clip/strap when baby isn’t monitored.”

In short, introducing a pacifier too early can interfere with learning how to suck correctly at the breast and mask important hunger cues.

Sucking is an Involuntary Newborn Reflex

If you touch a newborn baby’s cheek or mouth, they will move their head from side to side until their mouth finds that stimulation. This reflex is called “rooting.” It is involuntary, meaning a baby is born knowing how to do it and they do not need to learn this behavior. 

The rooting reflex allows a newborn to find their mother’s breast and then extract milk through sucking. Sucking is also a biological reflex. This survival instinct is present even before birth. Babies suck their thumbs in the womb! The sucking reflex can be broken down into two parts.

Expression – When baby places their lips around a breast, draws the nipple into their mouth and uses their tongue and hard palette to compress the nipple and extract milk.

Milking – When baby moves their tongue from the areola of the breast to the nipple and back again in a rhythmic pattern.

Learning this rhythm of expression and sucking calls for coordination. It can take practice. Some newborns drink readily at the breast right away, while others need time to learn how to suck and express milk efficiently.

This is one reason the American Academy of Pediatrics advises parents to wait to introduce pacifiers until after breastfeeding is well-established. They put this milestone at approximately 3 to 4 weeks of age. Babies need to practice the sucking motion and associate that coordination with getting fed. 

Another reason? Pacifiers may hinder a parent’s ability to detect early hunger cues.

Early Pacifier Introduction Masks Hunger Cues

Newborn babies need to eat about every two hours or between 8-12 times in 24 hours. Gaining weight, especially gaining back any lost birth weight, is their main job in the first few weeks of life.

By offering a pacifier before the neonatal period is up at four weeks, parents can potentially miss vital newborn hunger cues.

Hunger cues include:

  • Smacking or sucking sounds

  • Opening their mouth or sticking out their tongue

  • Rooting their head around from side to side

  • Putting their hands to their mouth

All of the above cues are subdued with a pacifier. A docile baby could sleep through feeds and miss important calories needed to gain weight. Overlooking hunger cues in the early days of life is serious. A baby may not be getting the calories they need, and going too long between feeds is detrimental to a mother’s milk supply.

Pacifiers Could Impact a Mother’s Milk Supply

Milk is made on a supply and demand basis. The more milk is removed, the more milk a woman’s body will make. Going too long between feeds tells the body to slow down on producing ounces. Using a pacifier in the early days of breastfeeding can cause a mother to skip feeds and lower her supply.

The American Academy of Pediatrics found that pacifiers are associated with shorter breastfeeding sessions:

“Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours, shorter duration of exclusive breastfeeding, and shorter total breastfeeding duration compared with no pacifier use. These associations were not found for thumb sucking. The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use. Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration.

More frequent use of a pacifier was associated with shorter breastfeeding duration, even among a group of mothers who were highly motivated to breastfeed. breastfeeding duration, breastfeeding pattern, exclusive breastfeeding, pacifier use, thumb sucking.”

Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers (early pacifier group; odds ratio: 1.5; 95% confidence interval: 1.0–2.0). Early (2-5 days), as compared with late (>4 weeks), pacifier use shortened overall duration (adjusted hazard ratio: 1.22; 95% confidence interval: 1.03–1.44) but did not affect exclusive or full duration.” 

If your primary goal is to continue a long-term breastfeeding relationship, hold off on introducing a pacifier until after your milk supply is well established.

Pacifiers Are Okay When Introduced Following the Neonatal Period

We have established that the main reason to abstain from using a pacifier early on is because it can detract from learning how to suck correctly, mask hunger cues and limit the number of times a breastfeeding mom brings baby to breast.

But once a baby and mother are in a healthy, sustainable pattern and a baby’s weight is gaining steadily, pacifiers have benefits to both mother and baby. 

Feeling Sore? A Pacifier Can Also Help with Nipple Pain

Some babies desire to nurse for comfort outside of feeding and this can lead to painful, sore, and bleeding nipples. Ouch!

“As a pediatrician and a mom, I know well the scream of a baby just wanting to suck. It can be unnerving to new parents. I always worry when early-stage nursing moms allow baby to nurse around the clock. There is a high risk of nipple trauma that could derail nursing altogether! I advise parents to use a pacifier for those babies who very much want to suck for calm and comfort between the 8-12 nursing sessions episodically to help soothe baby and lower mom’s stress about feedings. In the end, the most important thing is fed babies and sane moms.”

In this instance, a pacifier is a good tool to keep a baby comfortable and bring relief to a mother’s body. Just ensure that baby is maintaining all nursing sessions and gaining weight.

What else can I do to heal nipple trauma?

  • First, ensure that baby is latching correctly. An incorrect latch is painful and the main culprit of continued nipple pain.

  • Use a nipple cream or balm in between nursing sessions. (Pro tip! Pack this in the hospital bag and use it in between every feed as a proactive measure against nipple trauma in the early days.)

  • Keep a drop of milk on nipples after nursing. Breast milk contains anti-inflammatory agents and acts as a natural barrier. Just make sure breasts are completely dry before covering up.

  • Avoid trapped moisture in a bra, and change breast pads frequently when they are wet.

Pacifiers Can Reduce the Risk of SIDS at Bedtime 

Studies have shown that pacifiers can reduce the risk of SIDS (Sudden Infant Death Syndrome) when used at bedtime.

“Published case-control studies demonstrate a significantly reduced risk of SIDS with pacifier use, particularly when placed for sleep. Encouraging pacifier use is likely to be beneficial on a population-wide basis: 1 SIDS death could be prevented for every 2733 (95% CI: 2416-3334) infants who use a pacifier when placed for sleep (number needed to treat), based on the US SIDS rate and the last-sleep multivariate SOR resulting from this analysis. Therefore, we recommend that pacifiers be offered to infants as a potential method to reduce the risk of SIDS.” 

How to Use a Pacifier Correctly When Breastfeeding

  1. Find a pacifier that mirrors a maternal nipple shape.
  2. Limit pacifier use to between feedings.
  3. Pause the use of a pacifier when baby is cluster-feeding or going through a growth spurt.
  4. Never attach a pacifier to a baby’s clothing when sleeping or unsupervised.
  5. Offer a pacifier at night to reduce the risk of SIDS.
  6. Keep an eye on a baby’s hands when they are sucking on a pacifier. A hungry infant may be clenching their fists as a non-oral hunger cue.
  7. Stop the use of a pacifier if baby develops issues with breastfeeding or latch.
  8. Inspect pacifiers regularly to make sure the silicon is not breaking down. Replace any pacifiers that look worn or torn.