Learn the Basics

Lie #2: Pacifiers are Bad

By April 12, 2014 13 Comments

(Lie #1: Breastfeeding is easy.)

I am big fan of pacifiers.  Unfortunately, my daughter never took one and I came to peace with being her human pacifier. But, I recommend pacifiers quite a bit.  Funny, since practically every other breastfeeding professional seems to hate them and sites them as the source of all evil.

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Without getting too researchy on you, I wrote a paper for grad school on pacifiers. I took a look at all the literature and was really surprised to discover that both the WHO and the AAP make pacifier recommendations on outdated research published between 1997 and 2003. Many of these studies were observational studies, which may be misleading.

When I did my review of the literature, I found that there were really only two reliable studies out there on pacifiers.  Both of these studies found that if a pacifier is introduced after breastfeeding is going pretty well and mom has a strong desire to breastfeed, pacifiers have no effect on breastfeeding at all. That kind of blows my mind since the WHO asserts that “pacifiers are generally used to calm an infant without giving a feed, and infants who use pacifiers may have fewer daily breastfeeds. When breast stimulation and milk removal are reduced, milk production decreases, which can lead to early termination of breastfeeding.”

Here’s an excerpt from my paper:

Only two randomized control trials met the qualifications to be included in this meta-analysis. The two included trials yielded 1302 healthy, full-term infants to be included in the analysis.  From this meta-analysis, Jaafar et al.  concluded that pacifier use “in full-term breastfeeding infants after birth or after the establishment of lactation did not significantly affect the prevalence or duration of exclusive or partial breastfeeding up to the age of four months”

These researchers assert that until there is more reliable information about potential harm of pacifier use to the newborn, “mothers who are well motivated to breastfeed be should enabled to make a decision on the use of a pacifier based on personal preference” (Jafaar et al., 2012, p.8).

Read my whole boring paper here.

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So, I am going to step out and say that the whole “pacifiers are bad” thing is a lie. Pacifiers aren’t bad. They are just a scapegoat for lots of other problems with the breastfeeding support we provide to women.

Here is a list of really great times to use a pacifier:

  1. During a painful procedure: There is scientific evidence that shows that babies feel less pain and are more relaxed when they are sucking.  So, if your baby is getting a heel prick, a circumcision, or a vaccine, help him out by letting him suck through it.
  2. If baby is in the NICU or under phototherapy: All babies in the NICU need pacifiers. They are separated from their moms, they can’t be swaddled, and they aren’t given the luxury of endless skin to skin time. They need comfort.  The only way they can relax and calm is by sucking. The same applies to a baby in an incubator for phototherapy. If he’s in there, he’s probably screaming his head off because he can’t be held or swaddled.  A pacifier will make him cry less and you give a sigh of relief.
  3. If mom is in a crisis situation and needs two hours of sleep: The only times Lucy mouthed her pacifier were in the first few days of her life. After nursing her for 22 hours, I would hand her to Joe with the pacifier and say, “Two hours. Please.”  It isn’t fair to hand a daddy a baby, no bottle, and no pacifier and expect him to survive.  He isn’t built to soothe a newborn.  He needs a “dummy” to trick that baby into thinking he has boobs and can therefore keep her alive. Otherwise, that baby will be crying for you in 15 minutes.
  4. In the car: Most babies hate the car. You can’t take her out while you are driving. A pacifier may be the only way to keep her from screaming the whole ride to breastfeeding support group.
  5. If you have so much milk that your baby cannot nurse for comfort without displaying sign of bulimia: Do you have enough milk to feed a small village? Does your baby sound like he is doing a keg stand while he is nursing? After a four-minute chug, does he come on and off the breast looking like he is thinking, “I want to suck, but I am so full and I don’t want anymore milk, but I want to suck…”  Then, after you have coaxed him onto the breast for ten more minutes, he spits up what seems like his entire feeding right down your chest into your nursing tank? He needs non-nutritive sucking time and he can’t get that from your breast. Try a pacifier after a keg stand to give his little brain time to catch up with his little belly.
  6. If you choose to not be a human pacifier: Feeding on-demand does not mean you are your baby’s bitch. You don’t have to be okay with having the baby suck on your boob all day every day whenever he feels the spirit move him. Babies have a natural drive to stay on the boob sucking so that they know where their next meal is coming from at all times.  But that is why we have pacifiers. They feel calm because they are satisfying the urge and you feel sane because you can hook your nursing bra.
  7. If you plan on feeding bottles ever” When babies bottle-feed they don’t have non-nutritive sucking time, so they often are overfed by the bottle-feeder because they shows signs of hunger after finishing a bottle. This is because their brain hasn’t had time to catch up with their belly, so they think they are still hungry. (Think: you, starving, drive through window; 15 minutes later you are uncomfortably full.) Having a pacifier gives the bottle-feeder the opportunity to let the baby suck and digest before dumping more of your precious breastmilk into him. Also, if a baby knows how to suck a pacifier, she knows how to suck a bottle. The non-pacifier suckers can sometimes become non-bottle suckers. This happened to me and I wouldn’t wish it on my worst enemy.  Maintain the artificial nipple sucking skill so you can go out sometime. Ever.
  8. During sleep times because the AAP thinks there might maybe possibly be a protection from SIDS: Well, we don’t know what really causes SIDS or how to prevent it, so if a pacifier might help, let’s do it.
  9. If you are using a bottle and/or a nipple shield: He’s already nipple confused. Own that and give him a paci. Right? Isn’t a bottle nipple confusion? Isn’t a nipple shield nipple confusion? Well, then, just throw a pacifier on the pile. The best thing that will come of this is you will have a baby that is really adaptable to all nipples.

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Here’s when you might not want to use a pacifier:

  1. If your nipples are so sore that you can’t finish a breastfeeding because of the pain: I am not telling you to bite on a strap of leather and nurse through the pain; I am telling you to feed the baby, protect your supply, and seek help. Don’t short your baby milk because of your pain.
  2. To avoid feedings or to space feedings: There is a reason you are doing this and it isn’t fair to baby. If you are using a pacifier to “hold baby off” because you don’t want to nurse or some book told you it isn’t time to nurse your baby yet, cut it out.  If your husband is using the pacifier to “hold the baby off” because you are pooping for the first time after delivery (a long, scary, and religious experience that is often much easier than you expect it to be), then that is okay.
  3. If you are working on latching and the baby is a really shallow latcher and tends to leave your nipple looking like a new tube of lipstick, put that pacifier on the shelf until you get a better hang of breastfeeding.  But, if you are using a bottle for whatever reason, then you can use a pacifier, too. The kid’s got to get used to all kinds of nipples, right?

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I have been doing this a long time and I have to say, never once have I said, “You are having this problem because you let your baby suck a pacifier.” So, go ahead. Let your baby suck it.

P.S. Please don’t write a reply to this blog telling me that pacifiers are a bad habit and your niece is four and still sucks a pacifier.

1. If you don’t have a four-year-old, you aren’t allowed to pass judgement on how to mother a four-year-old.
2. I often talk about “staying in the present.” Re-read the blog if you need to. We do not make parenting decisions based upon what might happen four years from now. We make parenting decisions based upon what is best for our baby, ourselves, and our family now. It is developmentally appropriate for a baby to suck for comfort well into the toddler years. You can deal with getting rid of the pacifier when the time is right.

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