Pacifiers & Nipple Confusion

It is a common recommendation from breastfeeding experts to forego artificial nipples (pacifiers or bottles) for the first few weeks or even months of breastfeeding to avoid the dreaded and ever-elusive nipple confusion.

Instead, it is recommended that any sucking be done directly at the breast and if that is not possible, a finger is an adequate substitute.

Let me start by saying that nipple confusion is real. Not all babies get confused when offered a variety of things to suck on, but some do. 

When a baby is given anything other than a soft skin nipple to suck on, it stimulates a reflex on the roof of the baby’s mouth that makes them suck. 

This sweet spot is right at the juncture of the hard and soft palate in the baby’s mouth. This is not the same reflex that babies use to suck at the breast. The root reflex (like when baby tries to eat his own shoulder) is the reflex that gets a baby latched on and sucking. The problem comes when a baby becomes used to using the suck reflex instead of the root reflex to suck.

Guidelines for use: If you are planning to directly latch (nurse) your baby at all, consider the first two weeks of breastfeeding when you and baby are learning. You are learning when baby’s feeding cues actually mean “I am hungry” and baby is learning how to connect a feeding cue to acquiring milk. Neither of you know how to do this yet because you guys just met.

While you and baby are learning to nurse, try to limit pacifiers for the most part for two weeks, except for in the following circumstances…

During a Painful Procedure: There is scientific evidence that shows that babies feel less pain and are more relaxed when they are sucking. Help them out by letting him suck through things like a heel prick, a circumcision, or a vaccine.

If Baby Is in the NICU or Under Phototherapy: Most babies in the NICU need pacifiers. They are separated from their parents, 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 is by sucking. The same applies to a baby in an incubator for phototherapy. If baby seems uncomfortable and they can’t be held or swaddled, a pacifier may calm them and you give a sigh of relief.

If the Lactating Parent Needs Protected Space: A pacifier might help calm the baby and hold them off while the lactating parent sleeps, showers, or poops. Caretakers often need a “dummy” to trick the baby into settling. Since newborns can sense when the person holding them isn’t their milk-maker, the caretaker often needs to employ many fussy baby techniques to keep the baby content.

In the Car: Many babies hate the car. Since you cannot offer any soothing other than white noise while driving, a pacifier may help calm baby until you can safely take them out of the carseat.

If You Have So Much Milk That Your Baby Cannot Nurse for Comfort: If you tend toward an oversupply of milk, your baby may not be able to suck without getting milk. Non nutritive nursing is an important part of digestion and comfort for babies, so consider adding a pacifier in here.

If You Choose to Not Be a Human Pacifier: Feeding on-demand does not mean you have to do whatever baby wants. You don’t have to be okay the baby sucking on your boob for comfort. 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. Some of them never seem “done” at the breast. If you are noticing that baby is sucking but not drinking, try utilizing breast compressions to encourage active drinking. If baby doesn’t return to a drinking pattern, but continues to only suck, consider a pacifier.

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. 

During Sleep Times As a Protective Measure from SIDS: Well, we don’t know what really causes SIDS or how to prevent it, but there seems to be a correlation between pacifier use and decreased rate of SIDS.

If You Are Using a Bottle and/or a Nipple Shield: This baby 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.

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

If Your Nipples Are So Sore That You Can’t Finish a Breastfeeding Session 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 nipple pain.

To Avoid Feedings or to Space Feedings: Use caution when using a pacifier for sleep training. Some babies will allow pacifier sucking in place of eating and not gain enough weight or not achieve 8 feeds per 24 hours.

If You Are Working on Latching: If 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?