Pacifier Use for Breastfed Babies: Should I worry about nipple confusion for my breastfed baby?

Here’s what matters:

 

The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere with it.

  • We used to think that using a pacifier could make it hard for babies to learn how to suck correctly while breastfeeding – you have probably heard this called nipple confusion.
  • But, the more we looked at what babies did with their mouths we began to notice that they switched easily between breastfeeding and using a pacifier – they weren’t confused after all. In fact, they were very efficient, shifting their suck/swallow pattern as needed.

 

What not to do:

  • It turns out that giving a newborn a pacifier instead of food when they are hungry can slow down how quickly they learn to breastfeed.
  • Offering a bottle with a fast flow can also delay the baby learning to breastfeed efficiently, and your baby may come to prefer being able to have their food more quickly.

 

Pacifiers are beneficial for SIDS prevention, better quality sleep, calming upset babies, and even helping to strengthen the oral-muscular anatomy used for breastfeeding.

 

Here is what you should do:

  • Use the pacifier for pacifying, to support sleep and to help your newborn with self-regulation.
  • Allow your baby to use it when you put them down for sleep and do not reinsert it after the baby falls asleep – not because it interferes with nursing; because it creates an unsustainable habit of you getting up to replace the pacifier every time it drops.
  • Learn infant feeding cues vs. demand for non-nutritive sucking: Once your baby is sufficiently calm, a hungry baby will continue crying when the pacifier is removed from the mouth. If your baby has a high suck need- for example, they suck on your arm while falling asleep- then you may notice they fuss even after a full feeding.

 

Don’t like the idea of introducing a pacifier? Here are some other options:

  • Helping your newborn to suck on their own hands or fingers,
  • Sucking on the mother’s ‘emptied’ breast,
  • Your baby can also be offered an adult’s finger (freshly washed or wearing non-latex gloves), or even on an orogastric tube in the case of a hospitalized infant.

    * Note: These alternatives are great for avoiding pacifier use but not ideal for the development of independent sleep habits.

 

One last note: For pre-term infants using a pacifier is encouraged as a way to strengthen the underdeveloped muscles needed for sucking.

 

 


References:

 

  1. Jaafar, S. H., Ho, J. J., Jahanfar, S., & Angolkar, M. (2016). Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd007202.pub4
  2. Lubbe W, ten Ham-Baloyi W. When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician’s guide. BMC Pregnancy and Childbirth. 2017;17:130. doi:10.1186/s12884-017-1306-8.
  3. Zimmerman, E., & Thompson, K. (2015). Clarifying nipple confusion. Journal of Perinatology, 35(11), 895–899. doi:10.1038/jp.2015.83

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