Booby Traps Series: Pushing pacifiers?

This post is the 24th in a series on Booby Traps made possible by the generous support of Motherlove Herbal Company.

For several years I taught breastfeeding classes at area hospitals.  At one class, in addition to about ten expecting couples, there was a nurse from the childbirth center in attendance.  This was part of an effort to try to make our messages about breastfeeding consistent from prenatal class through postpartum care.

When I got to the issue of pacifiers I explained, “Pacifiers can cause breastfeeding problems, particularly in the early days when a baby is learning now to suck.  The American Academy of Pediatrics recommends:  For breastfed infants, delay pacifier introduction until breastfeeding has been firmly established, usually by 3 to 4 weeks of age.'”*

As I finished explaining this, I saw the nurse’s hand go up.  I was surprised, since the idea was that she was there to observe, not to participate.  But I called on her to speak.

She said, “You know what I find is really helpful?  Using a pacifier that first night after a baby is born.  It really seems to calm them down and keep them happier, and it allows the moms to get some sleep.  I’d really recommend that.”

Needless to say, I was disturbed by this comment, both because it completely contradicted what I had just said, and because it was the opposite of what the evidence has shown.  So I said, “I’m sorry, but I’m going to have to disagree with you.”  I then explained the ways in which the early introduction of a pacifier can harm breastfeeding.  As I did so, I heard a dad in the class say, “Oooooooh.”  I suddenly felt like I was back in seventh grade.

Thinking back on that moment, I think that this experience probably gave the families a realistic picture of the contradictions they were about to encounter on this and other issues related to breastfeeding.  One person says pacifiers are bad, another says they’re great.  Chances are this wasn’t the only confusing message they were going to receive.

National data confirm that pacifiers are still a commonly used item in our hospitals.  The CDC reports that only 30% of hospitals limit the use of pacifiers so that less than 10% of healthy full-term breastfed infants are given pacifiers by maternity care staff members.  This, despite the fact that “giving no artificial teats or pacifiers to breastfeeding infants” is one of the evidence-based Ten Steps to Successful Breastfeeding, and the AAP in their breastfeeding policy, says: “Pacifier use is best avoided during the initiation of breastfeeding and used only after breastfeeding is well established.”

Some of this pacifier use is driven by uninformed views like the one voiced by the nurse sitting in on my class, but some is undoubtedly a result of maternal request.  Here again, as we’ve discussed before on the issues of early elective birth and formula supplements in the hospital, health care providers have a responsibility to explain to mothers that pacifier use can get in the way of their goal of breastfeeding.  Not explaining this deprives moms of their informed consent.

I recently heard of one way in which some hospitals which are working toward Baby Friendly status deal with the pacifier issue:  they inform moms prenatally that the hospital where they are going to deliver simply does not stock pacifiers.  Think that sparks a discussion about pacifiers and breastfeeding?  I’m sure it does!

Did your hospital push pacifiers?  Discourage them?

* The AAP encourages the use of pacifiers as a means of preventing Sudden Infant Death Syndrome (SIDS) once breastfeeding is established.






11 thoughts on “Booby Traps Series: Pushing pacifiers?

  1. I was dead set against pacifiers when I had my son 7 years ago. Because of ALL the hoopla surrounding them. He never did have a pacifier and had no idea what to do with one, I was living in the UK at the time. Now my daughter on the other hand was opposite, without a pacifier her life would have been miserable not to mention ours, she had a pacifier a few days after birth and she breastfed just fine, she had no problems going from bottle, pacifier to breast. I personally think it depends on the child and parent. Some mothers need there sleep more than others.


  2. Now interestingly, when I took my CLC last year I was told that pacifiers were really as big a deal because it’s non nutritive sucking, ditto with thumb sucking, but they have other risks associated with their use. The problem is really the bottles, esp early on because there is a reward for suckling the wrong way. The big problem with pacifiers is baby needs to be gaining well first because too much pacifier is less food in their tummies and pacifier use is linked to a 20 something percent increase in ear infections because they’re so full of bacteria and yeast. The other big issue is babies who thumb suck tend to do it when THEY need calming and with pacifiers the baby gets it when the PARENTS want some quiet or don’t know what to. Parent driven soothing is not to the baby’s benefit in general. The last issue with pacifiers is shape, any pacifiers used should be round or oval in shape because when a baby is used to sucking an orthodontic pacifier they have the tendency to make the nipple shaped like that, and that’s very painful. It’s best to avoid them, but if you must delaying is def the way to go.

    My personal experience with them is I got one in the hospital with the first, was offered one in the hospital with my twins, all three of them were addicted until they were 3 1/2. With my last I left asap and was never offered but I didn’t want one anyway, although he did use them from 3-6 months.

    It’s not just hard for parents with all the contradictory information but as a peer counselor I get alot of contradictory info too. In the end we just have to try to tease out the best info we can and inform our moms of the pros and cons and support them no matter what they decide to do. I choose my battles, pacifiers while not the greatest are not on the top of my list of my “don’t do it ” list.


  3. That is sad that the nurse didn’t hear what you were saying. We didn’t use a pacifier at all, we waited the 3 weeks and our daughter at that point was not interested in artificial nipples. I must have been asked 6 times or more in the hospital if we wanted one to sooth her. I think every baby is different but we had a rocky start so not using a pacifier I think saved our breastfeeding relationship. Now 13 months and still going strong.


  4. The hospital never mentioned or offered a pacifier but it is working towards Baby Friendly status at the moment, so perhaps that’s why. Anyways, we introduced the pacifier (by my choice) at 5 days so that I could have a little break from our daughter’s near-constant comfort nursing between feedings. We chose not to introduce a bottle until 4 weeks when our nursing relationship was very well-established, because I felt that the bottle had more potential to cause nipple confusion than the paci did (since the bottle would have provided breast milk to her while the pacifier does not). I was careful about not using the paci to delay or replace a feeding; I nurse on demand and she was only offered the paci after having her fill of milk. The daycare girls also found that giving her a pacifier before nap time helped her sleep. It never interfered in any way with our breastfeeding relationship, which is still going strong at 16 months!


  5. The hospital where I had my daughter did not seem to have a view. I had no intention of using a pacifier, after about 2 days another mother offered me a spare new one and I gratefully accepted. My daughter had been sucking her wrists before being born and did not have the coordination to get her wrists to her mouth. I was given information to avoid using a nipple shield, but not a pacifier – luckily my daughter was a champion sucker and latcher – no problems with breastfeeding. The pacifier was withdrawn at around 6 months.


  6. Yup. I didn’t intend for my kid to start using a pacifier (and we were having issues with latching to begin with) but when he came back from the nursery one morning there it was stuck in his mouth. No one asked if it was okay, they just stuck it in there.


  7. With my first son, I told the nurses no pacifier. We didn’t want him to be attached to one. Yet a few days after leaving the hospital we offered him one anyways to stop the constant crying. The key to not having him be attached, was we never upgraded so he got frustrated and gave up. He took just fine to breast milk in a bottle. My second son was born with sucking blisters, we had to keep his hands covered for about a week after birth. He would not accept a pacifier as an alternative to his thumb. He also refused breast milk from a bottle. Unfortunately we have yet to be able to break him of thumb sucking, it’s not a pacifier to be easily set aside. 2 years 4 months and still sucks his thumb. We hope to discourage thumb sucking soon, so far no luck…


  8. In light of the latest recommendations regarding SIDS prevention the use of pacifiers became even more confusing. They state that both the use of pacifiers and breastfeeding reduce the risks of SIDS. However, if pacifiers can interfere with breastfeeding and if one waits to use a pacifier with a breastfed baby and that baby may rejects the artificial nipple as a result whatever is a SIDS preventing parent to do? I just wonder if the medical community who formed these new guidelines realize the potential for each to prevent the other.


      1. The most important signs are that your baby is gaining weight normally and that you’re comfortable (not in any discomfort) while nursing.


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