Tuesday, February 7, 2012

Pacifiers Part 2: Breastfeeding and Pacifier Use

By Jennifer Goldbronn, MAS, RD

Let’s talk some more about pacifiers! Today we will share evidence-based information about pacifier use and its effects on breastfeeding so that you can make an informed decision about whether or not to offer a pacifier to your infant.

Many parents use pacifiers as a tool to calm or soothe their infants. According to one study, about ½ of the babies in the United States are offered a pacifier by 2-weeks of age, and about 2/3 by 6-weeks. (Howard 1999)

Many breastfeeding professionals, however, recommend waiting until at least 4-weeks, or until breastfeeding is well established, before offering a pacifier to young infants. The American Academy of Pediatrics agrees, recommending that parents wait 4-6 weeks, or until breastfeeding is established. Let’s take a look at the evidence.

Why Wait?

A large, 2012 study of pacifier use found that pacifier use “most days of the week” before 4-weeks of age was associated with shorter breastfeeding duration. Mothers giving a pacifier before 4-weeks of age were 3 times more likely to have stopped breastfeeding than those who did not give a pacifier. Also, mothers giving a pacifier “most days of the week”, regardless of their babies’ ages, were 3 times more likely to stop breastfeeding compared to those who did not give a pacifier. (Mauch 2012)

In a study of the effects of pacifier use on breastfeeding duration, researchers found that pacifier introduction before 6-weeks of age was associated with an increased risk of shorter duration of both full (exclusive) and partial breastfeeding. They also found early pacifier use to be associated with fewer breast feedings per day. Women who introduced pacifiers were also more likely to report problems with milk supply at 12 weeks postpartum. (Howard 1999)

Both of the above studies are classified as observational (meaning the researchers just "observed" what people did on their own). Because of this, we can’t say without a doubt that pacifier use is associated with negative breastfeeding outcomes. When looking at the association between breastfeeding duration and pacifier use, it is unknown whether the pacifier use itself caused the breastfeeding problems leading to shorter breastfeeding or whether breastfeeding problems caused parents to start using pacifiers. However, it is plausible that in the early weeks of breastfeeding, pacifier use may interfere with moms' milk supply, lengthen time between feeds, and make it difficult for parents to see hunger cues.

Randomized controlled trials (RCTs) about breastfeeding and pacifier use would provide stronger evidence. Of 4 RCTs found as part of a 2009 systematic review, none showed a significant difference in breastfeeding outcomes associated with pacifier use. However, the studies were very different and difficult to compare. In those that compared pacifier use to non-use, it was found that many parents in the control groups, or “no pacifier” groups, still gave a pacifier even after they were instructed not to. (O’ Conner 2009)

Bottom line:

So, should you use a pacifier? That’s up to you. Most people use them but early use is associated with shorter breastfeeding duration. As our readers know, early on, babies will demand to feed many times per day. That demand is important for babies to be able to get enough to eat and for moms to build their milk supply. Waiting to introduce a pacifier seems a good idea and it is not a good idea to use one if you are having problems feeding your baby.


Howard CR, Howard FM, Lanphear B, deBlieck EA, Eberly S and Lawrence RA. The Effects of Early Pacifier Use on Breastfeeding Duration. Pediatrics. 1999;103;e33.

Mauch CE, Scott JA, Magarey AM, Daniels LA. Predictors of and reasons for pacifier use in first-time mothers: an observational study. BMC Pediatrics. 2012;12:7.
O’Connor NR, Tanabe KO, Siadaty MS, Hauck FR. Pacifiers and Breastfeeding: A Systematic Review. Arch Pediatr Adolesc Med. 2009;163:378-382.


  1. I recently read a comment on Lactnet about pacifier use and calorie expenditure. For a baby who is not gaining adequately, a pacifier will make them expend calories (sucking) while not putting any calories in. I would think that logically this makes perfect sense and you would really want a baby who is not a good gainer to be doing all of their "caloric expenditure" or sucking at the breast when they can get some intake.

  2. I've read that another potential problem with early introduction of pacifiers in breastfed infants is nipple confusion.