Updated: Jan 12
by Alissa Pemberton – Midwife & International Board Certified Lactation Consultant| www.suffolkbreastfeeding.com
Just yesterday I saw a mum whose baby was using a pacifier/dummy. The one thing I remember most from this was - the way she felt she needed to justify it to me. "We've tried settling her without it" "I know we're probably creating a bad habit" "I know we're not supposed to" I'll let you in on a little secret - whilst we don't actively recommend dummies/pacifiers for breastfed babies - they don't have to be the enemy - but you can change the way you use it to limit any negative effect on breastfeeding. Pacifiers are so intrinsically linked with babies - we just assume it's something we'll need to buy. Looking around you see them everywhere - when we see reference to a baby it's often with images of dummies/pacifiers.
Why would a baby need a pacifier/dummy? Pacifiers are one of the most controversial items of baby kit. Some parents won't touch them, others swear by them. So when might it be useful? Some babies appear to need the comfort of sucking more than others. They might find it helps them to settle off to sleep, or calms them when they have wind or digestive discomfort. It's important to remember though that using a dummy to fall asleep isn't any different in terms of forming habits to using the breast to fall asleep, or needing to fall asleep in someone's arms. Whilst some wind/tummy discomfort is normal - if your baby seems to be really struggling with this you might like to look into a) assessing whether there are any breastfeeding complications causing excessive wind (like poor latch, tongue tie etc.) and b) looking into alternative therapies like baby massage
to help sooth your baby's discomfort.
How could it impact on breastfeeding? Dummies/pacifiers can impact on breastfeeding in a number of ways. The most significant impact on breastfeeding is when dummies replace a breastfeed. Your milk supply relies on regular stimulation of your breasts and effective milk removal. The longer milk is left in your breasts, the less your body will produce as it thinks it's not needed. See notes below on how to minimise this. Secondly dummies (just like bottles) affect the way your baby sucks. Dummies aren't maliable like a breast is, meaning your baby doesn't take it as deeply into their mouth and they don't need to use their tongue to hold it deeply in their mouth - the long and short of it is babies who spend long periods with dummies and bottles can have difficulty latching deeply to the breast - causing pain and decreasing how much milk they can obtain during a feed. I've been told my baby is just 'using me like a dummy' - should I introduce a pacifier instead? Wow! That old chestnut! Here's the truth - your baby isn't using you like a dummy, they're using a dummy like you! Babies are programmed from birth to suck for comfort. It's biologically normal for them to fall asleep suckling at the breast. In order for babies to survive they instinctively want to spend as much time at the breast as possible. More time spent at the breast = higher milk supply = more food for baby. We are constantly told that our babies need to fall asleep on their own and that 'comfort sucking' is a bad thing. Oh, they're just comfort sucking. Yep - and that's normal! Milk flow changes through a feed - whilst you'll notice those big gulps at the beginning of a feed, they'll slow down towards the end of the feed as their sucking pattern changes and milk volume decreases. But even while they're resting at the breast, taking short infrequent bursts of sucking or 'comfort sucking' they're still getting milk and stimulating your milk supply. If you are content offering the breast to your baby when they're seeking comfort then there's no need to introduce a pacifier at all. If I do want to introduce a dummy - how do I do it? If you can, it's best to wait until 6-8 weeks when your milk supply has been established and your baby is breastfeeding well. Whenever you choose to use a dummy - the key to not impacting on breastfeeding is ensuring that it's never replacing time baby should be spending at the breast. Check these three things FIRST before you offer a pacifier: - If baby is unsettled or showing feeding cues always offer the breast first. Milk supply relies on milk being removed from your breasts so the more time your baby spends there the better - particularly in the first 6-8 weeks. - Always offer both breasts at each feed. Babies are incredibly skilled at regulating their appetite and they will reach a point where they'll only want one breast for some feeds, but always offering two means we're giving them the chance to take as much milk as they need. - Feel your breasts after a feed. They should feel softer, lighter, deflated. This gives you another indication that your baby has taken an adequate feed.
A NOTE ON WEIGHT LOSS: If your midwife, health visitor or lactation consultant (or yourself!) has concerns about your baby's weight gain - avoid introducing a pacifier. - Allow your baby to feed as frequently at they wish - Offer both breasts at each feed
- Assess your breasts post feed
- Seek professional breastfeeding support from a specialist like a lactation consultant
What about SIDS - doesn't pacifier use reduce the risk of SIDS? You've probably been told that using a dummy/pacifier reduces the risk of Sudden Infant Death Syndrome (SIDS) but if you're exclusively breastfeeding your baby you've already reduced your baby's risk of SIDS by more than 50% (Thompson et. al, 2017). Some research suggests that whilst sucking on a dummy babies remain in a lighter sleep state, waking more frequently and this helps to protect against SIDS which will more often occur in very deep sleep. But breastfeeding does this too! Baby's who are sleeping in the same room as their mother and waking frequently to breastfeed will also spend more time in a light sleep state and be at a lower risk of SIDS. (McKenna, J. & McDade, T, 2005) So should you use one? The long and short of it is no - not unless you want to. Long term pacifier use can also affect dentition (tooth development and decay) and can cause more significant issues with sleep/settling. If your baby is feeding well, gaining weight well and there aren't any concerns but they are unsettled using a dummy is unlikely to cause too many issues with their feeding, but if you're happy to continue offering the breast to settle that's completely fine and biologically normal for your baby.
Mckenna, J. J., & Mcdade, T. (2005). Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric Respiratory Reviews,6(2), 134-152. doi:10.1016/j.prrv.2005.03.006
John M.D. Thompson, Kawai Tanabe, Rachel Y. Moon, Edwin A. Mitchell, ClionaMcGarvey, David Tappin, Peter S. Blair, Fern R. Hauck Pediatrics Nov 2017, 140 (5) e20171324; DOI: 10.1542/peds.2017-1324