Step 9: The Pacifier

Pacifiers are so cute! In our home, we call a pacifier a “pacie.” Our oldest child might still have one if the dentist hadn’t called it quits when our daughter was (gasp!) nearly 4 years old! My husband and I knew limiting pacifier use was important for language and social development. So when our little Becky woke up, we said, “Night night” to pacie and tucked it into bed like a beloved stuffed toy. Sometimes during the day we would find our sweet girl standing by her bed taking a couple draws from her pacie before running back out to play.

Pacifier use is one of many choices a new parent has to make, and the decision to use or not use one is polarizing, not just among parents but also among professionals. Your lactation consultant says, “Stay away!” Your mother says, “You took one dear, and you’re just fine.” Your pediatrician says, “It prevents Sudden Infant Death Syndrome (SIDS).”  And don’t forget the baby!  The baby may say, “Blah! Don’t put that rubber thing in my mouth!” or “Yummy, yummy, yummy!”

What should new parents do? The Baby-Friendly guideline for the 2 to 4 day postpartum hospital stay is to give no bottles or pacifiers to breastfeeding infants. Here is that portion of our self assessment:

Step 9 Give no artificial teats or pacifiers to breastfeeding infants.

 9.1  Are babies who have started to breastfeed cared for without any bottle feedings?  No

9.2  Are babies who have started to breastfeed cared for without using pacifiers, except for short periods of time during painful procedures? Yes

9.3  If pacifiers are used during a painful procedure, are they removed from the crib prior to returning to the room? No

9.4  Do breastfeeding mothers learn that they should not give any bottles or pacifiers to their babies for at least one month until after breastfeeding is fully established? Yes

If I was a new or expecting parent, the only thing I would remember from this blog post up to this point is what the pediatrician says, “It prevents Sudden Infant Death Syndrome.”

Multiple research studies do support the use of pacifiers at bedtime and naptime. In October 2005, the American Academy of Pediatrics (AAP) began recommending using pacifiers for sleep. However, in October 2011 the AAP added breastfeeding as one way to help prevent SIDS.

8.  Breastfeeding is recommended. 
a. Breastfeeding is associated with a reduced risk of SIDS. If possible, mothers should exclusively breastfeed or feed with expressed human milk (i.e. not offer any formula or other non-human milk-based supplements) for 6 months, in alignment with the recommendations of the AAP.
b. The protective effect of breastfeeding increases with exclusivity. However, any breastfeeding has been shown to be more protective against SIDS than no breastfeeding.

Now if I was a new or an expecting parent, I would really be confused. The lactation consultant and the Baby-Friendly information is telling me that pacifier use is correlated with decreased likelihood a baby will be exclusively breastfed. The pediatrician is saying I should exclusively breastfeed AND use a pacifier. Hang in there. We only need to read a few more sentences in the AAP guidelines for this to all come together and make sense.

For breastfed infants, delay pacifier introduction until breastfeeding has been firmly established, usually by 3 to 4 weeks of age.

Parenting isn’t black and white. It’s hard to decide what the right thing to do is.  Conflicting advice from experts confounds our decisions as parents. Parents should take comfort in the fact that Baby-Friendly guidelines, the AAP and lactation consultants all agree on one message: Offer your baby a pacifier once breastfeeding is established.

To view the complete AAP guidelines with references on pacifiers and breastfeeding, please click on


About blogtobabyfriendly

blogtobabyfriendly is written by Amy Murray, a Childbirth Unit nurse with a touch of earth muffin crunch. A childbirth educator and IBCLC, she's been a breastfeeding advocate all her adult life, believing that if our bodies make milk, it just makes good sense to feed it to our babies. blogtobabyfriendly is her hospital's journey to Baby-Friendly designation. Click to get email updates on new blog posts. Our desire is to learn, share, and learn more.
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8 Responses to Step 9: The Pacifier

  1. LaToya Parhm, RNC says:

    Nice blog! Parents need to know that it is their decision to make whether they use a pacifier or not. Health care providers are responsible to help them make an informed decision…

  2. LaToya Parhm, RNC says:

    Nice blog! Parents need to feel comfortable making an informed decision regarding use of a pacifier. Health care providers can give the proper guidance to make those decisions:-)

  3. Lori Bauer, RNC-OB says:

    Nicely said! Being a parent is never easy, we listen to the advise of those professionals we trust, and choose what is right for our family.

  4. Claire says:

    So well written! You captured that apparent tension between the recommendations and advice parents get from everywhere. Polarizing into ‘camps’ doesn’t help the situation. Love how you brought it all together! And seriously, really well written.

  5. Paula B. says:

    Very well said, it is confusing when different people say different things! When health care providers share the same information it helps parents, who still may encounter different views from family and friends. Thanks for the blog!

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