Pacifiers -- blessing or curse?
I am unapologetically a huge proponent of pacifiers.
Some breastfeeding support folks argue that pacifiers interfere with a good latch, and that pacifiers shouldn't be introduced until six weeks of age, or not at all. But no one argues that you shouldn't offer a clean pinky to suck on. And why wouldn't that interfere with a good latch just as much?
Moreover, evidence-based research doesn't support the idea that pacifiers interfere with breastfeeding. Babies know the difference between what we call "non-nutritive sucking" and feeding. When I was a NICU nurse, I read academic articles that showed that pacifier useactually helped premature babies prepare for breastfeeding.
This double-blind meta-analysis (the most rigorous form of research) of 1302 infants found no difference in breastfeeding duration between babies who took a pacifier and those who did not. The study's authors concluded, "This meta-analysis shows that pacifier use does not decrease breastfeeding duration in full-term infants. The new evidence contradicts current WHO (World Health Organization) recommendations, however, which are based on less rigorous studies.8,9,13,14 The AAP (American Academy of Pediatrics) now recommends that pacifier use be implemented after breastfeeding is established.4 Based on the evidence, we think mothers who are motivated to breastfeed their infants should be allowed to make their own decisions regarding pacifier use, and pacifier use should not be discouraged."
Moreover, the AAP actually recommends the use of pacifiers as a way to decrease the incidence of SIDS. Dr. Harvey Karp recommends sucking as one of his "5 S's" as a way to soothe a newborn to sleep.
Anectdotally, as a parent and as a healthcare professional, I have never understand why one would offer breastfeeding when a baby wants to suck for comfort, not hunger. We wouldn't offer formula to a baby who wasn't hungry. Why would we offer breastmilk, then, when a breastfed baby isn't hungry?
As a baby grows older, out of the newborn stage, I recommend that pacifiers be restricted to times that a baby is tired or fussy. Babies use their mouths to explore the world, and that should be encouraged. They also need their mouths to coo and babble as the earliest stage of language development. But when it is time to sleep, pacifiers can be a wonderful tool.
That said, if pacifiers start to become more of a blessing than a curse, it's fine to eliminate them. Some babies love pacifiers but can't keep them from falling out of their mouths, and then cry for them to be replaced. If this happens to your baby multiple times a night, the pacifier may not be worth the inconvenience. In that case, I would recommend offering the pacifier once at bedtime but not replacing it, especially if your baby is no longer in your bedroom. Tugging gently on the pacifier once it's in your baby's mouth can strengthen the suction so it's less likely to fall out.
By six months, babies no longer have a biological need for sucking, but many still enjoy it for comfort. It's up to you if you want to eliminate it then or wait longer.
Both of my children used pacifiers. My older daughter used it until about four months old, and then gradually transitioned to sucking her thumb. She didn't stop sucking her thumb until five and a half years old and the weaning process required a full-scale assault. I wished many times that she used a pacifier instead -- it would have been so much easier to stop pacifier use than to stop using a thumb that was always with her!
My little one used a pacifier until age 3. It was an amazing help for her in sleeping through the night at ten weeks old. We kept her pacifiers -- a lot of them -- in the crib and car seat, only. Only once she was climbing in and out of the crib, and then transitioned to a toddler bed, did more frequent pacifier use become an issue since she was able to reach them whenver she wanted.
At age three, on the dentist's advice, we picked out a reward for giving up the pacifier -- she chose an Elmo doll -- and on the day she was ready, she threw the pacifiers in the trash and got her Elmo. Of course, a few minutes later, she changed her mind and wanted to throw Elmo in the trash and have her pacifiers back. But I held the boundary. At bedtime that night, I rubbed her back while she cried. I didn't try to plead or explain or convince her that her grief was wrong. And after about ten minutes, she fell asleep. The next night, she cried even less. And by the third night, we were done. She continued to speak fondly of her "pacis" for months to come but she never cried for them again.
I'm so glad that she was able to have the comfort of sucking when she needed it, and that she was able to partner in the process of giving them up. So to those who would argue that if you give a pacifier, it'll be hard to get rid of them -- no, I don't agree.
My girls preferred different kinds of pacifiers. One like the Phillips Avent pacifier while another preferred the Nuk. For each, I bought a few different options to see which they liked best. Oh, and each breastfed past a year, despite pacifier use and taking a bottle while I was at work.
So I recommend stocking up on a few different options and experimenting. Offer the breast or bottle first, if you think your baby is hungry. But if she's crying and pushing it out of her mouth, or if it's been less than 90 minutes and you're confident that she had a good feeding, try swaddling her or popping her in the baby carrier and offering a clean pacifier. She might just need some non-nutritive sucking to soothe herself to sleep. Rest assured, when the time comes that you need to wean her off it, you'll be able to manage it.
For more help with soothing your baby to sleep, or getting him to sleep all night, schedule a free chat with me and get your family sleep you deserve.
Abby Wolfson is a pediatric nurse practitioner, certified child sleep consultant and former NICU nurse. She divides her time between Brooklyn, NY and San Miguel de Allende, Mexico.