Pacifiers and Breastfeeding: No Problem?

It has been long-recommended that breastfeeding mothers stay clear of pacifiers. Now views are changing, according to Fern Hauck, M.D., researcher and associate professor of family medicine and public health sciences at the University of Virginia School of Medicine. In research published in the April edition of the Archives of Pediatric Adolescent Medicine, she found that the highest level of evidence on pacifier use and breastfeeding shows no adverse relationship between the two.

Hauck states, “Physicians, nurses and others who advise parents on infant care issues...need to be reassured that using the pacifier should not interfere with breastfeeding." She and a team of family medicine and public health researchers at UVA summarized 1,000 reports showing an association between pacifiers and breastfeeding. Of those, 29 studies met inclusion criteria for their review. The research came from 12 countries—Australia, Brazil, Canada, Hungary, Italy, New Zealand, Poland, Russia, Sweden, the United Kingdom and the United States. The results showed no difference in breastfeeding outcomes with different pacifier interventions (use with tube feedings, use after delivery or educational programs promoting non-use of pacifiers). Those studies were not observational studies, which have consistently reported an association between pacifier use and shortened duration of breastfeeding. Hauck believes that this association was likely due to other factors such as breastfeeding difficulties or desire to wean. She goes on to say that “mothers who breastfeed are often advised not to use a pacifier. This recommendation needs to be corrected. However, if a baby refuses a pacifier, it should not be forced upon him or her."

Hauck says that the best time to introduce a pacifier is usually when the baby is three to four weeks old, after breastfeeding is well established. The most important factor, she claims, is that mothers who choose to breastfeed need plenty of support. “The biggest barriers to continuing breastfeeding are a lack of support from family members, going back to work and using supplemental formula, especially before breastfeeding is well established.” And that is something we can all agree on, regardless of where we fall on the pacifier controversy.