Appropriate pacifier use

When should I use a pacifier?

Sometimes pacifiers can be useful, such as when a bottle-fed baby has been well fed but won’t settle, or when a breastfeeding mother is unavailable or unable to calm her baby by breastfeeding. Some mothers have a very large milk supply. Their babies may get upset when trying to breastfeed to sleep because there is more milk than they want. Pacifiers may help in that situation. They can also be useful for premature babies, helping them develop the ability to suck after the premature birth. They help calm premature babies, and studies have shown they can help them gain weight, start breastfeeding earlier, avoid NEC (a serious bowel disease), and leave hospital earlier.

A) Describing appropriate pacifier use

Pacifier use is appropriate in certain situations when the benefits outweigh the risks. Most healthy, term breastfeeding babies we care for do not use a pacifier or if so, only for minutes each day. Some babies are unable to suck on a pacifier just as some cannot use a bottleThis is normal and a baby should not be forced to take a pacifier.

B) Pacifier use when breastfeeding is not possible

Pacifiers can be helpful if mothers cannot breastfeed or are not present.

Pacifiers can be used to settle babies after bottle-feeding if they are clearly no longer hungry but need to suck a little to settle themselves.

Some babies need to breastfeed to go to sleep, but if breastfeeding is too painful or not an option, pacifiers can be used instead.

Pacifiers can be used:

  • To calm the baby during a painful procedure if breastfeeding is not possible at that time.
  • To calm a baby who is too upset from hunger to latch.
  • When the baby is upset in a car seat while the car is being driven.

Using a pacifier in this way may prevent obesity (Amer 2017).

C) Pacifier use when the baby cannot breastfeed to sleep because of a large milk supply

Pacifiers are sometimes used by mothers with a large milk supply. Their babies may become very frustrated when they are trying to breastfeed to sleep and are met with large amounts of milk they don’t want and let-downs they can’t control.

The first approach is to offer the emptier breast, the one that was just used. If the baby is still unhappy, a pacifier is a reasonable option.

D) Pacifier use when the baby is premature

Ultrasound examinations show unborn babies sucking as early as 4½ months after conception. This allows the baby to prepare the mouth and the digestive system for breastfeeding after delivery. After a premature delivery, a pacifier can help these babies continue to develop normally (Field 2003).

Pacifiers are useful for calming premature babies (Horne 2016). Studies have shown they can help them (Field 1982; Foster 2016; Pinelli 2002; Say 2018):

  • Gain more weight.
  • Start breastfeeding or bottle-feeding earlier.
  • Spend less time receiving milk by a feeding tube.
  • Avoid necrotizing enterocolitis, or NEC, a serious disease that affects the intestines.
  • Leave hospital earlier.

Premature babies are under stress in hospital intensive care units. Using a pacifier can calm them when their mother is not available to breastfeed or provide kangaroo care. Pacifiers can also calm premature babies when they are:

  • Unable to breastfeed because of prematurity or illness.
  • Being fed with a feeding tube (Widström 1988).
  • In pain (Pinelli 2002; Yin 2015).
  • Experiencing disturbed sleep.
  • Being overstimulated by noise and light.

Pacifiers are less important once babies are able to breastfeed and are no longer separated from their mother.

References

Amer A, Abusamaan M, Li X, et al. Does Pacifier Use in Infancy Decrease the Risk of Obesity? Clin Pediatr (Phila). 2017 Oct;56(11):1018-1022
 
Field TM. Stimulation of preterm infants. Pediatr Rev. 2003 Jan;24(1):4-11
 
Field T, Ignatoff E, Stringer S, et al. Nonnutritive sucking during tube feedings: effects on preterm neonates in an intensive care unit. Pediatrics. 1982 Sep;70(3):381-4
 
Foster JP, Psaila K, Patterson T. Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Cochrane Database of Systematic Reviews 2016, Issue 10. Art. No.: CD001071
 
Horne RS, Fyfe KL, Odoi A, et al. Dummy/pacifier use in preterm infants increases blood pressure and improves heart rate control. Pediatr Res. 2016 Feb;79(2):325-32
 
Pinelli J, Symington A, Ciliska D. Nonnutritive sucking in high-risk infants: benign intervention or legitimate therapy? J Obstet Gynecol Neonatal Nurs. 2002 Sep-Oct;31(5):582-91
 
Say B, Simsek GK, Canpolat FE, et al. Effects of Pacifier Use on Transition Time from Gavage to Breastfeeding in Preterm Infants: A Randomized Controlled Trial. Breastfeed Med. 2018 Jul/Aug;13(6):433-437
 
Widström AM, Marchini G, Matthiesen AS, et al. Nonnutritive sucking in tube-fed preterm infants: effects on gastric motility and gastric contents of somatostatin. J Pediatr Gastroenterol Nutr. 1988 Jul-Aug;7(4):517-23
 
Yin T, Yang L, Lee TY, et al. Development of atraumatic heel-stick procedures by combined treatment with non-nutritive sucking, oral sucrose, and facilitated tucking: a randomised, controlled trial. Int J Nurs Stud. 2015 Aug;52(8):1288-99