Dummies & Pacifiers for breastfed babies.
A few notes on dummies…not should you or should you not!
Dummies can be controversial, many families I support say they are are aware they are “Not recommended for breastfeeding babies” but are unaware of why. This can be a source of guilt or concern & sometimes leads to avoidable crying.
The world health organisation and United nation children's fund strongly discourage use of pacifiers because of their perceived interference with breastfeeding. Pacifiers given before four weeks and used most days are significantly associated with shorter duration of breastfeeding.*
However, when “motivation to nurse” is considered, researchers found no statistically significant association between pacifier use, and nursing outcomes, at least for the first four months**
Do dummies confuse breastfeeding?
One common concern is “nipple confusion”. This is the theory that when a baby is learning to breastfeed they can’t learn to latch well if they are swapping between breast and bottle or breast and dummy.
There is not good evidence for this, and in fact regarding bottles it’s now thought the problem is more likely to be a preference for the easy flow of the bottle. See my blog on bottle feeding breastfed babies here.
If you are struggling with sore nipples & shallow latch, it might be worth avoiding dummies until things improve if you can. It’s common in lactation that we don’t have robust evidence for something, but that’s not to say there is a body of evidence disproving it either.
How soon can you give a breastfeeding baby a pacifier?
For most babies, dummies are discouraged in the early days of breastfeeding when frequent feeding is vital for building milk supply.
Breastfeeding & Human Lactation VI edition says:
”Milk production is directly linked to frequent effective feeds, reducing a babies time at the breast, contributes to shorter and less exclusive breastfeeding among pacifier users”.
So if you are using a dummy it’s important to be vigilant that your baby is not soothed back to sleep or delayed from signalling. They could be missing an opportunity to gain calories and stimulate your supply.
LLL say***: "Whenever a substitute for sucking at the breast is used there is a risk of affecting the breastfeeding relationship, especially for a baby who has not yet mastered nursing at the breast."
But once breastfeeding is established many parents find dummies a valuable tool. (I can certainly recall a few car journeys myself where I was grateful for that tool in my armoury!)
Top tips for dummy use:
If youre going to use them use them as little as is practical, purely for settling or for times where you cannot breastfeed such as school run or car journeys or when twins+ need to take turns. If you can use the breast, use that instead as this will help to build supply and give your baby an opportunity to gain more calories.
Be very mindful of your baby missing an opportunity to stimulate milk supply & onboard more calories.
Special circumstances:
Dummies are actually sometimes recommended for premature babies & during separation such as SCBU as a comfort or even a “suck training” tool, so there are always exceptions & each family should consider their own circumstances when deciding whether or not to use a dummy.
A 2017 review article**** summarised situations in which pacifier use can be justified in a baby friendly hospital:
Babies who are low-birth-weight or pre-term, or separated from their nursing parent
Babies who need extra stimulation to develop and maintain mature sucking reflex (such as in cases of low muscle tome).
Babies who help with neuro-behavioural organisation (calming).
Babies for whom breastfeeding is contraindicated.
Important on dummies in relation to SIDS-
"The most recent UK research found that there was no increased risk of SIDS for babies who never used a dummy, but that if a baby was in the habit of sleeping with a dummy then they were at increased risk when they were without it. Therefore if parents choose to give their baby a dummy they should do so consistently until their baby is around 6 months of age". *****
Pacifiers generally fall out within 5 to 30 minutes of the infant, falling asleep, leading to speculation that other factors, including the frequent attention of a responsible adult, who replaces the pacifier may be the actual protective mechanism shown in some research.******
View a short film about this here.
I’d love to hear what worked for your family. Did your accept a dummy? Did it help?
If you have any questions regarding anything mentioned in this post, please feel free to get in touch.
Sally
*Batsta Et Al 2017, Mauch et al 2012 (linked)
**Breastfeeding Answers II
*** LLL page here.
****Lubbe & Ten Ham-Baloyi 2017 here.
*****References from BASIS here.
******Breastfeeding & Human Lactation VI edition
PS…
On the topic of dummies I’ll take the opportunity to mention this common phrase;
“Use you like a dummy”
When a baby is no longer gulping down a big portion of milk, as the feed slows there is sometimes a period at the end of suckling with very little swallowing.
Many families I meet worry that this is a bad habit or should be avoided for some reason.
If you are struggling with nipple damage then you might want to avoid this period of suckling, especially as it can often be a time when babies slide down the nipple a little and the latch can get a bit pinchy and shallow. In this situation a dummy may help, or to try patting/shushing/rocking to support your baby to snuggle down & nod off to sleep without the breast.
However, if you are comfortable, then allowing your baby to snuggle down to sleep at the breast or “use you like a dummy” or “just for comfort” is normal & natural & actually desirable as it does help to establish breastfeeding. Babies in this situation may be releasing fatty droplets of milk that were previously deep in the ducts so they could still be onboarding calories. Plus this is very calming & relaxing for babies & releases lots of lovely oxytocin in the baby and the breastfeeding parent.