Pacifiers: Do they really cause early weaning?

I am in my third trimester of pregnancy and planning to breastfeed. My friends have given me a lot of advice and one thing they have told me is not to introduce a pacifier, since it could cause breastfeeding problems. I just heard conflicting information on the news. Are pacifiers really a problem while breastfeeding, and can they cause early weaning?

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Kathy Kuhn

Kathy Kuhn is a registered nurse who has been working with breastfeeding families since 1981. She has been an International Board Certified... Read more

The information about how pacifiers impact weaning can seem conflicting at first glance. A recent study evaluated the impact of pacifiers on weaning up to three months of age. (Kramer, et al 2001) The authors of this study concluded that pacifiers do not cause early weaning, but rather, women who are experiencing breastfeeding difficulties, or who are less committed to breastfeeding, may be more inclined to use pacifiers and more likely to wean early anyway. This study provides no information about the weaning patterns of infants after three months.

According to the American Academy of Pediatrics statement on breastfeeding, optimally, infants should breastfeed at least one year, so this study only provides a small piece of early weaning information.

An interesting side note on this study found that the babies who used the pacifiers did not have any fewer incidents of crying or fussiness, so the pacifiers were not even providing the benefit that the mothers had probably hoped for in implementing their use.

Other studies have looked at weaning patterns up to one year of age, which in my view is a more appropriate evaluation. Those authors have concluded that daily pacifier use is linked with early weaning. (Vogel et al 2001) (Victoria 1993) Keep in mind though, it is always difficult to sort out all the variables in this type of study and absolutely establish if the pacifier led to the weaning or if it was some other factor.

In my opinion, based on my experience with breastfeeding mothers and a review of the available literature, I feel pacifier use creates an increased risk for early weaning.


Potential risks of pacifier use

Other studies have linked pacifier use with an increase in ear infections (Niemela et al 1994) and (North Stone K, et al 2000) and malocclusions (Warren et al 2000).

One study that has been in the news lately seems to suggest that pacifier use during sleep reduces the risk of SIDS (sudden infant death syndrome). These authors examined the relationship between pacifiers and the babies’ ability to arouse appropriately from sleeping. They concluded that the infants using pacifiers during sleep, who in this study were mostly formula fed, had an increased rate of appropriate sleep arousals. They also found however, that the breastfed babies who did not use a pacifier during sleep had this same presumed beneficial sleep arousal mechanism. They felt this ability to arouse appropriately during sleep may reduce the risk of SIDS. They did not directly connect pacifier use with any decrease in SIDS rates. If this arousal mechanism does protect against SIDS, this protective effect of pacifier use would only seem to apply to formula fed infants since the breastfed infants demonstrated appropriate sleep arousal mechanisms without using pacifiers. (Scaillet 2000)

Pacifiers may also expose the infant to latex, a common allergen, and present choking hazards from worn or faulty pacifiers.


If you introduce a pacifier

When parents decide to use pacifiers, I generally recommend against pacifier use for at least the first three-to-six weeks of age to allow breastfeeding to become established. Pacifiers may put some infants at risk for nipple confusion or suck dysfunction, and this risk seems greater in the early weeks of breastfeeding.

Some infants may also accept the pacifier inappropriately when they really need nourishment and this can lead to slow weight gain. Because of this concern, I caution parents to be especially careful about monitoring the baby’s weight and diaper output when beginning pacifier use.

I also caution the parents to be sure to check the pacifier daily for signs of wear that may cause parts to break off and lodge in the baby’s throat.

Pacifiers should never be tied around the baby’s neck or to the clothing because of the risk of strangulation. Additionally, parents should frequently check news sources for pacifier recalls.


References

  • Kramer MS, Barr RG, Dagenais S, Yang H, Jones P, Ciofani L, Jane F. “Pacifier use, early weaning, and cry/fuss behavior: a randomized controlled trial.” JAMA (2001) Jul 18; 286 (3):322-6
  • Niemela M, Uhari M, Hannuksela A , “Pacifiers and dental structure as risk factors for otitis media.” Int J Pediatr Otorhinolaryngol (1994) Apr; 29 (2):121-127
  • North Stone K, Fleming P, Golding J., “Socio-demographic associations with digit and pacifier sucking at 15 months of age and possible associations with infant infection. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.” Early Hum Dev (2000) Dec; 60 (2): 137-148
  • Franco P, Scaillet S, Wermenbol V, Valente F, Groswasser J, Kahn A., “The influence of a pacifier on infants' arousals from sleep.” J Pediatr (2000) Jun; 136 (6):775-779
  • Victoria, CG., Tomasi, E., Olinto, MTA, et al: “Use of pacifiers and breastfeeding duration.” Lancet (1993) 341:404
  • Vogel AM, Hutchison BL, Mitchell EA., “The impact of pacifier use on breastfeeding: a prospective cohort study.” J Paediatr Child Health (2001) Feb; 37 (1):58-63
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