Are Pacifiers a Problem
for the breastfed baby?

Shorter Duration of Breastfeeding

Long thought to be a help for crying babies and frazzled parents, there are some new insights into the use of pacifiers for breastfeeding babies. The innocuous pacifier, or "soother" as it is called in some countries, may affect initiation of breastfeeding as well as duration of breastfeeding.

In a study by Righard and Alade it was found that the use of a pacifier before 2 weeks of age resulted in superficial and ineffective suckling technique in many infants. These infants were more likely to have breastfeeding problems. Their "findings suggest that the prerequisite of an uncomplicated and uninterrupted breastfeeding period is a correct sucking technique from the outset, and that excessive use of pacifiers and the early introduction of occasional bottles should be avoided." They also found a shorter duration of breastfeeding in the group who used pacifiers.

Victora et al found in surveying 354 mothers that there was a three fold risk of early weaning from the breast in breastfeeding infants who used a pacifier. They speculate that either less breast stimulation may result in lowered breastmilk production or that pacifier use may be a marker for breastfeeding difficulties, or that mothers use it to initiate early weaning.

The Cholecystokinin Link

The hormone, cholecystokinin, is released in the infant's gut in response to suckling.  This release comes in two waves: the first, about 10 minutes into the feeding, is thought to be initiated by suckling stimulation to the vagal nerve and the second, about 30 minutes into the feeding, is stimulated by the presence of milk (fat) in the gut.

Cholecystokinin causes satiety, sedation and sleepiness.  This response happens when the infant is feeding at the breast and can happen while sucking on a pacifier.

Parents should be cautioned about the over-use of pacifiers resulting in missed feedings and failure to gain weight.

REFERENCES:

Righard, L., & Alade, M. (1992). Sucking Technique and Its Effect on Success of Breastfeeding. Birth 19:4, 185-189.

Victoria, C., et al. (1993). Use of Pacifiers and Breastfeeding Duration. The Lancet 341, 404-406.

Uvnaas-Moberg, K., Marchini, G., Winberg, J.  (1993) Plasma cholecystokinin concentrations after breastfeeding in healthy 4 day old infants.  Archives of Disease in Childhood 68: 46-48.