Breastfeeding mothers have been told for many years that pacifiers should be avoided, because of a fear that they might interfere with breastfeeding.

Now, a review article in the AMA's pediatrics journal (April 2009) reassures us that pacifiers may be okay for breastfed babies, after all.  4 randomized trials were reviewed; babies were assigned to the "pacifier" or "no pacifier" groups.  All four studies showed no effect of pacifier use on breastfeeding outcomes.  In fact, more than half of babies in the "no pacifier" groups actually were given pacifiers by their parents, but these babies breast-fed just as well.

In several observational studies, babies not using pacifiers did breastfeed somewhat more, but the authors speculate that this might be due to family attitudes towards breastfeeding, rather than an effect on breastfeeding by pacifiers.  That effect would be difficult to distinguish with this type of study, which is why the randomized trials carry more weight.

Why does it matter?  The American Academy of Pediatrics recommends that babies should be offered a pacifier for naps and sleep after 1 month of age (after nursing is established), for the first year or so of life.  (Some studies suggest that pacifiers during sleep might reduce the chances of SIDS, although this is not definite.)

So now I feel comfortable reassuring parents that it's ok to use pacifiers when their infant sleeps.  I still recommend that an alert but fussy infant should be offered a feeding before giving a pacifier, to encourage on-demand feeding.  And in any event, the use of pacifiers (and bottles) should be ended by 15 months.

(Archives of Pediatric and Adolescent Medicine 2009; 163(4): 378-382)

     -- David M. Epstein, MD