One of the most controversial topics for newborn care and postpartum time is pacifier use. Recently, the understanding is no pacifier until 3-4 weeks old if breastfeeding. This is done so that baby doesn’t get “nipple confusion” before getting their breastfeeding skills more settled. However, there is really no evidence to show this. Recently we have been discussing this in my journal club so I wanted to give you all a list of pointers on pacifier use!


  • If bottle feeding, go ahead and give a pacifier whenever needed. There is no risk of nipple confusion here.
  • What is nipple confusion?
    • Some of you may be thinking that right now so here is a short summary: A baby learns how to latch onto their mom’s breast in the first few days of life. The idea behind nipple confusion is that the baby can no longer effectively latch onto mom’s breast because they have gotten used to how the pacifier feels instead.
  • HOWEVER, there is very little evidence based practice on this topic. In our journal club, we did a literature review and the most compelling evidence found was that restricting pacifiers actually decreased the number of moms exclusively breastfeeding while increasing the number of moms supplementing with formula, or using formula exclusively.
    • This was thought to occur because when denied the pacifier, mom’s gave formula to quiet the baby.
    • This being said, mom’s who are motivated and able to put in the extra time to help their baby get past any nipple confusion that may occur, are usually able to continue exclusive breastfeeding.
  • Avoid a pacifier if able to always! However, some babies go through a phase, especially during the first few days of life, where they eat or cry constantly and become somewhat inconsolable. You need sleep of course! In this situation I am always willing to give my patients a pacifier rather than formula.
  • Sometimes you have an inconsolable baby who also has a hard time breastfeeding. I always try to avoid a pacifier in this situation with other soothing methods first. Here are some ways to avoid a pacifier:
    • Cuddle
    • Hold and walk around
    • Have baby suck on your finger
    • Skin to skin
    • Keep breastfeeding!
    • Rocking or swinging the baby
    • Swaddling up tight with warm blankets

The key with pacifier use is MOTIVATION. If you are motivated enough to continue breastfeeding and work a little harder the next day with your latch, then give that pacifier so you both can get some sleep! With babies who are quiet, sleep for long periods undisturbed, and have a hard time with their latch regularly, you should wait the 3-4 weeks to really settle in your feeding habits.

In the end, its your decision and your baby! You do what you think is best for you both. Hospitals stock pacifiers but may not routinely distribute them, so ask your nurse! But also, be prepared for this same information and possibly a lecture. Nurses are open to whatever you want to do, but they want to give you all the information and education you need. Just let them know you have done your research!




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