News | Published May 11, 2012

Confusion over nipple confusion: Do pacifiers help or hurt new infants attempting to breastfeed?

A recent article that got a lot of national media attention describes an observational study of newborn babies in Oregon that found that taking pacifiers away from newborns actually hurt the percentage of newborns that were exclusively breast fed. When pacifiers were readily available, 80% of newborns were exclusively breastfed. When pacifiers were taken away, the number of newborns who were exclusively breastfed dropped to 70%. This removal of pacifiers was done in an attempt by that hospital to achieve "Baby-Friendly Hospital" status in the belief that pacifiers hurt breastfeeding, causing "Nipple Confusion" due to the different types of nipples introduced into the newborn's feeding practice. The reality is that pacifiers can be helpful for babies once breastfeeding has been established and seem to have a protective effect against Sudden Infant Death Syndrome (SIDS).

At times I have tried using a pacifier to help a baby learn how to latch and suck when the infant was having trouble in this regard. Some infants will have some issues when using a bottle before breastfeeding is well established, they will become lazy and not feed well at the breast after the relative ease of drinking from a bottle. Most babies do fine either way, I have yet to see a newborn truly confused by using different nipples. My experience has been that pacifiers don't cause nipple confusion and hurt breastfeeding in newborns.

My recommendations are to do everything possible to promote breastfeeding. For ravenous newborns with a great latch and suck, I am fine with giving them a pacifier in between feedings to give mom a break and save her nipples. If the breastfeeding is not going well, there are many techniques to help, and that is where your pediatrician, lactation consultants and post-partum nurses come in to help ensure eventual breastfeeding success!