Breastfeeding is about so much more than getting calories. Babies suck for more reasons than feeding alone. The rhythmic pattern of sucking calms the baby by regulating their nervous system and can help them drift off to sleep. Pacifiers have a very long history. Many styles of pacifiers and materials have been used to help soothe babies. Parents have different considerations to weigh when deciding if using a pacifier is the right choice for them and what pacifier would best fit their baby.

In ultrasounds taken during pregnancy, you may see your baby mouthing and sucking on their hand. This early thumb sucking happens as early as 10 weeks in utero but is thought to be more random until the sucking reflex begins around 32 weeks during pregnancy. (2) After birth, the rooting reflex, elicited when the cheeks are touched, helps the baby get ready to suck. When the roof of your baby’s mouth is touched by their thumb, your nipple, a bottle nipple, or a pacifier, the suck reflex is triggered, and your baby begins to suck.

Centuries ago, people used natural materials to make objects for their babies to help soothe them. Early pacifiers were a combination of a rattle and a pacifier. Primitive pacifier rattles were made of beads, sticks, coral, bones, shells, pods, or other natural materials. (1) The materials used had textures that would feel good on the baby’s gums during teething and smooth materials that felt good for satisfying their need to suck.

A pacifier can be a helpful tool but is not needed or necessary for every baby. Babies have a high need to suck. They get nutrients from sucking when they feed, but the rhythm of sucking is calming, reduces discomfort, and can aid them in self-regulation when not breastfeeding. Nature's natural design is putting your baby on your breast whenever they want to suck, whether for calories or comfort. A pacifier can never replace being in your arms, against your body, and breastfeeding, but it gives parents an alternative option to soothe their baby's desire to suck while not on the breast.

• Car rides - it is best to plan lots of stops when taking a trip to be able to nurse your baby. A pacifier can be helpful to soothe your baby, especially if they are trying to fall asleep while you’re driving in the car. Some babies have a hard time with short car rides as well. This can be a symptom of more going on from body tension, oral restrictions, or their airway being compromised. The baby’s body position and posture while traveling in a car seat can lower their oxygen levels and constrict their airway, making breathing more difficult. (8) While you are addressing the root cause of their dislike of being in the car, a pacifier can help calm your baby when you do need to drive somewhere.
• Soothing a baby with reflux - babies with reflux may seem like they always want to nurse. Sucking is soothing, and drinking your milk can help relieve the pain from reflux, but it can also cause more refluxing, causing a vicious cycle. After you nurse your baby and know that they have had a full feeding, using a pacifier for them to continue sucking while you comfort them can be helpful. They should be upright or seated rather than lying flat while sucking on the pacifier. (3)
• You need a break - being a new parent is a lot of work. You are likely tired from adjusting to a new and different schedule, getting only snippets of sleep at a time. If your baby has been fed and still needs to suck, but you need a break, it is ok to use a pacifier as a tool for short periods of time. 
• When your baby is away from you - some families use a pacifier for their baby when they are with a caregiver and not with you to nurse as often as they like for comfort. Always have the caregiver offer your pumped milk first in case your baby is hungry. If they are fed and still need comfort from sucking, a pacifier can be helpful while your caregiver also snuggles your little one.

• It is recommended to wait until your baby is at least 4-6 weeks old before introducing a pacifier so it doesn’t interfere with establishing breastfeeding or your baby’s breast milk intake. 
• Choose a pacifier sized appropriately for the age of your baby. 
• Choose a pacifier shape best suited for your baby or recommended by your IBCLC (International Board Certified Lactation Consultant).
• A pacifier that is not very soft but has some resistance or rigidity is often preferred. When the material is very soft, your baby may compress the pacifier nipple with their mouth, resulting in a closed mouth rather than a wider, more open-mouth posture. This can create tight muscles around the mouth and negatively impact latching and feeding.
• Consider a pacifier nipple shape that looks similar to how you would expect your nipple to look after your baby nurses.
• Consider the material used to make the pacifier. All synthetic materials can have health implications, and you should do further research to choose the one you are most comfortable with.
• Choose a pacifier made from one piece to avoid the parts of the pacifier separating.

• Cherry - may be round or flat near the base and is more rounded and bulbous near the tip.
• Orthopedic - these are more flat, wide-shaped nipples. They were made with the thought it would allow for a greater range of motion of the tongue to be used. It can inhibit the tongue from being able to cup the nipple.
• Butterfly - the nipple is flatter in shape, and the tip is flared or has a lipstick shape at the tip
• Conical - this is typically the shape that is most often recommended for your baby. The nipple is long, straight, and the same diameter throughout except where it may widen close to the base. The material is typically more firm which allows your baby to put pressure against the nipple without it collapsing. The broader base encourages your baby’s lips to flange with an open mouth, more similar to being at the breast.

• Never use a string or other tether connecting the pacifier to your baby. It could pose a danger if it were to get wrapped around their neck.
• Using a pacifier can delay feedings or skip a feeding altogether. Always offer your milk first before the pacifier. If your baby has low or slow weight gain, pacifier use may not be appropriate.
• Using a pacifier regularly can interfere with your baby’s orofacial development. It promotes narrow jaw growth, a high palate, an open bite, and tongue thrust swallow. (5)
• There is an increased risk of ear infections associated with pacifier use. (4)
• Using a pacifier beyond 2-4 years old holds a higher risk of dental and oral growth complications. (5)

Breastfeeding is the original, nature-designed pacifier. (6) Remember that your baby breastfeeds to meet a variety of needs and not just take in calories. It is always appropriate to offer to nurse your baby even after you just fed them. Nursing comforts your baby, meets their emotional needs, and regulates their nervous system, breathing, temperature, and heart rate. A pacifier can be a handy tool, not a replacement for them to be at your breast. (7) If you decide to use a pacifier, consider its appropriate use and the shapes and styles available to help you decide which pacifier best fits your baby. There are plenty of situations your baby may still want to fill their need to suck, but breastfeeding isn’t an option, and a pacifier may come in handy.

1. https://www.encyclopedia.com/social-sciences-and-law/sociology-and-social-reform/sociology-general-terms-and-concepts/pacifier
2. https://en.wikipedia.org/wiki/Thumb_sucking
3. https://pubmed.ncbi.nlm.nih.gov/3412848/
4. https://pubmed.ncbi.nlm.nih.gov/11979200/
5. https://www.brianpalmerdds.com/bfeed_oralcavity.htm
6. https://www.theatlantic.com/health/archive/2016/03/breastfeeding-pacifier-comfort-feeding/475836/
7. http://www.nancymohrbacher.com/articles/2015/8/21/what-does-it-mean-to-use-your-breast-as-a-pacifier
8. https://www.webmd.com/parenting/baby/news/20090824/infant-car-seats-may-lower-oxygen-levels

https://books.google.com/books?id=jEIj1Zs7z3EC&pg=PA30&lpg=PA30&dq=dr+brian+palmer+mechanics+of+suck&source=bl&ots=Pl6IrquZEd&sig=ACfU3U0Ziu8tA_hliE_0TQTMm67vQCEBcg&hl=en&sa=X&ved=2ahUKEwiPmfHB99H0AhWUkIkEHfktDVwQ6AF6BAgCEAM#v=onepage&q=dr%20brian%20palmer%20mechanics%20of%20suck&f=false

https://www.aafp.org/afp/2009/0415/p681.html

https://www.breastfeedingbasics.com/qa/baby-uses-human-pacifier

https://www.diannecassidyconsulting.com/2021/05/30/help-my-baby-is-using-me-as-a-pacifier/

https://www.youtube.com/watch?v=ZD7Zh6wwltM

https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1668-3