What does the American Academy of Pediatrics (AAP) recommend?

In October, 2005, the American Academy of Pediatrics (AAP) revised its policy on the prevention of Sudden Infant Death Syndrome (SIDS). The AAP now states babies must sleep on their backs (sleeping on one side was removed as an option) in the same room as their parents but not in the same bed. The AAP also recommends pacifiers be offered at nap-time and bedtime. The complete policy, “The Changing Concept of Sudden infant Death Syndrome,” is available at www.aap.org.

The AAP recommends use of a pacifier throughout the first year of life according to the following guidelines:

• The pacifier should be used when putting the baby to sleep, but should not be reinserted once the baby falls asleep. If the baby refuses the pacifier, he or she should not be forced to take it.
  
• Pacifiers should not be coated in anything sweet.
  
• Pacifiers should be cleaned often and replaced regularly.
  
• For breastfed babies, delay pacifier use until 1 month of age to ensure breastfeeding is firmly established.

Why should pacifiers be avoided for the first month?

The quantity of milk a mother makes in the long-term is largely determined by how well the baby drains the breasts in the first weeks. For example, the more frequently a baby nurses in the first week, the more prolactin receptors develop in the glandular cells of the breast, and the more milk the mother will make. It makes good sense, therefore, for a mother to breastfeed any time her baby shows a desire to suck. In a newborn, sucking is a hunger signal.

Over the next several weeks, a baby’s increasing appetite will increase the mother’s supply, until it reaches a plateau at around one month. The quantity of milk produced is largely regulated by a substance in the milk called feedback inhibitor of lactation (FIL). If too much milk is left in the breasts, then FIL will decrease milk production. However, if the breasts are drained, then the supply can increase. Pacifier use can break the milk production cycle and result in chronically low milk production.

Are there risks to pacifier use after one month?

From a breastfeeding perspective, it is important to ensure a pacifier is not used to reduce breast stimulation. Therefore, pacifiers should not be used regularly to delay or reduce a baby’s access to his or her mother’s breasts. If breastfeeding is so overwhelming for a mother that she is tempted to use a pacifier to avoid breastfeeding, it would be wise to seek the help of a lactation consultant.

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