This is one of the questions nearly every new parent asks when they see us “when can we introduce a paci?!” While there are so many conflicting answers- our answer comes from our knowledge of proper oral function and development, the health and safety of your child and deep understanding of breastfeeding and breastfeeding mechanics. Read along to learn about the risks and benefits of using a pacifier, the best kinds of pacis to use, when to introduce one and when to use one.

First, lets talk about the basics of how to choose the best pacifier. Here, we have to consider how the tongue is used to feed at the breast and bottle, and the shape of the individual paci. While feeding, the baby’s tongue should be shaped like a taco. The sides of the tongue should be curled up and touching the sides of the breast or bottle like it’s giving it a hug. Now let’s think about the shape of pacifier nipples. There are a million to choose from… round ones, flat ones, angled ones… We want to choose the paci that will best help baby achieve this position so they can strengthen and develop these muscles to be better feeders and the best way to do that is to use a paci that is cylindrical in shape, with a wider base and no bulb at the end. Think Avent Soothies (hospital pacis), Itzy Ritzy, Ninni Co., and Dr. Browns pacifiers. What we want to avoid are flat-ish, angled or bulbed pacis. These pacis may be kept in with greater ease, but do not promote proper oral development because they keep the sides of the tongue pushed down and bulbs keep the back of the tongue pushed down. So generally speaking, for most babies, our recommendation is the plain old Avent Soothie.

Now, let’s chat about the risks and benefits of using a paci. I think it’s most important to note that the AAP (American Academy of Pediatrics) recommends the use of pacis during sleep for SIDS prevention. Here is their info on pacis:

Try giving your baby a pacifier at nap time and bedtime

This helps reduce the risk of SIDS, even if the pacifier falls out after your baby is asleep. But keep in mind:

• If your baby is breastfed, wait until breastfeeding is established before offering a pacifier. That means your milk supply is good, breastfeeding is comfortable and consistent, your baby is latching well and they're gaining weight like they should. If you're not breastfeeding your baby, you can start the pacifier whenever you like.
• It's OK if your baby doesn't want a pacifier. You can try offering again later, but some babies simply don't like them. If the pacifier falls out after your baby falls asleep, you don't have to put it back in.
• Don't hang a pacifier around your baby's neck or attach it to their clothing when they're sleeping.

The additional benefits to using a paci include easier soothing and calming, and the ability to do so when you otherwise wouldn’t be able to calm them (like in a car seat or diaper change), better sleep and possibly developing a better suck. Of course, using a paci does carry some risk- our opinion is the most notable is masking hunger cues. Sometimes, a baby will calm with a paci or sleep through feeding cues even if they are still hungry- it can lead to suboptimal weight gain and underfeeding. Additionally, over use can cause high palates (I’ll explain this later) and generally, dentists want pacifiers weaned by 3 years to prevent a permanent open bite (a gap between the top and bottom teeth where the paci sits)

Now that we’ve established the best kind to use and risks and benefits- let’s chat about when to use a paci. Our opinion is that pacis can be used for short durations for calming as soon as baby is born when the breast cannot be offered- think diaper changes, warming a bottle, or getting ready to breastfeed and car rides, but should not be offered outside of those short bursts and for sleep, as recommended by the AAP. As mentioned previously, one of our greatest concerns with early paci use is masking of feeding cues or underfeeding- so offering the paci after a feeding if a baby is still hungry but settles with a paci can lead parents to believing their baby had a full feeding. 

Our general recommendation is to wait to use the paci until weight gain is sufficient and the parent’s milk supply is in. Baby’s using pacis should be monitored for adequate urine and stool output- at least 6+ heavy wet diapers and 3, quarter sized stools every 24hrs if your baby is beyond day 4 of life. As far as latch interference- babies are smart! It is unlikely that latch would be greatly affected if you are using a good paci. If you have concerns, consider a Ninni Co., Avent Soothie, or Dr. Brown paci. In a word of caution, we do encourage limited use of the paci as it disrupts the tongue/palate seal (the tongue should be suctioned to the roof of the mouth at rest) and this can cause baby to have a high palate since the suction and seal keeps the optimal palate shape. We don’t have a time limit, but as with nearly all parenting decisions- use your best judgment!

If you have any additional paci questions or concerns, don’t hesitate to reach out to Feed Well or your favorite IBCLC. As always, we are open for in person and virtual appointments. You can schedule your appt. Here: https://feedwellco.com/pages/book-now