Dummy (pacifier) use has become a cultural norm in many parts of the world. However there is widespread belief that this use may impact on breastmilk production and lead to cessation of breastfeeding. It is hypothesised that this may be due to the mechanical differences between sucking at the breast and sucking on the dummy or because offering a dummy instead of the breast to calm the infant may lead to less frequent breastfeeding. This in turn may reduce breastmilk production and shorten duration of breastfeeding in the long term. Conversely, it remains unclear whether breastfeeding cessation and a maternal intention to wean the infant from exclusive breastfeeding precedes the use of the dummy or vice versa.
A review of studies related to dummy use and breastfeeding success was carried out by the Cochrane Collaboration. Only two trials met all of the reviewers criteria for reporting and they included 1,302 healthy, term breastfeeding infants.
In one (1), 1,021 mothers who were highly motivated to breastfeed were recruited at 15 days and in the second (2) 281 mothers were recruited at birth. Meta-analysis of the two combined studies showed that dummy use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 1.00; 95% confidence interval (CI) 0.95 to 1.06), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.97 to 1.02), and at four months of age (RR 1.01; 95% CI 0.98 to 1.03).
The review concludes that in motivated mothers, there is moderate evidence from these two studies that dummy use in healthy term breastfeeding infants before and after lactation is established does not reduce the duration of breastfeeding up to four months of age.
The authors also note however that there is insufficient information on the potential harms of dummies on infants and mothers, for example neither study assessed the review’s secondary outcome measures for mothers (maternal confidence, rate of breastfeeding difficulties such as cracked nipples, breast engorgement, mastitis) or infants (incidence of sudden infant death syndrome, oral candidiasis and dental malocclusion and infant crying or fussing). They add that further research is recommended to address the effect of dummy use on duration of breastfeeding in less motivated women and to assess the rate of breastfeeding difficulties faced by mothers associated with dummy use and the long-term effect on mother and infant health.
1. Jenik AG, Vain NE, Gorestein AN, Jacobi NE, for the Pacifier and Breastfeeding Trial Group. Does the recommendation to use a pacifier influence the prevalence of breastfeeding? Journal of Pediatrics 2009;155(3):350–4.
2. Kramer MS, Barr RG, Dagenais S, Yang H, Jones P, Ciofani L, et al. Pacifier use, early weaning, and cry/fuss behavior: a randomized controlled trial. JAMA 2001;286(3):322–6.
Jaafar SH, Jahanfar S, Angolkar M, et al. (2011) Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding (Review). The Cochrane Collaboration.