By Maria Larrain MPhil BOst DPO PgC ACE (clin ed)

I love dummies for newborns. This may go against what parents are told about dummies during the first few weeks of breastfeeding. It is said that using a dummy or pacifier may cause ‘nipple confusion’. This is a poorly understood condition where the baby refuses the breast or bottle when transitioning from one to another.

When you look at the evidence there is very no agreement on what ‘nipple confusion’ means, or if it even exists. Do babies who use reflexes that start in utero get confused? Do they ignore hunger cues by sucking on their dummy, jeopardising mum’s milk supply? I am not so sure.

When breastmilk is establishing, the stimulation of the nipple and surrounding breast tissue will produce more milk in a feedback loop. It would make sense that giving the baby a dummy when it needs soothing would reduce breast stimulation and milk production. It is therefore commonly advised not to introduce a dummy (or bottle) for the first 6 weeks.

However, a Cochrane Review concluded that there was moderate evidence to suggest dummies did not affect breastfeeding success for women motivated to breastfeed (Jaafar et al, 2016). Most recently a systematic review concluded that pacifiers or dummy use by newborns was not associated with lower breastfeeding rates (Tolppola et al, 2022). Given that between 34% to 96% of women report nipple pain (Page et al, 2003) when initiating breastfeeding, would it not be kind to mum to give her a little break from the baby’s need to constantly suckle?

Babies need to suckle for pleasure (non-nutritive suck) and for feeding (nutritive suck). The non-nutritive suck develops earlier than the nutritive and is usually faster in rate, because the nutritive suck requires baby to rhythmically suck, swallow and breathe (Lau, 2015; Popescu et al., 2008).

When babies are unable to maintain the latch (suction) on the breast but can do so on the bottle it is because the bottle teat is harder and easier to latch on to. It may indicate that nipple shields would offer an advantage to babies experiencing difficulties (Lau, 2015). This would enable the baby to get breastmilk and as their sucking matures without the need for mum to be constantly expressing.

Public health advice is often slow to follow and, in many cases, based on cultural and social norms that women often feel pressured to follow. Whether this is pressure from peers, family, partners or healthcare professionals, or pressure from oneself to “do the right thing”. These decisions can leave you anxious and confused, particularly as you get conflicting advice.

The risks and benefits of using dummies or nipple shields should always be presented objectively without an agenda. Ultimately, women and babies are individuals and should be treated as such.

Parenthood can be a very stressful and anxiety-inducing time, especially for women who face difficulties with their infant feeding choices.

My advice to parents is based on personal experience with breastfeeding pain, but also through my academic research into women’s infant feeding experiences. A pragmatic approach by healthcare professionals supporting parents through the first few weeks of a baby’s life is paramount.

Amaizu, N., Shulman, R., Schanler, R., & Lau, C. (2008). Maturation of oral feeding skills in preterm infants. Acta Paediatrica (Oslo, Norway : 1992), 97(1), 61–67.

Bryant-Waugh, R., Markham, L., Kreipe, R. E., & Walsh, B. T. (2010). Feeding and eating disorders in childhood. International Journal of Eating Disorders, 43(2), NA-NA.

Degenaar, H., & Kritzinger, A. (2015). Suck, swallow and breathing coordination in infants with infantile colic. The South African Journal of Communication Disorders = Die Suid-Afrikaanse Tydskrif Vir Kommunikasieafwykings, 62(1), E1–E10.

Jaafar, S. H., Ho, J. J., Jahanfar, S., & Angolkar, M. (2016). Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database of Systematic Reviews, 2016(8).

Lau, C. (2015). Development of suck and swallow mechanisms in infants. Annals of Nutrition and Metabolism, 66, 7–14.