What an OT Actually Thinks About Pacifiers and Breastfeeding
Using a pacifier with babies is a controversial topic for some. There are those who feel it is detrimental for babies and those who feel using a pacifier is just part of being a baby. It’s yet another topic for parents to feel confused, stressed or guilty about. I hope this article gives you clarity and supports you in making a confident decision for your baby.
I am Maria Bossert, an Occupational Therapist specializing in infant feeding and oral motor development. I work with families in the Twin Cities navigating the early days of feeding, and questions about pacifier use come up constantly. So let’s talk about pacifier use, the most common concerns I hear from parents and how to make a decision that feels best for you.
Common Concerns
First, let’s name the common concerns about giving a baby a pacifier.
- Giving a pacifier to a baby is just that, it’s pacifying your baby and that’s bad for them. They should be able to express themselves or self-soothe.
- The pacifier shapes the upper palate of the mouth, so if you want your baby’s palate to be the right shape (wide with a gentle arch) then use a flat pacifier or don’t use a pacifier at all.
- The pacifier will affect the position of baby’s teeth, causing buck teeth or a need for braces in the future, for example.
Understanding Oral Motor Skills and Regulations
Ok so now that we know the concerns, let’s talk about development, specifically oral motor skills and regulation.
When do we usually give a baby a pacifier? When they are tired or upset, which is addressing regulation. The action of using the pacifier is by sucking, aka use of oral motor skills. Let’s talk regulation first.
First of all, babies cannot self-soothe. This is antiquated information that is simply incorrect. I talk more about this in my blog on co-regulation that you can read here. So, babies need support to regulate. That is, to move through the spectrum of states from social and safe/parasympathetic, to active/discontent/sympathetic, to sleep/parasympathetic. There are a variety of ways to support a baby with regulation. The most primitive and accessible (if oral motor skills are functional) regulation tool for babies is sucking.
When a baby is sucking, the tongue is the star of the show with the cheeks and jaw providing support. The tongue should stay forward in the mouth, while cupping the sides up into a taco shape and then doing a wave like motion from front to back. This is the ideal and most optimal way to suck.
Lastly, the upper palate of the mouth is shaped by the tongue! Optimal oral rest posture is when the tongue is suctioned to the roof of the mouth and the jaw and lips are gently closed. The tongue suctioned to the upper palate is actually the first posture that a baby ever achieves and this happens in utero. This is why the upper palate should be wide and flat, the tongue is wide and flat!
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Addressing the Common Concerns
Now that we’ve covered the basics of regulation and oral motor skills, let’s look back at those concerns about pacifier use.
Concern #1: Giving a pacifier to a baby is just that, it's pacifying your baby that's bad for them. They should be able to express themselves or self-soothe.
Response: Since babies cannot self-soothe, they need support from their caregivers one way or another. Rocking, boucing or sushing your baby isn’t considered pacifying. Giving your baby a way to use the main tool they have to regulate, sucking, shouldn’t be seen as pacifying either. Also, it is important to provide a pacifier thoughtfully rather than popping it in baby’s mouth as soon as crying starts. Tune into your baby’s cues and offer the pacifier when baby is sleepy or upset, and other basic needs have been met (for example, hunger or soiled diaper).
Concern #2: The pacifier shapes the upper palate of the mouth, so if you want your baby's palate to be the right shape (wide with a gentle arch), then use a flat pacifier or don't use a pacifier at all.
Response: Pacifiers DO NOT shape the upper palate, the tongue does. If a baby is getting proper oral rest posture with the tongue suctioned to the roof of the mouth, the palate will be shaped by the tongue. If a pacifier is being used inappropriately, then yes, it can exacerbate or influence shaping of the mouth.
Since the tongue makes a taco shape when sucking, the optimal shaped pacifier to use is a cylindrical one (i.e. a symmetrical tube like the Soothie or similar). This will fit in the concave space of the tongue properly, and therefore, have the least effect on palate. It will also reinforce optimal oral motor skills. Any other shape of pacifier is leaning into what compensations a baby already has when sucking. That means a baby might be struggling with sucking and is finding other ways to move their tongue, jaw or lips in order to suck and feed.
A flat pacifier tends to work for a baby that is using compression (i.e. an up and down motion of the tongue and jaw) rather than cupping of the tongue. That pacifier will be repeatedly pushed up into the upper palate. The bulbous type of pacifier tends to fit into a high arched palate and makes holding the pacifier easier for baby so the tongue is doing less work.
Concern #3: The pacifier will affect the position of baby's teeth, causing buck teeth or a need for braces in the future, for example.
Response: This is true if a pacifier is being used past infancy when teeth have come in, and especially, if a child is using the pacifier for extended periods of time. It’s ideal to quietly make the pacifier go away around 6 to 7 months when baby’s social nervous system is maturing and well after the suck reflex has integrated (this happens around 3 months of age). This is ideal because baby doesn’t have an emotional attachment or the awareness to experience upset by the pacifier not being available. An infant of this age is also ready to rely more on social co-regulation with a caregiver rather than sucking the way they needed to as a newborn.
What About Babies Who Use a Pacifier and Struggle at the Breast?
I often see babies who struggle with both breastfeeding and pacifier use. When this is the case, the underlying cause is usually limited oral motor function. A baby who is struggling to maintain a deep latch, coordinate suck and swallow, or manage tongue positioning will demonstrate challenges with breastfeeding and/or maintaining a suck on a pacifier. I say and/or because there are a variety of variables at play with breastfeeding.
There are situations where breastfeeding seems successful (i.e. baby is getting plenty of milk and growing), but there are still oral motor challenges. One example is when the mother has a healthy milk supply and fast flow, so baby just has to kind of hang on and swallow. But the oral motor challenges are noticeable when baby uses a pacifier because it’s too much work to sustain a suck and keep the pacifier in the mouth..
There are also situations where a baby will struggle with breastfeeding, but will seem to use a pacifier just fine. In these situations, the baby is often using a pacifier that’s shape matches the baby’s oral motor compensations (as mentioned in “concern #2” above). Or parents might share that baby loves the pacifier but they have to hold it in while baby sucks.
Tethered oral tissues (tongue tie, lip tie, or cheek tie) are one of the most common reasons babies struggle at the breast. If your baby is having a hard time with breastfeeding alongside pacifier use, a tongue tie evaluation with a qualified infant feeding therapist is worth considering before drawing conclusions about the pacifier.
Can Breastfeeding and Pacifier Use Coincide?
Yes, with thoughtfulness.
Here is what I recommend:
Focus on breastfeeding early on. In the first couple weeks postpartum, focus on establishing breastfeeding (if that is your desire) and feel free to offer your breast to support sleep and calming for your baby. Contrary to other advice, offering your baby your breast to support regulation or sleep is in alignment with our biophysical innate drive and function. The parent and baby brain are designed for closeness, connection and bonding. When breastfeeding, the mother’s nipple and baby’s sucking action elicit the release of oxytocin for both mom and baby. Oxytocin, “the love hormone,” is what fortifies and reinforces a deep bond and sense of safety between mom and baby.
Always feed first. A pacifier is not a hunger solution. It is a regulation tool. Before offering the pacifier, make sure your baby’s feeding cues have been addressed. Hunger cues like rooting, hand to mouth, or increased alertness should always be met with a feeding first.
Do not use a pacifier to stretch feedings. Newborns need to feed frequently, often every two to three hours early on. A pacifier should never be used to delay or replace a feeding session.
Signs That Something More Is Going On
If you are using a pacifier thoughtfully and your baby is still struggling with feeding, it is time to get some support. Watch for these signs:
- Difficulty latching or repeated unlatching during feeds
- Clicking or popping sounds while nursing
- Baby falling asleep at the breast before a full feed
- Breast refusal or strong preference for the bottle
- Poor weight gain
- Nipple pain that is not improving after the early days
These are signals to reach out to a lactation consultant or infant feeding therapist. They can help identify whether something structural or functional is affecting how your baby feeds, and they can work alongside your birth and postpartum team to support you.
If you are local to the Twin Cities, Happy and Healthy Therapy offers infant feeding evaluations and support for families navigating these challenges.
The Pacifier and Breastfeeding Dos and Don'ts
Use these guides to utilize a pacifier optimally and in a developmentally appropriate way.
Things to Do:
- use a pacifier that is cylindrically shaped (i.e. a symmetrical tube like the Soothie or similar)
- offer the pacifier when support for calming or sleep is needed
- remove the pacifier when baby is asleep and ensure baby’s mouth is closed
- discontinue use of the pacifier when baby is about 6 to 7 months old and focus on co-regulation strategies such as talking or singing to baby, reassuring touch/hugging/holding, movement (rocking, swaying, bouncing), soothing objects (special stuffy or blanket), etc.
Things to Avoid:
- using a pacifier that is not cylindrically shaped
- using or forcing the pacifier without first tuning into your baby’s cues to ensure it’s not a solid diaper or hunger that is causing upset
- allowing the pacifier to “live” in the mouth when baby is awake, active, calm, not actively sucking
- allowing baby to sleep with the pacifier in the mouth
- using a pacifier that is not cylindrically shaped
- allowing use of the pacifier into toddler years
The Botton Line: It is not "right" or "wrong" to use a pacifier.
What matters is how and why the pacifier is being used, and most of all, if it’s effective for your baby. In the end, what your baby needs is nurturing support and tuned-in, mindful caregivers. You may find that what is needed varies from child to child. It’s ok to use a pacifier in a thoughtful and developmentally appropriate way. And it’s ok to not use a pacifier if it’s not helpful or there are other effective ways you can meet your baby’s needs. Ultimately, how you provide for your children is up to you!
It’s important to note that some babies struggle with the pacifier or will only suck on a specific shaped pacifier because there are underlying challenges with sucking. In these cases, seek an evaluation and support from a licensed infant feeding therapist.
If breastfeeding feels hard, that information is worth acting on regardless of pacifier use. Get support. Ask questions. You do not have to figure it out alone.
To learn more about how to support your baby’s feeding and development experience or to support your journey into motherhood, head to Happy and Healthy Therapy to set up a free consultation call with Maria or sign up for one of her parent empowering classes.
And if you are looking for more support around birth and the early days with your baby, the How2Mom team is here for you. Head to how2mom.com to learn more about our doula services, lactation support, and childbirth education resources.
How Happy Healthy Therapy Can Support You
At Happy & Healthy Therapy I offer OT sessions for infants from birth to the crawling stage for feeding and whole body therapy. I predominantly serve babies with oral restrictions and I incorporate craniosacral therapy and MNRI into my work. The work that I do is gentle and not forced. I am working to facilitate and not manipulate. And therapy is individualized to your baby and your family goals.
The first session is evaluative where I gather information on your and your baby’s journey, assess your baby’s skills and provide my feedback and recommendations. From there, follow up visits are focused on the interventions that will improve your baby’s skills and achieve your family goals.
If you’re noticing signs of a tongue tie in your newborn, don’t wait—reach out to Happy & Healthy Therapy to schedule an evaluation and get support tailored to your baby’s needs.
See more from Happy & Healthy Therapy in our Resource Directory
Website: www.happyandhealthytherapy.com
Maria Bossert is an Occupational Therapist with 16 years of experience serving children and families. She is the founder of Happy and Healthy Therapy in the Twin Cities, where she specializes in infant development, tethered oral tissues, and guiding moms through the transition to motherhood. Maria is also a mama of three and brings both professional expertise and lived experience to her work with families.
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