Exclusive Breastfeeding, Pacifiers and Safe Sleep
BFUSA promotes exclusive breastfeeding and the safe implementation of practices that support exclusive breastfeeding while also reinforcing safe infant sleep messages and practices. BFUSA believes strongly that the promotion of exclusive breastfeeding and risk reduction of SIDS and other sleep-related causes of infant death, such as suffocation, are complementary initiatives. In fact, breastfeeding is recommended as a key strategy for reducing SIDS risk . The protective effect of breastfeeding increases with length of exclusivity.
In this context, we are pleased to showcase this important video produced by the Eunice Kennedy Shriver National Institute of Child Health and Human Development as part of the Safe to Sleep® campaign. We encourage you to share it with your patients.
Additional Guidance for Step 9
Professionals working on safe sleep initiatives often ask BFUSA to clarify the designation criteria related to pacifier use. Step 9 of BFUSA’s Guidelines and Evaluation Criteria (GEC) states that breastfed infants should not be given pacifiers by hospital staff and that mothers who request pacifiers for their infants should be educated about how pacifier use could affect the success of breastfeeding. Early and frequent breastfeeding in the newborn period is essential to build up a mother’s milk supply. Pacifier introduction too early in the breastfeeding relationship may interfere with this important biological process and mask potential breastfeeding problems.
BFUSA’s GEC is in alignment with the American Academy of Pediatrics’ (AAP) recommendation for pacifier use found in the 2012 AAP Policy Statement: Breastfeeding and the Use of Human Milk  and the AAP SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment , both of which recommend that mothers of healthy term infants be instructed to use pacifiers at infant nap or sleep time after breastfeeding is well established, at approximately 3 to 4 weeks of age. While it is acknowledged that the exact timeframe for the establishment of breastfeeding may vary from mother to mother, it rarely occurs during the first 2 days of life.
BFUSA recognizes the evidence pertaining to pacifier use and SIDS risk reduction. It is important for parents to receive information about safe sleep and SIDS risk reduction during the birth hospital stay. This education may be compatibly provided to parents by using safe sleep materials that also promote breastfeeding. Hospitals may use safe sleep materials that include information on pacifiers as a SIDS risk reduction strategy and remain in compliance with BFUSA’s GEC, so long as they provide additional written and verbal education that includes:
- Pacifier use in the breastfed infant should be delayed until breastfeeding is well established, usually around 3-4 weeks of life.
- How mothers can know that breastfeeding is well established.
- Breastfeeding is associated with a reduced risk of SIDS and the protective effect increases with breastfeeding exclusivity.
 American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, SIDS, and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. no. 138 (2016) 138(5). doi: 10.1542/peds.2016-2938.
 Lawrence M. Gartner, Arthur I. Eidelman, Jane Morton, Ruth A. Lawrence, Audrey J. Naylor, Donna O’Hare, and Richard J. Schanler. “Policy Statement, Section on Breastfeeding: Breastfeeding and the Use of Human Milk.” Pediatrics 115, no. 2 (2005): 496–506. doi: 10.1542/peds.2004-2491.