Routine pacifier use in infants: pros and cons

Dear Editor,

My Editorial “Routine pacifier use in infants: pros and cons,” recently published in the March/April 2019 issue of Jornal de Pediatria,¹ highlighted the conflicting recommendation of the American Academy of Pediatrics (AAP) as opposed to the 10 Steps for Successful Breastfeeding advocated by the World Health Organization/United Nations Children Fund (WHO/UNICEF) regarding pacifier use. As noted, the AAP recommends routine use of pacifiers at sleep time once breastfeeding is established (usually by 3–4 weeks of age)² as opposed to the WHO/UNICEF categorical step 9 of the 10 Steps guideline, which stated: “Give no artificial teats or pacifiers to breastfeeding infants.”³

It is important to note that, since my writing of the Editorial, the WHO/UNICEF 10 Steps program has been revised; step 9 now states “Counsel mothers on the use and risks of feeding bottles, teats and pacifier”.⁴

While not endorsing the routine use of pacifiers, this still somewhat unbalanced statement clearly retrenches from the previous categorical ban and is more consistent with the consensus (as noted in my Editorial) that the benefits of routine use of pacifiers in reducing the risk of SIDS and in enhancing a calming effect on infant behavior outweigh- any theoretical unproven risks.

Conflicts of interest

The author declares no conflicts of interest.