Why is it considered socially acceptable for babies to fall asleep with a pacifier, but not to be fed to sleep?

by Consuela Hendriks

It is widely accepted that babies fall asleep with a pacifier. In fact, if babies routinely use a pacifier, it’s recommended to give it to them at every sleep as this reduces the risk of Sudden Infant Death Syndrome (SIDS) (Fleming et al., 1999; Li et al., 2006, Moon et al., 2012). If a baby usually has a pacifier and does not have one on a certain night, that’s what increases the risk of SIDS (McGarvey et al., 2003).


Interestingly, a pacifier can help regulate a baby’s nervous system and calm them, similar to how breastfeeding does.  However, feeding a baby to sleep is still viewed negatively, as it is seen as a sleep crutch that the baby can become dependent on. And the sleep training industry wants us to believe this is a bad thing.


Why worry about babies becoming reliant on something that not only nourishes them but also is designed to facilitate sleep for both the mother and the baby?


Why be concerned about babies developing a dependence on something that regulates the nervous system of both the mother and the baby?


Breastfeeding provides metabolic and emotional co-regulation in mammalian mother-infant pairs (Porges, 1998). The coordinated social exchanges during feeding provide relaxation for both mother and baby (Jansen et al., 2008). But even if you take the social piece out of the equation, it is believed that breastfeeding helps with regulation of physiological state and contributes to the ability of babies to socially co-regulate (the so-called gustatory-vagal hypothesis, Porges & Furman, 2011; Porges & Lipsitt, 1993).

Mutual vagal stimulation during breastfeeding is a co-regulating phenomenon that affects regulation in other contexts through a purely physiological process (Lan et al., 2022; Quigley et al., 2017). Vagal regulation within the parasympathetic nervous system supports self-regulation and social engagement. Physiological regulation of babies and mothers can be shaped by breastfeeding, independent of accompanying social factors. How beautiful is that? But this is not accepted, while an attempt is made to mimic it with a pacifier.


How twisted is it that you’ll often hear people say you should “never let the baby fall asleep at the breast” when from an anthropological and evolutionary perspective, this is perfectly normal baby behavior?


How twisted is it that such biologically normal baby behavior is pathologized?


How twisted is it that ways that facilitate breastfeeding (such as feeding to sleep or safe bedsharing/breastsleeping) are discouraged when we know that breastfeeding reduces the risk of SIDS by 50% (Ip et al, 2009, Thompson et al., 2017; Vennemann et al, 2009;)?


How twisted is it that ways that facilitate breastfeeding (such as feeding to sleep or safe bedsharing/breastsleeping) are discouraged when the World Health Organization (WHO), given all the health benefits, recommends that all babies be exclusively breastfed for the first 6 months of life and then gradually introduced to appropriate complementary foods while continuing breastfeeding for 2 years or longer?


It is normal for babies to wake up at night. And it is normal to feed your baby to sleep during those wake-ups. Night feeds are very normal. The hormones in breast milk facilitate sleep for both mother and baby and contribute to the development of a circadian rhythm in the baby. An additional benefit is that breastfeeding mothers actually get more sleep than non-breastfeeding mothers, up to 30-45 minutes more! (Doan et al, 2007; 2014; Quillin & Glenn, 2004).


So, if it works for you and your baby, just feed your little one to sleep without feeling guilty!




Doan, T., Gardiner, A., Gay, C. L., & Lee, K. A. (2007). Breast-feeding increases sleep duration of new parents. The Journal of perinatal & neonatal nursing, 21(3), 200-206.


Doan, T., Gay, C. L., Kennedy, H. P., Newman, J., & Lee, K. A. (2014). Nighttime breastfeeding behavior is associated with more nocturnal sleep among first-time mothers at one month postpartum. Journal of Clinical Sleep Medicine, 10(3), 313-319.


Fleming, P. J., Blair, P. S., Pollard, K., Platt, M. W., Leach, C., Smith, I., … & CESDI SUDI Research Team. (1999). Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study. Archives of Disease in Childhood, 81(2), 112-116.


Jansen, J., de Weerth, C., & Riksen-Walraven, J. M. (2008). Breastfeeding and the mother–infant relationship—a review. Developmental review, 28(4), 503-521.


Lan, Q., Li, H., Wang, L., & Chang, S. (2022). Breastfeeding duration and vagal regulation of infants and mothers. Early Human Development, 171, 105620.


Li, D. K., Willinger, M., Petitti, D. B., Odouli, R., Liu, L., & Hoffman, H. J. (2006). Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study. Bmj, 332(7532), 18-22.


Mcgarvey, C., McDonnell, M., Chong, A., O’Regan, M., & Matthews, T. (2003). Factors relating to the infant’s last sleep environment in sudden infant death syndrome in the Republic of Ireland. Archives of Disease in Childhood, 88(12), 1058-1064.


Mitchell, E. A., Taylor, B. J., Ford, R. P., Stewart, A. W., Becroft, D. M., Thompson, J. M., … & Allen, E. M. (1993). Dummies and the sudden infant death syndrome. Archives of disease in childhood, 68(4), 501-504.


Moon, R. Y., Tanabe, K. O., Yang, D. C., Young, H. A., & Hauck, F. R. (2012). Pacifier use and SIDS: evidence for a consistently reduced risk. Maternal and child health journal, 16, 609-614.


Porges, S. W. (1998). Love: An emergent property of the mammalian autonomic nervous system. Psychoneuroendocrinology, 23(8), 837-861.


Porges, S. W., & Furman, S. A. (2011). The early development of the autonomic nervous system provides a neural platform for social behaviour: A polyvagal perspective. Infant and child development, 20(1), 106-118.


Porges, S. W., & Lipsitt, L. P. (1993). Neonatal responsivity to gustatory stimulation: The gustatory-vagal hypothesis. Infant behavior & development.


Quigley, K. M., Moore, G. A., Propper, C. B., Goldman, B. D., & Cox, M. J. (2017). Vagal regulation in breastfeeding infants and their mothers. Child development, 88(3), 919-933.


Quillin, S. I., & Glenn, L. L. (2004). Interaction between feeding method and co‐sleeping on maternal‐newborn sleep. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 33(5), 580-588.


Thompson, J., Tanabe, K., Moon, R. Y., Mitchell, E. A., McGarvey, C., Tappin, D., … & Hauck, F. R. (2017). Duration of breastfeeding and risk of SIDS: an individual participant data meta-analysis. Pediatrics, 140(5).


Vennemann, M. M., Bajanowski, T., Brinkmann, B., Jorch, G., Yucesan, K., Sauerland, C., … & GeSID Study Group. (2009). Does breastfeeding reduce the risk of sudden infant death syndrome?. Pediatrics123(3), e406-e410.