Pacifier use in full-term infants and its impact on breastfeeding: A scoping review

Problem: The widespread use of pacifiers among healthy full-term infants has raised concerns about possible interference with breastfeeding. Conflicting recommendations in clinical practice reflect uncertainty about their impact on breastfeeding outcomes. Background: Pacifier use is common across different cultural and healthcare settings. Despite extensive research, its effects on breastfeeding initiation, exclusivity, and duration remain unclear. Divergent findings and incon- sistent professional guidance highlight the need for a comprehensive synthesis of the evidence. Aim: To map and describe the literature on pacifier use in healthy full-term infants and its relationship with breastfeeding outcomes, and to explore influencing factors such as timing of introduction, maternal intention, and healthcare practices. Methods: A scoping review was conducted following established methodological frameworks and reporting standards. Four databases were searched for studies published between 1994 and 2024. Italian national and international guidelines were also reviewed. Eligible studies included those published in English and involving healthy full-term infants. Data were charted across predefined categories; no critical appraisal was performed. Findings: Fifty-four studies were included. Observational studies often reported a negative association between early pacifier use and breastfeeding, whereas randomized trials and systematic reviews did not confirm this association. Contextual factors such as maternal intention, cultural norms and healthcare policies appeared influential. Discussion: Substantial heterogeneity and inconsistent findings suggest that pacifier use interacts with broader maternal and healthcare factors rather than exerting a simple causal effect. Conclusion: Evidence on the relationship between pacifier use and breastfeeding outcomes remains inconclusive. Timing of pacifier introduction appears critical. Further research should clarify causal mechanisms and guide coherent, evidence-based recommendations.