Do teats and pacifiers affect baby's suck and cause nipple pain?
The research shows that pacifier use and drinking from bottle teats don't cause abnormal neuromuscular pathways which impact upon breastfeeding. This is because the way your baby uses his tongue and muscles of suckling responds to the context in which he is suckling. Use of the pacifier or bottle doesn't cause nipple confusion or disrupted sucking biomechanics.
Babies can however become used to silicone teats and nipple shields, and often won’t take the breast unless the shield is on if they’ve used the shield for a time. It's also true that babies may not have a strong appetite drive to transfer milk from the breast once they are predominantly satiated over a 24-hour period with bottle-feeding.
You don’t need to worry, however, that your baby will develop neural pathways of dysfunctional tongue movement if you are using a pacifier or bottle. The biomechanics of sucking are simple and robust, and the same whether or not a nipple shield is being used. Once a baby’s mouth is full of breast tissue, the vacuum from the jaw drop acts to draw out the milk, regardless of previous bottle or teat use, as long as there is appetite drive.
The tongue moulds around a teat the same way it moulds around the nipple and breast tissue that is drawn up inside the mouth as the jaw drops. The tongue's shape and movement don't drive breastfeeding forward. Your baby’s tongue simply responds to the amount of nipple and breast tissue, and or to the shape of the silicone shield or teat, which he finds in his little mouth.
The way (otherwise healthy, non-neurologically impaired) infants suck depends on context!
Recommended resources
The terribly misundestood and beautiful baby tongue.
How babies breastfeed: the biomechanics of infant suck (video & animation)
In term babies, suck problems are only occasionally caused by birth trauma
Is baby's suck too weak or too strong?
Does a pacifier or dummy help with baby sleep?
Selected references
Bonaccorso A, Reato F, Giamaoli G. Pacifier use in full-term infants and its impact on breastfeeding: a scoping review. Midwifery. 2026:doi:10.1016/j.midw.2026.104760.
Zimmerman E, Thompson K. Clarifying nipple confusion. Journal of Perinatology. 2015;35(11):895-899.
McClellan HL, Kent JC, Hepworth AR, Hartmann PE, Geddes DT. Persistent nipple pain in breastfeeding mothers associated with abnormal infant tongue movement. International Journal of Environmental Research and Public Health. 2015;12:10833-10845.